Ep. 59: Dr. Alan Goldhamer – How Fasting Can Support Your Recovery and When to Do It

Fasting can be really helpful when done right… and really bad for you when done wrong.

It must have been in my very late teens or early 20s when I did my first fast. It lasted 3 days and as many people would confirm, the first 36 hours are the worst. And then – things got easy, or easier. After three days I kind of had to force myself to start eating again because I completely lost my appetite. If I could go back to that time I’d do things differently, but wise decisions usually come with life experiences.

Fasting is a useful tool, but it is one of those that really needs proper guidance and supervision. And rest!

With my first fast there were some mistakes that I made but resting wasn’t one of them. This is something that I’ve seen people do so many, too many times. They just stop eating for a period of time without any other changes. Without eliminating the stress or just keeping it very low, without skipping their workouts, without taking it easy.

Dr. Alan Goldhamer, Director of the True NorthHealth Cente is board-certified in fasting supervision and has 40+ years of experience with guiding people through fasting and helping them adjust their diet and lifestyle to truly maximize the health benefits. If you’ve ever wondered how fasting can help your body and healing, this conversation is a great resource.

In this episode, you’ll discover:

  • Why and how what you eat affects your body’s ability to heal.
  • When water-only fasting could be appropriate for you – and when it’s definitely not.
  • How ketosis and keto diet affect your ability to heal.
  • What intermittent fasting is and how it can benefit you and your body.

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Show notes & links

The show notes are written in chronological order.

  • Dr. Alan Goldhamer’s website: https://www.healthpromoting.com/
  • Dr. Alan Goldhamer’s books:
  • Dr. Alec Burton | Arcadia Health Center 
  • Wang, S., Liu, H. Y., Cheng, Y. C., & Su, C. H. (2021). Exercise Dosage in Reducing the Risk of Dementia Development: Mode, Duration, and Intensity-A Narrative Review. International journal of environmental research and public health18(24), 13331. [read it here]
  • Marosi, K., & Mattson, M. P. (2014). BDNF mediates adaptive brain and body responses to energetic challenges. Trends in endocrinology and metabolism: TEM25(2), 89–98. [read it here]

00:00 – excerpt from the episode
00:48 – intro (listen to discover a little more about your host. Martin will tell you a new lesser-known fact about Dr. Maya)

01:23
Dr. Maya Novak:
It must have been in my very late teens or early 20s when I did my first fast. It lasted 3 days and as many people would confirm, the first 36 hours are the worst. And then – things got easy, or easier. After three days I kind of had to force myself to start eating again because I completely lost my appetite. If I could go back to that time I’d do things differently, but wise decisions usually come with life experiences. I say usually because sometimes that’s not the case and I’ve heard too many horror stories of people who just did it ‘by feel’ and things went wrong. Or they went too long, or decided they would do a dry fast on their own. Especially the last one is very popular among bodybuilders when preparing for their competitions and sometimes things go very wrong with this one. Fasting is a useful tool, but it is one of those that really needs proper guidance and supervision. And rest! With my first fast there were some mistakes that I made but resting wasn’t one of them. This is something that I’ve seen people do so many, too many times. They just stop eating for a period of time without any other changes. Without eliminating the stress or just keeping it very low, without skipping their workouts, without taking it easy. So yes, fasting can be really helpful when done right but it can also be really bad for you when done wrong. I talked about this topic in depth with Dr. Alan Goldhamer back in 2020. He was a guest on my summit and because this topic never goes out of fashion, I think it’s important to also be released here on my podcast The Mindful Injury Recovery Talks. Enjoy!

03:18
Dr. Maya Novak:
In this interview, I’m joined Alan Goldhamer, who is a chiropractor and has been a Director of the True NorthHealth Center for the past 35 years. He is Board certified in fasting supervision and a member of the International Association of Hygienic Physicians. Dr. Goldhamer is the author of The Health Promoting Cookbook, and co-author of The Pleasure Trap: Mastering the Hidden Force that Undermines Health and Happiness. Dr. Alan, thank you for being here.

03:47
Dr. Alan Goldhamer:
It’s my pleasure.

03:49
Dr. Maya Novak:
So, before we go into the juicy part of healing and fasting, for those that don’t know you yet, can you please share a bit about yourself and what led you to become a chiropractor?

