The Diary of a CEODr. Pradip Jamnadas: How fasting erases visceral fat
Why insulin damage actually starts decades before diabetes shows up; the fasting protocol that lowers insulin, mobilizes plaque, and resets arteries.
CHAPTERS
- 0:00 – 13:00
Visceral Fat, Insulin and the New Face of Heart Disease
Jamnadas introduces visceral fat as a critical warning sign and frames heart disease as an inflammatory, metabolic process increasingly affecting younger people. He explains what plaques are, how heart attacks are actually caused by plaque rupture and clots, and why treating only the blockage misses the deeper causes.
- •Visceral fat in the belly is highly inflammatory and tightly linked to heart risk.
- •Heart disease involves multiple components: heart muscle, coronary arteries, valves, peripheral and microvascular circulation.
- •A heart attack typically results from a small, inflamed plaque rupturing, followed by a clot that completely blocks the artery.
- •Only about 20% of people with significant blockages experience chest pain; many are asymptomatic.
- •Modern lifestyle has created a ‘perfect storm’ of more plaque formation, plaque instability, and more clot‑prone blood.
- 13:00 – 27:40
A 28-Year-Old Heart Attack and the Insulin Problem
Using a 28‑year‑old heart attack patient, Jamnadas illustrates how prediabetes and hyperinsulinemia damage arteries long before diabetes is diagnosed. He describes how he discovered widespread glucose intolerance and later high insulin in supposedly ‘non‑diabetic’ cardiac patients.
- •The 28‑year‑old patient was overweight with central obesity, fatty liver, and high insulin but normal glucose.
- •Insulin is atherogenic: it promotes smooth muscle growth in arteries, vasoconstriction, clotting and inflammation.
- •Early in his practice, glucose tolerance testing revealed many cardiac patients with hidden glucose intolerance.
- •Subsequent insulin testing showed huge insulin spikes despite only modest glucose elevations.
- •Hyperinsulinemia is central to metabolic derangement and coronary artery disease, often preceding diabetes by ~10 years.
- 27:40 – 41:20
Glucose, Insulin, and How Frequent Eating Breaks Metabolism
Jamnadas explains in simple terms how glucose and insulin work, how glycation damages proteins and accelerates aging, and how frequent carb intake locks people into chronically high insulin. He links processed, low‑fiber foods and frequent snacking to insulin resistance and visceral fat.
- •Glucose is vital for energy but toxic in the bloodstream because it glycates proteins and disrupts their function.
- •Insulin moves glucose out of blood into liver, muscle and other cells, but frequent carb intake keeps insulin high.
- •Insulin remains elevated longer than glucose; eating every 2–3 hours prevents insulin from returning to baseline.
- •Persistent high insulin leads to insulin resistance, requiring even more insulin for the same glucose control.
- •Glucose‑derived fat tends to accumulate as visceral fat inside the abdomen, around organs, not evenly over the body.
- 41:20 – 53:40
Why Fasting Beats Calorie Restriction for Visceral Fat and Repair
He draws a sharp distinction between simple calorie restriction and true fasting, arguing that fasting uniquely lowers insulin and triggers a suite of regenerative processes. The conversation covers glycogen depletion, visceral fat mobilization, inflammatory fat types, and how he prescribes various fasting protocols.
- •Calorie restriction slows metabolic rate and leads to loss of both fat and muscle.
- •In fasting, after ~12 hours glycogen runs low and the body begins mobilizing fat, starting with visceral fat.
- •Visceral fat is biochemically different from subcutaneous fat, producing inflammatory cytokines like IL‑6 and TNF‑α.
- •Fasting lowers insulin, enabling fat breakdown and ketone production.
- •Protocols: start with 12:12, move to 18:6; for severe obesity/diabetes he uses 48‑hour weekly fasts, 3‑day water fasts, and OMAD cycles under supervision.
- •Supervised extended fasts have reversed diabetes, normalized blood pressure, and caused large, skin‑retracting weight loss.
- 53:40 – 1:11:20
Ketosis, Autophagy, Stem Cells and Fasting Physiology
The discussion dives into the deeper biology of fasting: ketones as a clean brain fuel, cycling between glucose and ketone metabolism, stem cell mobilization after refeeding, and autophagy/mitophagy as mechanisms for cellular renewal and improved mitochondrial function.
- •When insulin is low, fat is mobilized as free fatty acids, which the liver converts into ketones.
