Zero Live #1: Weight Loss, Ozempic, and Protein

In our first session of Zero Live, Dr. Naomi Parrella, MD, and RichLaFountain, PhD, answer questions from Zero Members about weight loss, Ozempic, protein, and more.

Video

Transcript

Dr. Naomi Parrella, MD: (00:04)

The first question that came up, um, was how do you break a weight loss plateau? So the question started out with, I’m currently doing a 19 hour fast with a five hour eating window and I’ve lost about 25 pounds in nine months. I feel fabulous, but I still have weight to lose. So again, the question about the weight loss plateau, what to do. So we get this all the time. Weight loss plateaus are, they can be for a number of reasons. And so in the clinic, if somebody comes in and says, Hey, I’ve plateaued, what am I supposed to do? First we have to understand the difference between a plateau and what I call a set point. So some people feel stuck at a weight, but they’re like, you know, doc, my pants are getting looser, things are fitting better, but somehow the scale looks exactly the same.

Dr. Naomi Parrella, MD: (01:01)

And they’ll call that a weight loss plateau. And yes, the number on the scale is the same, but it may be as simple as your body composition is changing, meaning the distribution of the weight is shifting. So you might be having more muscle and less fat tissue. So that’s really an awesome thing, right? So we want that to happen where you’re building some muscle and you’re improving your body’s metabolic health by doing that. But the scale might look the same, but it’s still satisfying ’cause your clothes start fitting better. So that’s one thing. The second thing is many people have been told they’re going to be losing one to two pounds per week for an infinite period of time. And of course we know, Rich, don’t we? That this is absolutely not how physiology works. So the human body has been designed to gain weight and only lose weight if it’s sick or dying, right?

Dr. Naomi Parrella, MD: (02:04)

So it’s unnatural to lose weight, and if you lose a lot of weight very quickly, your body’s gonna put on the brakes and try to protect you. So it’s actually a protective mechanism to slow things down periodically. Now somebody loses 10 pounds and then they’re like, Dr. P, I’ve lost the momentum. It’s like I’m working really hard and I’ve plateaued. What do I do? Well, first of all, if that’s the case and you’re still following your fasting routines and your exercises, it can be as simple as your body composition is changing. So again, you might notice your clothes continue to fit better, but your weight is not changing very much. That’s okay. Um, a lot of times people are disappointed, but I’m, like, high fiving. I’m like, you are crushing it. Your body is getting healthier and it’s gonna break through that plateau and get moving again.

Dr. Naomi Parrella, MD: (03:00)

So again, understanding is this a physiologically normal plateau or pause in the, uh, number change on the scale? Or is it something else? Now, if you told me I’m drinking some more alcohol, I’ve stopped exercising, I’m eating a lot of sugary foods, or I went on an all you can eat cruise and I couldn’t help myself, I ate every pastry known to mankind. Yes, you are going to plateau. Absolutely. You may even gain weight. So again, this is something where tracking and identifying are you keeping your fasting windows or do you need to extend them a little bit? Do you wanna change out what you’re eating or how you’re breaking your fast or what you’re eating before your fast? There’s lots of different ways to do this, and that’s why we’ve tried to make it as simple as possible that you may not be able to go see somebody who specializes in this, but you could tap into your app and you can use that to help guide you to the next step so that you can break through and crush it, right?

Dr. Naomi Parrella, MD: (04:04)

So that’s the plateau, uh, question that often comes up and can be very frustrating, but oftentimes is a wonderful sign that you’re actually doing really well and your body is adjusting. So second question. Um, I’ve been doing intermittent fasting for almost two years, doing a 16:8 protocol. I’ve been stalled for several months with my weight going up and down, but no real progress and 12 pounds from my goal weight, and what is the best way to jumpstart my weight loss again, I also eat a ketogenic diet. Thank you. Alright, so this is somebody who’s really doing everything that has been working for them to get within 12 pounds of their goal. A congratulations. That’s, like, so awesome . So, you know, I would be high fiving big time in the office and people, you know, outside of the office would be hearing me cheering. But anyways, um, so, so that’s really great. As you start approaching your goal weight, first of all, is it really the true goal weight? Meaning is that the best weight for your weight? Or do you have, um, more muscle mass? So for example, bodybuilders that I work with, I can’t pinch any fat off their body, but their BMIs might show that they’re overweight or obese and they say, my doctor told me I should lose X amount of weight. Fortunately, most people figure

Dr. Naomi Parrella, MD: (05:24)

That’s probably not correct. So, um, body composition, again, if you carry on, so, to anticipate for your height. So the best way to jumpstart weight loss, again, that’s tricky because again, we talked about the plateau is actually adapting and try and figure out, do I need to use more later or not? That’s a really, really important thing.