04:02
Dr. Alan Goldhamer:
Well, I’ve been in practice for about 35 years now. Originally, I went to Chiropractic College because I was interested, actually, in nutritional medicine, and at that time, chiropractors were much more open to the idea that diet and lifestyle had an important part in playing a role in health. After I finished training as a chiropractor in the United States, I went to Australia and attended the Pacific College of Osteopathic Medicine. There, I was able to do training with Dr. Alec Burton, who was the person that was the most experienced in the use of water-only fasting in the treatment of disease. So, I had the chance to get another kind of perspective and additional training. I returned to the United States in 1984 with my wife, Dr. Jennifer Marano, and we opened the TrueNorth Health Center. We’ve been doing this work ever since then.

04:52
Dr. Maya Novak:
So, how come you were interested in nutrition? Because usually when I talk with doctors, physiotherapists, and chiropractors who are interested in nutrition, usually they find this later on, but you were actually interested in that before.

05:09
Dr. Alan Goldhamer:
Well, I got interested in the idea of getting healthier very young. I was a basketball player and I competed with my friend, Doug Lisle, who happens to be the clinical psychologist at the TrueNorth Health Center. So, we grew up together and he always beat me badly, and I thought maybe if I got healthier, it would give me an edge, and I’d be able to finally beat him. Of course, it completely failed because he adopted the same diet and lifestyle changes that I did and he still beats me badly to this day. So, I’m now 60 years old and I’m still getting beaten consistently. But, it did get me interested in this whole field, so I guess I’m grateful for that.

05:43
Dr. Maya Novak:
So, you actually absolutely have firsthand experience as well with yourself, and with your friends, that diet has an important role when it comes to health, and when it comes to recovery?

05:55
Dr. Alan Goldhamer:
Well, it’s interesting; Dr. Lisle and I still play competitively. Of course, now the people we’re playing with are 20 or 30 years younger and it’s interesting to see even as they hit their 30s or 40s they begin to age out. And so, I think it’s more than coincidence that those people that adopt health-promoting diets and lifestyles and lifestyles are able to sustain a level of functioning much later and much longer in life than those people that live conventionally.

06:19
Dr. Maya Novak:
Yes, it makes sense. So, as mentioned before, you are the Director of the TrueNorth Health Center where you specialize in medically supervised water-only fasting. Can you explain a bit about what the difference is between your approach and so-called regular fasting, something that people do at home without any supervision …

06:45
Dr. Alan Goldhamer:
Sure.

06:45
Dr. Maya Novak:
… or perhaps on a retreat without any medical supervision person by their side.