- •Ketones provide an alternative, ‘cleaner’ fuel with fewer reactive oxygen species than glucose.
- •Ketosis boosts brain‑derived neurotrophic factor (BDNF), enhancing cognition, reflexes and sensory acuity.
- •Fasting increases growth hormone and mobilizes stem cells, including endothelial progenitor cells that repair blood vessels.
- •Autophagy recycles damaged cell components; mitophagy renews mitochondria, improving energy and reducing fatigue.
- •He recommends not staying in ketosis constantly; instead, cycle between feasting and fasting, e.g., intermittent 36‑hour fasts monthly.
- 1:11:20 – 1:29:40
Best Exercise for the Heart: Rethinking Cardio
Jamnadas challenges the primacy of long, steady‑state cardio, asserting that excessive endurance work increases inflammation and arterial disease in his patients. He outlines a balanced exercise prescription emphasizing short aerobic sessions, body‑weight resistance, and properly structured HIIT, especially timed with fasting.
- •Excessive chronic aerobic exercise correlates with more coronary artery disease and inflammation in his clinic.
- •He suggests 15–20 minutes of aerobic training for basic endurance, not hours.
- •Resistance training and HIIT (30–45 seconds all‑out, 30–45 seconds full rest) are preferred for vascular health.
- •Rest intervals allow antioxidant systems (glutathione, superoxide dismutase) to clear metabolic byproducts.
- •For fasting individuals, he prefers resistance/HIT near the end of the fast to exploit higher growth hormone while avoiding prolonged glucose depletion.
- 1:29:40 – 1:47:00
Gut Microbiome, Leaky Gut and Fatty Liver as Cardiac Risks
The conversation turns to the gut as the body’s most important interface with the environment. Jamnadas explains how a disrupted microbiome and leaky gut lead to fatty liver, systemic inflammation, and coronary disease, and how he uses coronary calcium scores to track interventions.
- •The gut, not the skin, is the main barrier with the external world, hosting ~100 trillion bacteria and hundreds of trillions of viruses.
- •Healthy microbes make micronutrients (e.g., short‑chain fatty acids) and maintain intestinal barrier integrity.
- •Leaky gut allows bacterial fragments (LPS) into the portal circulation, driving fatty liver and inflammation.
- •Major causes of fatty liver: excess alcohol, leaky gut, and high insulin converting glucose to fat.
- •He links fatty liver with higher coronary artery disease; improving diet, fiber, microbiome and liver health can stop coronary calcium from rising.
- •He uses coronary calcium scores as a long‑term marker of plaque burden and treatment success.
- 1:47:00 – 1:56:40
Calcium Supplements, Vitamin K2, and Nutrient Gaps
Jamnadas pushes back on routine calcium supplementation, especially for women, highlighting its association with vascular calcification. He emphasizes hormones (vitamin D3 and K2) over raw calcium, notes the impact of warfarin on K2, and argues that modern diets are too low in K2, necessitating supplementation.
- •High‑dose calcium supplements are associated with increased cardiovascular events and coronary calcification.
- •He stops calcium pills in cardiac patients and prioritizes vitamin D3 for absorption and K2 to direct calcium into bones, not arteries.
- •Warfarin/Coumadin depletes vitamin K1 and K2, accelerating vascular calcification.
- •Dietary K2 comes largely from fermented foods, which most people under‑consume, so he routinely supplements K2.
- •Many young women in sunny climates still have osteopenia, which he attributes to D3/K2 deficits rather than lack of calcium intake.
- 1:56:40 – 2:08:40
Building a Heart-Healthy Gut: Fiber, Ferments, Sleep and Omega-3
He offers practical gut‑health guidance: high and diverse fiber intake, fermented foods, and lifestyle habits like sleep and stress management. He highlights our widespread fiber deficiency and links even a single bad night of sleep to next‑day insulin resistance.
- •Fiber is mainly removed in processed foods to extend shelf life; real, unprocessed foods are the key fiber source.
- •He recommends supplemental inulin with FOS as soluble fiber to feed good bacteria.
- •Fermented foods (e.g., kefir) provide beneficial microbes and their postbiotics (e.g., K2, short‑chain fatty acids).
- •We should aim for 30–40 different plant foods (including spices) per week to support microbial diversity.
- •Sleep deprivation alters the microbiome and causes measurable insulin resistance after just one bad night.