Speaker 1: (05:53)

Hey Naomi, I’m just gonna break in your audio is, uh, a little

Rich LaFountain, PhD: (05:56)

Clunky maybe. Uh, try to, okay,

Dr. Naomi Parrella, MD: (05:58)

Is this better? Is this better right now? There

Rich LaFountain, PhD: (06:02)

We go. Yep. Okay. That sounds a bit better. Yeah,

Dr. Naomi Parrella, MD: (06:05)

Okay, sorry about that much,

Rich LaFountain, PhD: (06:07)

Uh, for everyone in the chat letting us know, that is very helpful.

Dr. Naomi Parrella, MD: (06:11)

Yeah, so again, the most important thing, so if you are trying to jumpstart your weight loss, the key is to make sure first you track and understand what you’re doing now. So again, uh, how often are you eating? What are you eating? What kind of exercise? How’s your sleep? Are you connecting with other people? Are you laughing enough during your day? Right? Like the sort of general things like how are you doing? And then once you understand where you’re starting from, you can make a tweak in one of the areas. You may extend a fast for a little bit, you may change how you break your fast. So you might say, for example, I’m going to break my fast with some protein, or I’m gonna add exercise before I break my fast. So you can kind of change things up a little bit and see if that makes a difference for you.

Dr. Naomi Parrella, MD: (07:04)

Again, it starts with tracking and figuring out where you’re at and then identifying, okay, what do I need to do to tweak some of the levers such as what you eat, the timing of when you eat the frequency. A lot of people have been told they should eat like six times a day, and obviously that’s not helpful. That’s a grazing pattern and then tells your body you need to grow. So if you’re done growing taller and you’re not working out in the gym all the time, it’s kind of only one other way we grow. So just kind of think about that, um, as, uh, you’re thinking about what could jumpstart your weight loss, what do you think, Rich?

Rich LaFountain, PhD: (07:44)

I wholeheartedly agree, I think, yeah, um, definitely would like to reiterate the congratulations, uh, for this particular individual who submitted the questions. You’re very close to your goal. Um, it would be again, start working on if you seem like you got the fasting and nutrition kind of in line, what’s your stress? What’s your sleep? Are there ways, you know, you’ve mentioned, uh, Dr. P about are you laughing enough during the day? Are, you know, what kind of leisure time are you able to experience on a regular basis? Um, stress is a pretty potent weight loss resistance in, you know, factor. So it can slow things down a bit or it can kind of stall you out. Just, you know, kind of related to that weight loss plateau that we talked about in question one. Uh, this is right in the same vein there.

Dr. Naomi Parrella, MD: (08:33)

One great question. Hi doctor. We know fasting is a good thing, but when does fasting become too much of a good thing? What are your thoughts on the line between just right and too much fasting? Wow, so this is a, you know, don’t you hate getting answers from doctors that are like, well, it depends, but that’s kind of the answer here. So here’s how I would respond to that. Fasting is something your body can naturally do, so that you can survive. So that’s important. You can, uh, fast better the more metabolically healthy you are, meaning that your body can use different fuels easily. It’s harder to fast if you might have insulin resistance or pre-diabetes or diabetes. And so you have to listen to your body and your body signals you and you signal back. So if you are doing extended fast, I can’t really speak to that.

Dr. Naomi Parrella, MD: (09:34)

I would say you need to have medical supervision and make sure your electrolytes look okay and that you’re not on any medications. And then of course, there’s people who should not be fasting. And so of course if you’re pregnant, definitely we don’t recommend fasting. We don’t recommend fasting for your children. We don’t recommend fasting if you have an eating disorder or a history of an eating disorder. Some people have a history of substance abuse or dependency and we don’t wanna sort of trigger some kind of, um, you know, maladaptive behaviors. And so you wanna make sure if you have any, uh, concerns that you’re working together with a professional who can really help guide you and hold your hand because it’s very powerful. So you wanna make sure you do it well and get that guidance. Any other thoughts or additions? Rich?

Rich LaFountain, PhD: (10:28)

Um, yeah, I think that definitely takes care of it. Fasting is, uh, not for everyone. It’s also not a one size fits all. Um, something if you’re newer to it, you maybe wanna start a little bit more gradual, closer to the 12 or 13 hour range as you kind of get more accustomed to it. Um, you may find it gets a little easier and if you wanna push closer to the 16 or 18 hour range, um, that can work great. I currently do more in the 14 hour range and I’ve been fasting for probably about a decade at this point. Um, I just, that’s right now that’s working for me. I’ve tried a variety. Um, I definitely started on the shorter. I, well, I started and failed at 16 hours and tried to get daily 16. So if that doesn’t work for you, um, I tried kind of the training wheel effects, which we’ll probably talk about a little bit later, like the bulletproof coffee or fatty coffee with butter in it and stuff, um, to try not to spike insulin, but I wanted to like get some calories to try to make it to 16 hours.

