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Dr Rangan ChatterjeeDoctors Won't Tell You This - What Happens If You Don't Eat For 36 Hours | Dr. Pradip Jamnadas
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CHAPTERS
- 0:00 – 2:17
Fasting benefits Dr. Jamnadas saw in cardiology patients
Dr. Jamnadas describes the changes he saw after 30 years as a cardiologist when he began using fasting with patients. Weight, blood pressure, diabetes and heart disease progression all improved, along with mood and strength.
- •Patients lost weight and blood pressure came down
- •Diabetes reversed and coronary artery disease progressed less
- •Fewer rehospitalizations, falls and fractures
- •Stronger muscles and better mental state
- •ER doctors noticed his patients rarely arrived with heart attacks
- 2:17 – 8:04
Why few doctors promote fasting and the role of empowerment
Dr. Chatterjee asks why so few doctors recommend fasting. Dr. Jamnadas says it is a hard sell with no tablet to hand over, requiring a deeper look at the patient's life. They discuss how fasting empowers patients and opens up introspection, in contrast to relying on a procedure.
- •Fasting is a lifestyle change that takes time to discuss
- •Doctors are too busy treating disease rather than prevention
- •Patients are told they are not their habits and can change
- •Fasting puts patients back in control and prompts introspection
- 8:04 – 12:17
Fasting from other addictions: dopamine, sugar and digital habits
Dr. Chatterjee widens the idea of fasting beyond food to social media, alcohol and caffeine. Dr. Jamnadas links constant eating to addiction and reward-seeking, and mentions the book Dopamine Nation.
- •Fasting can include social media, alcohol and caffeine breaks
- •Eating every few hours is described as an addictive pattern
- •Priming one reward area can lead to slipping into others
- •Dr. Jamnadas asks patients about sugar, caffeine, alcohol and digital addiction
- 12:17 – 20:05
Insulin, insulin resistance and how Dr. Jamnadas found fasting
Dr. Jamnadas explains the body's feeding and fasting cycle and how constant eating keeps insulin high. He describes how testing insulin responses in patients led him to fasting as a way to lower insulin.
- •Glycogen runs out and the body then burns fat and makes ketones
- •Frequent eating keeps insulin high and causes insulin resistance
- •Insulin testing revealed massive insulin responses despite near-normal sugars
- •High insulin was linked to hardening of the arteries
- •Fasting was his tool for lowering insulin without a drug
- 20:05 – 28:06
Blood pressure, weight loss and mood: what patients experienced
Dr. Jamnadas explains insulin's effect on nitric oxide and blood pressure, and why fat is released when insulin falls. He describes patients who looked and felt better than on calorie-restricted diets, with better mood, less joint pain, lower CRP and better digestion.
- •Insulin depletes nitric oxide, so lowering it lets vessels dilate and blood pressure fall
- •Insulin is a storage molecule, and falling levels free fat for use
- •Fasting patients lost weight without looking drawn, unlike earlier calorie-cutting patients
- •BDNF and better mood and alertness during fasting
- •Less inflammation, joint pain and bloating
- 28:06 – 32:18
Freedom from hunger and regaining control
Dr. Chatterjee reflects on how fasting is about doing less, and Dr. Jamnadas describes patients realizing they are not their hunger. He explains how they learn to wait out hunger waves, which improves their sense of control and compliance with medications.
- •Fasting asks people to do less rather than add more
- •Patients realize they don't have to eat just because it's lunchtime
- •Ghrelin rises for about an hour and then falls
- •Water and keeping busy help pass hunger
- •Compliance with medications improved as patients took control
- 32:18 – 44:18
Ketones, autophagy, stem cells and growth hormone
Prompted by Dr. Chatterjee's story of his son running fasted, Dr. Jamnadas explains the body as a hybrid engine using glucose and ketones. He covers the repair processes triggered by fasting, linking them to Dr. Chatterjee's mention of Dr. William Li's defense systems.
- •Ketones are a second energy currency, and regular ketosis is beneficial
- •Cutting refined carbs brings ketone production earlier, around 15-16 hours
- •Autophagy and mitophagy occur more in the fasted state
- •Stem cell mobilization and higher growth hormone occur with fasting
- •Fasting also affects the microbiome and immunity
- 44:18 – 49:59
A graded fasting protocol: diet first, then skipping meals
Asked for different grades of fasting, Dr. Jamnadas lays out his stepwise approach. Patients first cut sugar and processed foods, then skip meals, then move to 18-hour fasts and one-meal days.