- •He stresses adequate omega‑3 intake as another pillar of gut and systemic health.
- 2:08:40 – 2:25:20
Toxins, Mold and Their Surprising Role in Heart Disease
Jamnadas defines toxins broadly—pesticides, plastics, heavy metals, and especially mold—and describes how modern environments overwhelm liver and gut detox systems. He shares how often he now finds mold toxicity and how treating it can flatten coronary disease progression.
- •Toxins are molecules the body was never meant to handle, including pesticides, herbicides, PFAS, BPA, molds and heavy metals.
- •A dysfunctional gut increases susceptibility because healthy gut bacteria normally help bind and eliminate many toxins.
- •Modern exposure burdens liver and gut beyond their detox capacity, measurable via blood, urine and stool testing.
- •He finds many cardiac patients with elevated pesticides, metals and significant mold; mold exposure is present in ~70% of homes via water damage.
- •Mold can colonize sinuses and gut, causing chronic reinoculation and low‑grade inflammation.
- •Removing mold sources and treating colonization improve symptoms and slow coronary artery disease progression.
- 2:25:20 – 2:52:40
Food Sensitivities, Micro-Inflammation and Rethinking ‘Healthy’ Foods
The discussion explores non‑traditional drivers of inflammation such as celiac disease and food sensitivities, then tackles common dietary misconceptions around bread, rice, fruit, and cooking methods. Jamnadas offers specific preparation techniques to reduce harm from staple foods like white rice.
- •There is almost always an identifiable source of inflammation driving coronary disease, including leaky gut, mold, pesticides, and food sensitivities.
- •Undiagnosed celiac disease can cause premature coronary artery disease even without obvious GI symptoms.
- •Most bread is nutrient‑poor; he tolerates small amounts of fermented sourdough but sees bread as ‘survival food’.
- •White rice often contains arsenic; he advises soaking overnight, discarding water, cooking in excess water, discarding again, then cooling and reheating to create resistant starch that feeds gut bacteria instead of spiking insulin.
- •Over‑browned or charred foods and deep frying generate advanced glycation end products that sharply increase inflammation.
- •Excess fruit and fructose promote fatty liver; he recommends modest, seasonal fruit, not fruit as a staple.
- •Vegetable seed oils high in omega‑6 (in most packaged foods) are inflammatory; he favors olive oil, butter/ghee, and coconut oil.
- 2:52:40 – 3:09:00
Everyday Signs of Systemic Inflammation and Poor Cardiovascular Health
Jamnadas outlines how he informally assesses cardiovascular risk by looking at patients, then broadens to systemic signs of inflammation like joint pain, skin issues, and mental health. He also connects oral and sinus microbiomes, bad breath, and chronic sinusitis to heart valve and coronary disease.
- •Key visual cues: excess weight and particularly a protruding belly indicating visceral fat and likely insulin resistance.
- •Joint pain, autoimmune conditions, psoriasis and other skin issues often improve markedly when inflammation is reduced via diet and lifestyle.
- •The oral and sinus microbiome is continuous with the gut; poor dental health and bad oral bacteria are strongly linked to valvular disease and coronary calcification.
- •Chronic sinusitis, especially fungal, is associated with systemic inflammation and coronary artery disease.
- •He emphasizes that everything—diet, stress, sleep, environment—feeds into coronary artery health.
- 3:09:00 – 3:20:40
Caffeine, Palpitations and the Vagus Nerve
Using the host’s experience of post‑workout palpitations, Jamnadas explains how excessive exercise and caffeine can dysregulate the autonomic nervous system via the vagus nerve. He describes how gut ischemia from over‑exercise impairs vagal tone and outlines how he treats functional arrhythmias by fixing the gut.
- •High caffeine intake mimics chronic adrenaline, keeping people in sympathetic (fight‑or‑flight) mode and raising arrhythmia risk at high doses.
- •Over‑exercise diverts blood from gut to muscles, causing relative gut ischemia and disturbing the enteric nervous system.
- •The vagus nerve, with a large presence in the gut, is key for shifting from sympathetic to parasympathetic (rest, repair) states.
- •Impaired vagal function can lead to tachycardia, POTS, and palpitations in otherwise healthy young people.
- •He frequently resolves POTS‑like symptoms by repairing the gut and thus restoring vagal tone.