Rich LaFountain, PhD: (11:31)

So I’ve, I’ve tried a variety of things. Um, there is some trial and error involved. Uh, if, you know, if you’re looking for more weight gain and growth, which tends to be a minority of folks, you’re gonna wanna be a little bit, maybe shorter on the fast duration. Uh, if you’re looking for weight loss, sometimes it does help to get into the 14 and 14 hours or longer, um, just to help your body switch into tapping into some of those fat stores and burning those away. Um,

Dr. Naomi Parrella, MD: (11:58)

Those are really good points. I mean, it really is personalized and the way I think about it is, um, if you’re fasting and it’s causing you stress, so you’re looking at your clock and you’re like, oh my gosh, I have another 30 minutes. It is no longer serving you. Right? That’s what I mean by listening to your body signals. So if you are very hungry, you probably need either hydration, some salts or some protein. And, um, and that’s important to listen to your body if you are experiencing that. So you don’t wanna force a fast, you wanna train your body to be able to fast safely and effectively

Rich LaFountain, PhD: (12:33)

It’s a, uh, fasting is a stress, but it’s, it’s a good stress or it can be an adaptive stress, uh, like a, you know, metabolic health training, uh, approach in some ways. So, just like exercise, if you overdo the exercise that is counterproductive and fasting’s the same way, you can’t just always be pushing too hard on that, uh, or pulling too hard on, you know, that level of health. Um, so that’s important to keep in mind if you’re having a stressful week, right? Yeah. There’s things outside of your control,

Dr. Naomi Parrella, MD: (13:05)

Right? And I agree, stress, it doesn’t have to be stress, right? So it can actually just make life easier. So those of us, um, who have crazy schedules, you might have small children, you might be working long hours, be a caregiver, um, shift work, you might really use this as a tool to simplify your life and it works quite well if you do it well. So if you ever have any questions, get some support with that because there’s many ways to do it really well. Some of you might have heard of a medication called Ozempic or Wegovy or Manjaro or Zepbound, and these are the injectable weight loss medications. So a lot of people have questions about that. And so I have a question here. My insurance company’s recently stopped covering ozempic, which is the injectable weight loss medicine. And I’m worried that I’ll gain back the 45 pounds that I’ve lost over 10 months, as well as see the return to a pre-diabetic state and higher blood pressure.

Dr. Naomi Parrella, MD: (14:03)

What can I do? Is it inevitable that I will regain all the weight I lost? Wow, that’s, that’s a very common question. And honestly there’s it, it’s such a complicated answer, but I’m gonna try to simplify it for the general public to, um, you know, and of course, uh, talk with your doctor about this. Studies show that weight loss based on medications, when you stop the medications, you will regain the weight. That’s for all weight loss medications that have that we have on the market right now. It includes the injectable medications and they show specifically for the injectable medications that by about two years you’re gonna regain the weight. Now is that for everyone in the general population? We don’t really know for sure. Alright, so people who have been using these medications that were in these studies and they were told to cut their calories, so that’s a different kind of a plan.

Dr. Naomi Parrella, MD: (15:03)

And they, and nobody was monitoring, are you doing exercise? So there’s, we don’t know what happens if you actually are crushing it with the exercise and um, you know, including your intermittent fasting, including your protein intake, staying hydrated. But it’s likely that unless you’re really making a significant change in what you’re doing, you will regain that weight. So what can you do? You can again track and figure out what you are doing now and make sure that gets better, at least stays the same. And, um, stay in close contact with your doctor because there might be things you can do. For example, somebody will be started on a new medication not related to weight. That can cause weight gain. If you’re on a medicine that causes weight gain, it almost doesn’t matter, right? Like you’re sort of gonna have to work at that and figure out some solutions.

Dr. Naomi Parrella, MD: (15:58)

So there are options — you do not have to necessarily return to a pre-diabetic state. Even if you start regaining some weight, you can actually improve that with things that lower your insulin — take a walk, go swimming, hang out, you know, in a physically active location, right? Where maybe you’re standing, like right now I’m doing a standup desk, right? So I’m trying to make sure I keep my insulin down too, right? So, um, that’s helpful. Doing the intermittent fasting, finding that fasting window that works really well for you. And what, what we mean by working really well is that you are sorry about that. What we mean by working really well is that you are going to be in control even after you’re fast. So if fasting prompts you to eat, you know, irrationally afterwards, that’s probably not a good fast duration for you because it puts you out of control. So fasting should give you back control and allow you more control over what you’re doing and how you’re feeling. So that would be the most important thing. I think.

Dr. Naomi Parrella, MD: (17:13)

I’m also gonna then switch over to another interventional weight loss option bariatric surgery. So people have the question, what are your thoughts on time restricted eating, intermittent fasting, prolonged fasting for people who have undergone gastric sleeve surgery and we’ll extend that out to a rue and y gastric bypass, which is the one that, um, has been around the longest, right? So yes, there’s a lot of weight loss with both of those procedures. So sleeve gastrectomy and uh, run wide gastric bypass. They work a little differently. So let me explain the difference between the two sleeve gastrectomy means they shrink the size of the stomach, they take a piece of the stomach out so that your stomach is really like a smaller tube, the food still goes through the same path. Then there’s the surgery gastric bypass where they basically shrink the size of the stomach and can plug it in a little bit later.