06:50
Dr. Alan Goldhamer:
Well, everybody fasts. Every night you have your final meal. You go through the evening without eating, wake up in the morning, and break with breakfast. So, the idea of extending that period of fasting, which is now popularly referred to as intermittent fasting, may have benefits physiologically. The idea is to narrow your feeding window to say eight or 10 or 12 hours a day and allow for an 8, 10, or 12 hours a day fasting period. Some people advocate extending that fasting period to 16 hours a day so that you’re feeding within an eight-hour window. Maybe you don’t have breakfast before, say 9:00 or 10:00 in the morning, and you don’t eat dinner at 5:00 or 6:00 at night. Allowing for an extended period of fasting, even that brief period of fasting, is thought to induce metabolic hormone neurochemical changes that are associated with promoting health. It may also be that just not eating, before you go to bed, for example, for three hours before you go to sleep, may improve sleep quality, digestion, function, and performance. And the idea that not eating anything at all for two-thirds of the day, even if what you eat in the one-third isn’t ideal, you may still eat less of it. And so that may have a benefit as well. So, we do advocate intermittent fasting for all of our patients at the TrueNorth Health Center. We limited our feeding window to between 8 and 10 hours, depending on the patient, and then go for fasting. Now, you can extend that period of fasting for days, weeks, or many weeks as a matter of fact. At the TrueNorth Health Center, we’re fasting people anywhere from five to 40 days on water only. That part does need to be done with some care. Medical history, physical examination, appropriate monitoring, and laboratory testing is necessary to ensure a safe effective experience. Not everybody is a candidate for long-term water-only fasting. There are people that have conditions or they’re on medications and they have other issues that would contraindicate, sometimes strongly contraindicate the use of extending fasting. But for those people where it is appropriate, where their history, exam, and labs suggest that fasting is going to be safe and effective, there’s really nothing else that works exactly like water-only fasting. And not surprisingly, the places where water fasting has its greatest efficacy is in conditions that are caused by dietary excess. The most obvious is obesity and the consequences of being overweight, but more specifically cardiovascular disease including high blood pressure, type 2 diabetes, autoimmune disorders, as well as lymphoma and other forms of cancer. So, these conditions are well documented to respond effectively to extended periods of water-only fasting. And, of course, the problem with fasting is you still have to eventually go back to eating and when you do, what we advocate is a whole plant food SOS-free diet. SOS, of course, is the international symbol of danger. It stands for salt, oil, and sugar, which are the chemicals added to food that fool the satiety mechanisms in the brain, lead to overeating, result in obesity, and inflammation, and the diseases of dietary excess. So, fasting is just basically a way to reverse the process that’s come about in large part because we’ve made poor diet and lifestyle choices. There’s another thing I want to mention. If you look at exercise, exercise induces changes that are thought to be extremely helpful healthily. For example, brain-derived neurotrophic factor or BDNF increases with exercise. If you take rats in a cage and half the rats have access to a wheel where they can exercise and the other rats don’t, everything else being equal. The rats in the cage with the wheel will have dramatically lower dementia rates. They don’t get the equivalent of Alzheimer’s disease in humans. It’s thought because of the exercise, the brain-derived neurotrophic factor, which protects the nervous system, is enhanced. Well, it turns out in addition to exercise; BDNF also goes up with fasting. And in fact, if you look at all of these different chemical changes from leptin and all the way down the list that are impacted by exercise, they’re also impacted by fasting. You might way say, well, now wait a second. Why would resting, which we do with fasting, and vigorous physical activity result in the same neurochemical changes and the same kind of benefits? But when you think about it, exercise and fasting both do one thing in common. They’re undoing the consequences of dietary excess. So, it’s really not surprising that we find parallels between consistent regular exercise and the occasional use of long-term water-only fasting or the frequent use of short-term intermittent fasting. It’s not actually that shocking or surprising at all. And it definitely seems to be holding up as more and more research is done.

11:43
Dr. Maya Novak:
Yes. So, you mentioned exercise, but a lot of listeners who are tuning into this Summit, they are most likely injured. So, when it comes to exercising, especially with serious injuries, usually it’s not possible. But my question here is, sometimes I get a question from injured people is it okay for me to fast right now when I’m recovering. So, is this a good thing? Especially with serious injuries, the body needs more energy healing. Is fasting okay or perhaps it’s better to wait?

12:23
Dr. Alan Goldhamer:
So, injuries often respond well when fasting is used as a component in care. But again, to determine if a specific individual with a specific injury should heal, it’s not going to be the injury that’s often the limiting factor. It’s the other physiological parameters. In other words what medications - if the person’s on medications, you already know you’re going to have to modify the program because you typically will not use medications, particularly pain medications, steroid medications, etc., in conjunction with water-only fasting. So, there are modified versions of fasting where people get, for example, 600 or 800 calories a day. It might be in the form of juices or other food limitations that might be able to be used in conjunction with injuries where medications are being applied. But water only fasting typically is going to be done in cases where people can stabilize enough to eliminate medication use. Now, what’s interesting, many people are medicated in injuries because of inflammation. But the most powerful anti-inflammatory influence includes a healthy diet and fasting. And a healthy diet in relation to injury is a diet that’s going to be relatively low in arachidonic acid and other pro-inflammatory factors. So, you wouldn’t be like throwing gas on the fire of inflammation if you’re injured and taking, for example, milk products, which are notorious for turning up the inflammatory temperature in the body. You would want to be using foods with powerful anti-oxidant constituents such as fresh fruits and vegetables – high water content, high nutrition density, low caloric density foods. And, of course, if you’re eating large amounts of fruits and vegetables, not only are you get getting your vitamins and minerals, but you’re also getting – if your caloric level intake is adequate, you’re getting adequate levels of protein as well. So, you don’t need to necessarily try to enhance the healing response by eating a very concentrated diet, which may in fact actually suppress the response and slow down the rate at which you recover.

14:43
Dr. Maya Novak:
Oh, I know firsthand how this is. In 2012 when I fractured and dislocated my talus bone, my doctors, and PT, they were all surprised how I was not experiencing much swelling or pain.

14:40
Dr. Alan Goldhamer:
Yeah.

14:40
Dr. Maya Novak:
And I think the diet was absolutely very important in my healing process.