- •Two to three weeks of whole foods with no fasting first
- •Then skip meals randomly for about two weeks
- •Two meals within six hours on weekdays for 18-hour fasts
- •Later one meal on Monday, Wednesday and Friday
- •Going straight to once-a-day eating led to a higher failure rate
- 49:59 – 1:02:22
Who it's for: coronary calcium scores and metabolic syndrome
Dr. Jamnadas says the approach applies to nearly everyone and describes the patient groups he sees. He explains atherosclerosis, ischemic heart disease, stress tests, the coronary calcium score and metabolic syndrome.
- •Patients with existing coronary disease are easier to motivate
- •Calcium score shows whether atherosclerosis is present, regardless of stress test results
- •Metabolic syndrome features are tied to insulin
- •Weight is described as a side effect of faulty metabolism
- •Advanced testing is offered even when insurance does not cover it
- 1:02:22 – 1:08:30
Motivating patients, compromises on diet and coming off medications
Dr. Chatterjee raises how extreme cutting out bread and pasta can seem. Dr. Jamnadas explains how he motivates patients with the wider consequences of metabolic disease and accepts compromises like sourdough. He describes patients coming off blood pressure drugs, insulin and statins.
- •Explains risks beyond the heart: dementia, kidney disease, peripheral vascular disease, cancer
- •Compromises such as pumpernickel or sourdough are acceptable
- •Patients got off blood pressure medication and insulin
- •Some patients on statins had zero calcium and he stopped the statin
- •Treatment is individualized
- 1:08:30 – 1:18:16
Withdrawal, women, South Asian risk and individual obstacles
The two compare a gentler 12-hour starting point with the three-week lead-in, which Dr. Jamnadas uses to get through withdrawal. They discuss fasting in women, higher coronary disease in South Asian women, and obstacles like sleep apnea.
- •Withdrawal has mental and biochemical components, and passes in about three weeks
- •Dr. Jamnadas sees coronary disease in Indian women as at least as bad as in men
- •Fasting doesn't work the same for every woman, so nuance matters
- •Stress, finances, relationships and sleep apnea can block adherence
- •CPAP may be used temporarily
- 1:18:16 – 1:26:08
Longer fasts: 24, 36 hours and the three-day water fast
Dr. Jamnadas explains how he handles medications during fasts and builds patients up to 36-hour and three-day water fasts. He explains ketone testing and using the three-day fast for weight plateaus.
- •Blood pressure monitored and oral diabetes agents continued; insulin halved at 24 hours and stopped beyond
- •A 36-hour fast is done once a week by skipping an evening meal
- •Most patients are in some ketogenesis by 36 hours
- •Urine ketone sticks can motivate patients
- •Three-day water fast used for plateaus, with salt water if cramps occur
- 1:26:08 – 1:30:25
Eating disorders and overdoing fasting
Dr. Chatterjee flags that skipping meals can be triggering for people with eating disorders and asks if fasting can be overdone. Dr. Jamnadas has not seen patients overdo it but says those with eating disorders or addictions need a specialist.
- •Advice is not for people with eating disorders
- •Dr. Jamnadas tells patients to settle into two meals a day for maintenance
- •Patients with disordered eating are referred to an addiction psychologist
- •Addictions can slide from one to another
- •Processed food content is addictive
- 1:30:25 – 1:36:11
Fasting as a unifier across diets
Dr. Chatterjee suggests fasting can unify tribes of diet. Dr. Jamnadas explains how his dietary advice evolved toward unprocessed ancestral foods, and says fasting lowers insulin response to foods.
- •Competing diets confuse the public and physicians
- •Insulin response to bread is lower in a fasted state
- •Populations with different diets share no processed foods or sugar
- •Patients choose preferred foods in unprocessed form, including grass-finished meat
- •Plants are needed for gut bacteria and fiber
- 1:36:11 – 1:47:29
Freedom, identity, meditation and top tips
The conversation turns to the mental benefits of fasting, including freedom from dependency on food. Dr. Jamnadas describes a change of identification, a simple breathing meditation and social determinants of health. He closes with four tips.
- •Fasting gives freedom from dependency on food and boosts confidence
- •Patients report better relationships and work performance
- •Simple breathing meditation to find gaps between thoughts
- •Social factors affect health outcomes
- •Four tips: natural foods, eat infrequently when hungry, sleep seven hours, find pleasure in life