Dr. Naomi Parrella, MD: (18:07)

Okay? So you actually skip a part of your intestine so you don’t absorb as much. You can imagine with both of those you eat a lot less. So fasting is kind of a way we, uh, eat less. Um, but also if you did surgery, then you’re eating less because of the restriction of the surgeries. If that happens, then you would have to make sure you’re getting enough protein and hydration and salts. And again, that would be something that if you can fit it into your eating window, that’s fine. I would not do a prolonged fast. And I would also make sure if you start feeling super hungry, then you might have to talk to your doctor to see a different way around it because we don’t wanna trigger the sort of uncontrolled eating after breaking the fast.

Dr. Naomi Parrella, MD: (18:59)

So that would be important. And of course you have to be taking your vitamins and so you have to make sure you time those well. So it’s a little bit more nuanced, but there’s doctors that can help you with that and dieticians as well. So just make sure you’re, uh, sticking with a support group regarding uh, bariatric surgery and then you’ll have great outcomes too with the intermittent fasting. Um, alright, the next question is, I’m afraid a sustained fasting regimen will result in muscle mass loss. Can you suggest some approaches to minimize muscle mass loss while maintaining or building muscle mass? Thank you. Great question and really, really important. So of course you need to have muscle. Muscle is longevity. That’s what we’re going for here at Zero, right? We want you to live a really long life feeling great. So, um, it’s about the muscle.

Dr. Naomi Parrella, MD: (20:03)

If you fast, it means you are going to be very careful and deliberate about what you put in your body when it’s your eating window because you have now sort of primed your body to be able to absorb the nutrients that it needs and that it’s gonna thrive on. So, uh, yes, there are ways to do that. One, make sure you are getting adequate protein in your diet. So we often talk about roughly about one gram per pound, plus or minus a little bit, whether you’re active or not active. Um, I find one of the easiest things to think about is your palm. So if you look at the thickness and the size of your palm, that tells you kind of how meaty you are, right? So some people have really big palms and they have a lot of muscle mass, so they’re gonna need some more protein than somebody like who has a smaller amount of muscle on their hand.

Dr. Naomi Parrella, MD: (21:06)

So when you see that, you can pretty much guesstimate that it’s about three to four palms of protein that you need in a day to be able to get sufficient protein. So your body can do all the things it needs to do because every cell in the human body’s made from protein. So it’s the one thing you have to have no matter what. If you are older, really older than 50, you will need a little bit more protein than somebody who is younger than 50 because your cells are gonna just require a little bit better quality turnover replacements, right? Because the, uh, cells can start breaking down. So what we wanna do is make sure that you’re getting adequate protein. And so if your BMI, which we’re gonna uh, use right now is greater than 30 and you’re not a competitive athlete or a bodybuilder, then you wanna aim for roughly about a half to one pound of, uh, one gram of, uh, protein for every pound of, uh, your body weight. If you have had bariatric surgery and you are, like, looking for what’s the bare minimum, you have to have 60 grams or more, usually more. I usually recommend closer to 90 or a hundred if you have a BMI that’s less than 30 and you’re over 20, uh, you’re over 50, you exercise regularly or you’re really trying to lose weight and optimize your body composition, again, aim for about one gram per pound of your body weight and that will be helpful. Rich, anything else you wanna add?

Rich LaFountain, PhD: (22:54)

Yeah, I mean, fasting sometimes gets, uh, maybe a bad rap for changes in lean body mass, but the research doesn’t bear that out. In many of the research studies, uh, fasting performs quite well in terms of reducing body fat mass and protecting lean mass. Um, because of, you know, the metabolic changes that happen when you’re fasting, you kind of shift into more of this fat burning state, um, which helps you to protect that lean mass. Uh, in addition to that, um, make sure you’re, you know, watching your protein intake is huge, that’s for sure. Like top priority. If you don’t wanna lose muscle mass, make sure you’re hitting those daily protein goals. Uh, that pound, uh, that gram per pound is what makes the math easy. So, uh, that’s a good target to shoot for. And even if you undershoot or you, you know, you don’t hit that reliably every day, um, you’re still in good shape ’cause you kind of have some buffer built in, uh, with that higher protein target.