14:45
Dr. Alan Goldhamer:
We hear this from surgeons a lot too in our patients that are recovering from surgeries. Those that utilize intermittent fasting, and utilize a health-promoting plant-based SOS-free diet, that they heal dramatically more efficiently and effectively than what the surgeons are used to experiencing. And we often get calls, you know, what the heck is going on here because they’re surprised at how effective the body is healing if you get out the way.

15:13
Dr. Maya Novak:
Yeah. So, in your experience, it just important that the majority of the diet is a fruit, vegetable, or wholefood plant-based diet? Or is this, the recovery time, the time to be more on the 100% side?

15:31
Dr. Alan Goldhamer:
Well, we believe, all of the time is a good time to be on a health-promoting diet. It’s just even more critical when a person is ill or injured. And it becomes more apparent just how beneficial it is when a person is ill or injured because you see the effect on inflammation more dramatically.

15:48
Dr. Maya Novak:
Yes.

15:49
Dr. Alan Goldhamer:
So, from my viewpoint, it’s just like we know the cure of cancer is prevention, and the best treatment of injury is prevention. Once an injury occurs, you still want to create the environment which is going to maximize recovery, and that’s going to be a whole plant food SOS-free diet.

16:08
Dr. Maya Novak:
So, with an SOS-diet, you mentioned salt, oil, and sugar, and sugar has been the devil for a few years now and people understand sugar inflammation. But why are you talking about oil and salt as well?

16:25
Dr. Alan Goldhamer:
[inaudible] So, it also turns out that a high-fat intake also has an anti-inflammatory effect on the body, and also it can limit circulation. You can all see the videos of and other things that happen in people if they’re eating a high-fat diet. So, it’s not surprising to find out that reducing the fat to a healthier level, that’s 15-18% of calories from fat rather than the 30%, 40%, or 50% of calories from fat, is going to be associated with better circulation, and a better healing response. And salt is an interesting component. It’s an essential nutrient without which you’d die; you have to get enough sodium in the diet. It turns out though the sodium you need is provided by a whole plant-food diet. Sodium is a natural component, especially in a vegetable-rich diet. And salt itself, when it’s isolated in the chemical form, just like sugar, or just like oil, has some negative properties. If you think about it, an important part of your defense mechanism is your microbiome. You have, what, five pounds of bacteria living in your intestinal tracts right now. Living creatures eating, drinking, and defecating inside you right now. So, five pounds of creatures pooing inside you, and what they poo in you could be pro-inflammatory or anti-inflammatory. It could be health-promoting or health-compromising. If you feed your microbiome animal products, you’re going to get things like trimethylamine oxides form, which thought to be counterproductive in terms of healing. If you feed your bacteria soluble fibers, you’re going to get Vitamin K and other health-promoting fertilizers so to speak. So, what you feed your body affects your microbiome, and your microbiome affects your healing response and it’s all intertwined. And the idea that you have to add a chemical in the form of sodium chloride that’s been isolated and fractionated out of food in order to get enough salt is not true, any more than you have to rip apart plants and extract oil. Or that you have to refine multiple pounds of sugar cane into a refined carbohydrate in the form of sucrose in order to be able to get enough energy. So, it’s not that we don’t think you need complex carbohydrates or essential fatty acids, or enough sodium in your diet. But we’re arguing that you get that from a whole plant food diet that doesn’t need to be processed and fractionated in order to be able to nourish you adequately. And by avoiding all those chemicals, you avoid what we call the pleasure trap. The artificial stimulation of dopamine in the brain that leads to systematic overeating and ultimately results in these diseases of dietary excess.

18:57
Dr. Maya Novak:
Do you have any advice – so, if the person right now is deciding, okay, I really think that I should cut out sugar and salt and oil as well – but many times at the beginning, the food is a bit bland. So, do you have any tips on how people can go through this period?