- 3:20:40 – 3:34:20
Hacking the Vagus Nerve: Breathing, Cold, Humming and More
This segment details practical ways to stimulate and strengthen the vagus nerve. Jamnadas describes controlled breathing patterns, eye movements, cold application, humming, laughing, and the Valsalva maneuver as simple tools to boost parasympathetic activity and promote cardiovascular and emotional resilience.
- •The vagus nerve is the largest nerve, heavily innervating the gut, heart, lungs and face, constantly relaying body status to the brain.
- •Modern life keeps people in prolonged sympathetic activation; we under‑use the parasympathetic ‘repair’ state.
- •Breathing drill: inhale for a count of 4, exhale for a count of 8 for about 10 minutes to stimulate vagal tone.
- •Other hacks: slow eye movements, gentle eye and facial stimulation, cold water/ice packs on the front of the neck, humming, singing, laughing, and the Valsalva maneuver.
- •Improved vagal tone lowers heart rate and blood pressure, reduces inflammation markers, and enhances heart rate variability.
- 3:34:20 – 3:54:20
Cholesterol, LDL, Statins and the Real Culprit: Small Dense Particles
Jamnadas reframes cholesterol’s role in heart disease, emphasizing that total LDL is less important than whether LDL particles are small, dense and oxidized. He outlines the five key drivers of damaging LDL, questions blanket statin therapy, and notes risks of statin side effects.
- •Cholesterol is essential; every cell makes it and the liver produces most of it. LDL is the main carrier particle.
- •Damage and oxidation create small, dense LDL particles, which are taken up by macrophages, become foam cells, and form plaques.
- •He uses LDL subfractionation to distinguish benign large, fluffy LDL from harmful small, dense LDL.
- •Five main promoters of small, dense, oxidized LDL: sugar, omega‑6 excess, advanced glycation end products, environmental toxins, and leaky gut/LPS.
- •Some data suggest higher LDL is associated with longevity; he cautions against over‑focusing on LDL quantity versus particle quality.
- •Statins reliably lower LDL but can cause muscle loss, diabetes, cognitive issues, and liver dysfunction in a significant minority; benefit depends on whether they reduce harmful LDL and events, not just lab numbers.
- 3:54:20 – 4:10:40
Blood Pressure, Breakfast, and the Doctor’s Own Routine
He connects hyperinsulinemia and sleep apnea to high blood pressure, suggesting many cases are reversible. The conversation then turns to practical daily eating patterns, his skepticism of breakfast, and details of his personal diet and supplement regimen.
- •Chronic high insulin causes impaired vasodilation and contributes to hypertension; treating insulin resistance often normalizes blood pressure.
- •Sleep apnea is another major reversible cause of hypertension.
- •He recommends adults often skip breakfast and use a two‑meal eating window like 18:6, or have breakfast and lunch but no dinner to maintain that fasting period.
- •For those who insist on breakfast: a couple of eggs or kefir with a few berries and inulin—not carb‑heavy meals.
- •His own diet includes small amounts of carefully sourced animal foods (grass‑finished, organic), plenty of vegetables, and limited starches.
- •His supplement stack: vitamin D3, K2, omega‑3 fish oil, vitamin C, inulin, kefir, magnesium, nattokinase (for clot risk/fibrinogen), and a spore‑based probiotic.
- 4:10:40
Screening for Silent Disease and The Importance of Presence
In closing, Jamnadas lays out the two key tests he thinks every adult over 30 should get, then reflects on loss, limitation and living in the present. He shares his father’s story of outliving grim cardiac prognoses through lifestyle changes and how medicine taught him to focus on the current moment.
- •Everyone over 30 with concerns should get: (1) a coronary calcium score (zero is ideal; any positive score warrants serious prevention), and (2) a comprehensive inflammatory panel such as Cleveland Heart Labs (particle sizes, CRP, IL‑6, TNF‑α, HbA1c, etc.).
- •Inflammation often shows up as mental fog, depression, sleep disturbance, and subtle physical changes before overt disease appears.
- •He emphasizes that depression is frequently a manifestation of brain inflammation, often improved by an anti‑inflammatory lifestyle.
- •Jamnadas recounts his father, expected to die in his 60s after bypass surgery, living to 89 with extensive travel after adopting lifestyle changes.
- •The death of his father and repeated patient losses taught him about limits and the need to stop second‑guessing the past.
- •He stresses present‑moment awareness—being fully with each patient or task—as a learned skill crucial for both physician and patient well‑being.