Rich LaFountain, PhD: (23:53)

Um, make sure you’re moving, ideally loading up the bones and muscles. Um, you want to be doing resistance training minimum two to three times a week. Uh, if you can kind of, you know, if you’re familiar with like a one to 10 scale in terms of, like, how difficult you’re training, try to be in the seven to 10 range where you’re, you know, you’re struggling at the end of that set. If you’re going for 10, um, make sure that you probably couldn’t get 12. You wanna be having a hard time to get those last few reps if you’re doing some resistance training regularly. Um, but even if you’re not really into resistance training and you’re kind of starting more, you know, a little bit not quite there in terms of being able to jump into the gym and start lifting all kinds of weights, that’s perfectly fine.

Rich LaFountain, PhD: (24:40)

Just make sure you’re moving. So if you’re sedentary and you’re fasting, you’re not getting enough protein that sends a signal to your body that you’re not really using your muscles as much, um, and you’re not really providing the raw materials to support your muscles. Um, so you may start maybe burning up some of those muscles for fuel, especially when you’re fasting. Um, so you wanna support your fasts by making sure you’re getting the protein, making sure you’re moving your body, activate those muscles to tell your body we need these, we’re using them, we’re moving around regularly. Um, and that will be, I think, the first most important steps in terms of, uh, maintaining as much lean mass as possible. And just don’t overdo the fasting. Don’t cut too many calories. Um, we’re not, you know, we’re not trying to, again, cause these severe calorie restrictions ’cause that does send some stress signals to the body and it changes how your body interacts with muscle, especially in that case.

Dr. Naomi Parrella, MD: (25:34)

I think that’s a great point. So again, you have to load the muscles. If your muscles don’t work, if you don’t work them, then they are going to stop working for you, right? So your body is gonna meet demand if you demand from your muscles that you need to have muscles. So, you get up from a chair, you try to move as much as possible. If you can’t get up from a chair, start working towards that, right? Anything you can do that works your muscles and puts them, you know, to work, you are going to be signaling to the body, I need muscles, I need strength, and your body is going to hold onto that muscle. If you are sitting for too long, then your body is like, I don’t really need this muscle. It’s very expensive to maintain, I’m gonna let it go. Right?

Dr. Naomi Parrella, MD: (26:17)

So that’s the most important thing, is just keep active, move as much as possible. And if you’re, you know, wheelchair bound, you could still tap your leg, you could, you know, tap your, um, arms, you can lift with your upper body. We’ve got some really cool people, uh, stories of, uh, individuals who are even sedentary who can do really great things with their body just from making deliberate effort. So, excellent, excellent. Um, viewing a lot of research that during a fast you should supplement with protein. What is your take? What kind of protein should I be consuming? This is a wonderful question because, you know, there’s so much out there about protein shakes and protein supplements and everything on the, you know, uh, grocery store shelves will list protein or high protein. Uh, it’s, it’s a big thing. And of course it should be because we need to have protein in our diet to be healthy.

Dr. Naomi Parrella, MD: (27:15)

So, yes, um, the, my take is always real food. If great grandma, great-grandpa could recognize what it is, it’s probably a whole food, a real food. And then if it’s something you could hunt, fish, or kill her that used to have a mom, it’s a protein, right? So you can pretty much make it very simple. If you are having the opportunity to eat those kinds of proteins or even eggs, yogurt, cottage cheese, chicken, fish, beef, pork, lamb, whatever it is, those are all fabulous and your body knows what to do with it. If you’re vegetarian, you might have, for example, soybeans or tofu or tempeh. You might have some legumes like chickpeas or, uh, black beans, red beans, things like that. Those are also sources of protein. Those usually require, um, some additional, um, unless it’s quinoa or soy, it will require some grain to make a complete protein.

Dr. Naomi Parrella, MD: (28:16)

Meaning giving your body all the amino acids that you need to have an immune system to have the energy to do things, to build new cells. So protein, protein, protein, yes. And if it’s a real food, it’s better. If you are going to supplement, then you wanna make sure there’s not, it’s really what’s with the protein that matters, right? So sometimes you can get like a real, just a protein, it doesn’t taste very good in a powder form or in a bar or something. You have to make sure it’s not loaded with sugar, first of all, or some kind of sugar that can really work against you because sugar and protein turns into a very hard candy in the body and that doesn’t, uh, do well for your organs or your blood vessels. So you wanna look and see what’s with your protein. If it’s a protein shake, you wanna make sure it’s third party tested. NSF or USP will be the label that’s on the package. You wanna make sure that your proteins are also with the least number of other ingredients in the package. Um, and if it has a bunch of names that you don’t recognize, that’s a problem, right? So, um, what you’re trying to do is give your body all the nourishment it needs so that it can thrive. You’re not trying to confuse it and give it things that it’s going to impair that process. Um, Rich, do you have any thoughts on this?

Rich LaFountain, PhD: (29:44)

Um, I guess I’ll double click on the third party testing. Uh, not as many companies will, they actually have to seek out the third party like N-S-F-U-S-P to get that label put on, um, their products. So they have to pay money, they have to send in their sample of their product to get that, uh, test to occur. And if they go through kind of, you know, they jump those hurdles, they cover those hurdles, um, they’re, they’re proud of their product and usually it’s a safe product that’s kind of been guaranteed if you see those labels on there. Um, so it also helps because there’s so many products out there, the number that will actually go through that third party testing is lower. So it, like, it narrows the field, I suppose, if there’s, you know, too much or you get, there’s so much noise, there’s so many options out there, you want to narrow that down a little bit.

Rich LaFountain, PhD: (30:39)

Um, good idea to go for the third party. Uh, supplemental protein especially can be helpful, um, in certain diet preference types if you’re vegetarian or vegan. Um, if it helps you hit your protein total for the day, that daily target of about one gram per pound body weight, um, it’s worth it. Try your real food, do your best with real food, but if you need to supplement, um, your lean mass is crucial. So, um, try to do your best and do what is necessary to maintain that if supplementing is required. Um, there’s, there’s really nothing wrong with that. It’s better than, uh, being protein deficient in your diet.

Dr. Naomi Parrella, MD: (31:19)

Yeah, if you wanna do, breaking the fast. So there are some questions about, um, you know, what breaks a fast, does this break a fast? Does that break a fast? And we get a lot of these questions a lot. Um, so, uh, we had a question, can we add cinnamon to the coffee while we’re fasting? Uh, yes you can. So really with regards to fasting and what breaks a fast, if it has calories, it’s definitely breaking a fast. And you can think about what’s the purpose of the fast. I think that’s a really important thing to recognize. Are you trying to reset your metabolism? Are you trying to decrease the number of calories you’re having? What’s the purpose of the fast? Is this a gi like your, uh, stomach doesn’t feel good and you’re just trying to give it some rest so that it can recover?

Dr. Naomi Parrella, MD: (32:06)

Are you trying to lose weight? And based on that you might decide, uh, how important this is. So, uh, common question: cream in my coffee doc, is this breaking my fast or not? So if you are going for autophagy where you’re really trying to rest your gut and you put cream in your coffee, that’s breaking the fast. However, if you’re going for weight loss and you’re trying to avoid a caffeine headache, not such a big deal with regards to the overall goal of that. And so, um, you can think about how you’re using your fast and what the purpose is. So, um, it can impact hormones depending on what you put in your body. Um, Rich, do you have any specific comments you wanna talk about related to, in relationship to that?

Rich LaFountain, PhD: (32:57)

Um, yeah, those, those two main, uh, things you’re looking to do if you’re trying to determine, we get so many, uh, questions and, uh, feel free, send them in through social and, uh, through other channels. And, uh, we love making sure, it’s actually pretty interesting how many products now we’ve been able to, um, take a closer look at to look at ingredients and such. Uh, but what you’re looking to do is, again, avoid calories. Um, you’re gonna find extremely low calorie numbers in stuff like black coffee and tea. Um, technically, you know, we consider those not to be, um, things that will break your fast. They’re fast friendly, in other words, um, specifically because they don’t spike your blood glucose or insulin levels. And that in particular is what’s going to shut down the fat burning benefits associated with your intermittent fast. Um, and that, that second one about, you know, will it increase my glucose or insulin levels?

Rich LaFountain, PhD: (33:52)

Uh, that one can involve a little bit of a deeper dive on the ingredients label. Um, so yeah, definitely those are some, uh, some of the, the basics to keep in mind. Um, we get a lot of questions about, like, again, things like gum and, you know, even cough drops I think was a recent one we got. Um, again, if they have are low calorie sugar free gum usually is okay, you’re, uh, looking for things that are not gonna contain, uh, specific artificial sweeteners, which I know, uh, Dr. P you’re, um, there’s, there’s at least three or four that you’re familiar with that can cause this, you know, insulin response because they taste sweet and it signals your brain to release insulin at the, uh, GI tract. Um, I dunno if you wanna yeah. Elaborate on those ones in particular.

Dr. Naomi Parrella, MD: (34:48)

Well, so I think, um, basically what we’re saying is anything that causes your body to have to respond to what you put into it, like with regards to your hormone response. So if you put certain foods in your body, your body has to respond to it because you’re signaling to the body and the body has to respond. So if you are, uh, causing your body to focus on what you are putting in your body, it’s going to change it. So artificial sweeteners, specifically things like sucralose, which is Splenda, has been shown in several studies that it can cause your insulin to increase. Insulin is a hormone in the body that’s naturally produced. We need insulin to survive. And insulin basically tells your body to store. It’s a building hormone, it’s a growth hormone. So if you eat things that cause your insulin to go up, your body goes into storage mode.

Dr. Naomi Parrella, MD: (35:44)

So if you’re trying to lose weight, not so great. If you’re trying to build muscle because you’re working out fabulous, right? Or if you’re a small child and you’re trying to grow taller, that’s really important. But otherwise, many of us do not wanna grow wider and we’re not sitting in the gym all the time or working out in the gym all day long. So you might wanna be careful about what you’re eating so that you don’t spike your insulin. So I just wanna do sort of med school 1 0 1 and I’m gonna simplify this because I think it’s actionable. All right? This is what people come to my office for right now. Your body runs on fuels like glucose, which is blood sugar in ketones. And we’re gonna set ketones aside right now and we’re gonna talk about blood glucose, blood glucose, I’m gonna use the word sugar to describe blood glucose just ’cause it’s easier to say.

Dr. Naomi Parrella, MD: (36:34)

Okay? So you have to have a certain amount of sugar in your bloodstream at any one time, that is blood glucose. And if we use baking measurements like teaspoons, tablespoons and cups, you need about one teaspoon of sugar at any one time to have that perfect level of blood sugar so that your body can fight infections, do all the things you wanna do, play and have fun, right? So you have to have about one teaspoon in your bloodstream at any one time. Now the key to understand is if your body has very, very high sugars in the bloodstream, it is no longer fuel. It’s poison, it causes blindness, kidney failure, heart attacks, strokes, cancer, nerve damage, cognitive decline, depression, anxiety, all of those things from very, very high sugars. We call that diabetes. Diabetes means the sugars are in a range that are so high, it’s poisoning every cell in your body.

Dr. Naomi Parrella, MD: (37:33)

Now your body doesn’t wanna be poisoned, it wants to survive, it wants to thrive. And so it has a defense mechanism and it’s a powerful defense. And that defense comes from your pancreas that sits behind your stomach and it pumps out insulin every time the sugars skyrocket. And what does insulin do? It brings down the blood sugars. And it does that in two ways. First, it turns off your body’s ability to burn fat so that your body will prioritize using the sugars in the bloodstream. And if you are not running a marathon all the time, you can’t burn off a lot more extra sugars. So anything you can’t turn off or burn off your body is going to be signaled by insulin if you can’t burn it, store it. And where do we have infinite storage space in our fat cells? And that’s the tricky part.

Dr. Naomi Parrella, MD: (38:29)

So anything that makes insulin go up, you’re in storage mode, right? And you’ve turned off the ability to burn fat at that time while your insulin is high. And that’s the whole challenge. So fasting trains your body to be able to bring that insulin down, and that’s what Zero’s doing. We’re making it easy for anybody, anywhere on the planet to be able to tap back into that fat burning potential that your body has been designed to be able to do. And so that’s what’s really fun is once you understand that, you understand, oh, this is why I’m fasting, this is why I’m training my body to be able to be nimble and take care of itself. And this is why your metabolic health improves and we can increase longevity. ’cause your body has constant fuel, it knows that it can tap into fat cells or it can use the fuel that you just put in your body. So it’s super, super awesome. So that, so I think that is a really important thing that I just wanted to throw out there before we open it up for more questions.

Rich LaFountain, PhD: (39:31)

Will taking oral supplements or even Tylenol for headache during your fasting window break a fast?

Dr. Naomi Parrella, MD: (39:40)

Wow, that’s such a good question. So, um, I’m gonna say no, but if you have it as a syrup, you know, like a, you know, a liquid form, yeah, probably that is not the, uh, that will break the fast. But if you’re taking a pill, it’s so negligible, I wouldn’t worry about it.

Rich LaFountain, PhD: (40:00)

Well, very good, thank you very much. Um, we do have a related, uh, video in-app, uh, within the explore tab. You can take a look if you’d like. Uh, if this was your question, uh, the title of the video is, does ibuprofen break a Fast? And it, uh, addresses the exact same topic for the most part. Another question, how do you take supplements during the fast if it requires food and, um, if the supplement’s fat soluble, for example, you know, vitamin A, vitamin E or D uh, or KI suppose if you wanna include ’em all, um, how do those factor in? Because again, they’ll be packaged with some calories.

Dr. Naomi Parrella, MD: (40:40)

Well, that, I mean, if you eat, you eat right? Like that’s, that’s, that’s breaking the fast. So, um, it’s a pretty simple answer. Good question though. I get that a lot.

Rich LaFountain, PhD: (40:52)

Another question. Can you do a combination of low calories and fasting to kinda get a two for one benefit?

Dr. Naomi Parrella, MD: (41:01)

Well, great question. So I’m, I’m not a huge fan of calorie counting overall because it does matter if you’re having, you know, certain calories as Skittles versus certain calories as a steak. So, um, I would recommend focusing on the fact that you’re fasting for a reason, simplifying life, making your health better, you know, feeling more energetic, sleeping better, those types of things. If then when you eat, you are eating foods that nourish your body and give it all the great access to fuels that you need to have like a fabulous life and feel great and live a long time feeling great, then you’re going to prioritize protein, have your vegetables that are fibrous, um, and make sure you’re staying hydrated. Everything else is kind of like accessory foods, right? So, um, as long as you’re doing that, you’re feeding your gut microbiome by having your veggies, you’re having protein, which is giving your body the nutrients it needs. And if it’s a real food, it comes with all, all the other stuff it needs like collagen, which will be part of what connects the, for example, chicken to the thigh bone, right? Those things, um, that are in bone broth, that’s all part of it. So I would just say eat real food as much as possible, and otherwise you’re prioritizing protein and vegetables in the ways that you, you’ll get to them

Rich LaFountain, PhD: (42:36)

The last two hours before bedtime are always the hardest. Um, that’s the time I’m the most hungry. Uh, yeah. How does that factor into fasting? What, what can that person do? Um, love to hear your thoughts on this one. ’cause I,

Dr. Naomi Parrella, MD: (42:51)

I know Yeah, that is a fabulous question. Common question. Yeah. Oh, totally. I get this all the time. So nighttime is tricky because some people have just habits of eating at night. Like you sit in front of a TV or you’re doing something, you’re sort of de-escalating and maybe you end up sitting with some food because it’s something to do. Um, if you’re hungry later at night, it means you didn’t get adequate nutrition earlier in the day. That means maybe you need to shrink your fasting window a little bit or make sure you’re getting adequate protein within your eating window, right? So that’s gonna be super, super important. If you’re not getting enough protein, you’re gonna be hungry. And what’s cool is your body can, you know, sort of do okay for a day or two, you can white knuckle it, right? But if you are constantly deficient in your protein, evolution’s gonna kick in and that evolutionary drive to eat is gonna kick in.

Dr. Naomi Parrella, MD: (43:49)

You’re gonna be hungry and you’re gonna be eating foods that maybe you didn’t choose to, you didn’t wanna be eating, right? So I would recommend first, uh, figure out are you getting enough protein? Remember we talked about your palm size protein. Are you getting three to four servings of that in, ah, in your eating window? If so, you’re doing well. If you’re not and you’re still hungry, you need to be eating protein. So, uh, add that earlier in the day, maybe when you break the fast, you need a bigger dose of protein. Um, if somebody’s on medications, like these weight loss medications, they’re not supposed to eat within two to three hours of bedtime because the food then comes back up. And so that also impacts dieting patterns, right? So it makes people eat less if you’re told don’t eat within two to three hours of bedtime because otherwise the food’s gonna revisit you potentially, right? So, um, just something to keep track of — it does make a difference and it’s super helpful for weight loss if you can sort of decrease that late night eating.

Rich LaFountain, PhD: (44:54)

Uh, what are some good resources that follow and where might I go looking for information about women exercise and fasting specifically?

Dr. Naomi Parrella, MD: (45:03)

Wow, well you’ve come to the right place. Like this is where you go, right? So, um, in the faster, in the fast in the Zero app, uh, that’s a great place to go to get information and especially up to date information. So Rich who’s with us right now, right? Rich hosts, uh, science reviews every week with the latest research in this space. And so it’s really fantastic because then that gets implemented into our content that you can actually just get right on your, um, app. And so that’s what we’re trying to do is make it as easy as possible for people to understand what we know now and what might be changing with more knowledge. And then you can always have the most up-to-date information. So with regards to women and fasting, there’s lots of, um, you know, confusion because women and men are not exactly the same in the way our body composition responds to different treatments.

Dr. Naomi Parrella, MD: (46:06)

And so it’s very, very important for women to do weight bearing activities as much as possible, maintain bone strength and make sure you’re maintaining your muscles. In addition, your hormones, when you don’t have estrogen anymore, it changes where the fat distribution is going to be on your body. So when you have estrogen, this is premenopause, your body will prioritize putting on fat if you’re a woman, okay? It will prioritize putting fat tissues sort of in an hourglass kind of way. So on your lower extremities, your butt, your hips, right? Or in your, um, breast tissue after menopause, you don’t have that same level of estrogen anymore. And so what ends up happening is you end up putting the weight exactly where a man might put weight around the waistline. And that’s what we often see in that space. So just understanding estrogen determines where the fat goes.

Rich LaFountain, PhD: (47:07)

Alright, we do have, uh, again, very good resources. Uh, there was a recent article that we published, uh, everything you need to Know about Fasting for Women. Um, we have another series of articles in there as well. So if you are in the app, hit the Explore tab. There actually is a search bar. You can type in women and fasting, uh, and it will pop up a curated, uh, list of articles and content directly in your app.

Dr. Naomi Parrella, MD: (47:31)

So this webinar is for general informational purposes only and does not constitute the practice of medicine nor the giving of medical advice. So no doctor patient relationship or has been, uh, established and the content of this webinar is really not a substitute for professional medical advice. So under no circumstances should any of this information be used to disregard or delay obtaining medical advice from your own physician or healthcare team. So we are just here to, uh, share some information, but again, uh, turn to your own doctors and healthcare team if you have specific individual questions.