19:17
Dr. Alan Goldhamer:
Yes. It’s not just bland it’s tasteless as well. If you’re addicted to the artificial stimulation of those drugs that have been added to your food, when you first eat healthy foods it’s not so appealing. So, the good news is that neuroadaptation – taste neuroadaptation is predictable. On average, patients will take about 30 days to neuro adapt to a low sodium diet. So if people can persist with a low sodium diet for about a month, healthy foods start to taste better. With fat, it’s a little trickier. It takes about three months for people to be satiated or feel satisfied on a lower-fat diet. The good news is that with fasting, that process can be dramatically sped up. Most patients, by the time they’re done with fasting, find that good foods start to taste good. In fact, they’re shocked that something like Swiss chard, which normally they may not have even liked, now has this very powerful salty flavor to it. Cigarette smokers find that by the second or third day of fasting they have no cravings for cigarettes. Now, some people say, well, they’re probably so miserable fasting they don’t even think about the cigarettes, but that’s not true. It’s just the process of detoxification occurs much rapidly. So, if you’re patient, you will neuro adapt to healthier foods so that good food starts to taste good. One of the ways I know a person needs to fast is because foods don’t taste good to them. They don’t like good foods because they’re addicted to the pleasure trap.

20:36
Dr. Maya Novak:
Mhm. So, now you are again describing water-only fasting. Is this seen also with, for example, intermittent fasting?

20:48
Dr. Alan Goldhamer:
Yes, it is seen with intermittent fasting. It’s also seen on modified calorie intake programs where people put themselves say, for example, on fresh vegetable-based juices for a few days. It’s just not as quick. It’s not quite as powerful as the water-only fasting, which is like, you know, kind of the nuclear version of it. But even these modified feeding regimes will help with taste neuroadaptation and they do make a transition easier and smoother.

21:15
Dr. Maya Novak:
So, if we go back to injuries and recovering from an injury, is it okay for the person to have a water-only fast, or how do they decide? Or is it better to talk to someone like yourself and then discuss if this is really a good time for them to fast or not?

21:37
Dr. Alan Goldhamer:
Right. So, everybody – I shouldn’t say everybody – virtually everybody can do intermittent fasting where they’re limiting their feeding windows to somewhere between 8 and 12 hours, whatever it is they’re going to do. In order to determine if longer-term water-only fasting is good, it would be best for the patient to talk to a physician that’s not an idiot to make sure there’s no contraindications to them extending that fasting. Number one, as I mentioned, would be medications. There are other conditions, for example, people that have atrial fibrillation, or people that have difficulties with kidney function. Or they have problems where they may have difficulty adapting safely to the fasting state. They would be better off doing a modified version of fasting than the water-only fasting. But if they’re a good candidate for fasting, the other complication is long-term water only fasting needs to be done in an environment of rest. It’s not something you can do where you’re driving to work and carrying on. And here’s why, when you go on a water-only fast the body adapts and changes fuels from burning, normally, glucose to burning, essentially, fat. And specifically, you go into ketosis and your brain changes over and burns predominantly beta-hydroxybutyric acid. This is a big adaptation and a big chemical shift. If you’re very active when you’re doing this process, mentally or physically, you will need more glucose. You will force the muscles to use glucose or you’ll force your biggest user of glucose, your brain, to burn glucose. If you’re forcing the body to burn glucose but there is no glucose coming in and you’ve depleted your glycogen stores, the only place to get glucose is from the breakdown of protein. And so gluconeogenesis will kick in and you will deplete protein reserves. That’s not what you want to do. What you want to do is you want to mobilize fat reserves, detox the body, and preserve your lean tissue. The only way that happens in fasting is with rest. So, you have to take it easy. And so people that are very active when fasting may feel fine, but what they’re doing is instead of living off their fat reserves, they’re living off their protein reserves. So, you get a diminishing return, particularly for an athlete that’s trying to maximize healing response and minimize recovery time. Being active in conjunction with fasting is not so good. Now, this does not apply to intermittent fasting. For example, you can wake in the morning, do vigorous exercise, and delay your morning meal. During that time, you’ll be predominantly burning fat because you still have glycogen stores to meet your minimal glucose needs. But when we start talking about longer-term fasting – two, three, four, five, 10, 20, 30, 40 days, those principles become important. For people that are interested in the detailed physiology of fasting, they can actually go to the website fasting.org. Fasting.org is the fasting compendium website of the TrueNorth Health Foundation where all of the research on fasting is presented. It’s freely available and you can actually go through that and really get well educated about what’s actually happening in this fasting scene, and why we make the recommendations that we do.

24:40
Dr. Maya Novak:
I have so many follow-up questions. You open up such a great topic in regards to it. So, you mentioned a few things. First of all, you mentioned that the body goes into ketosis when we do water-only fasting. Now, ketosis and the keto diet, has been very popular for the last few years. Can we talk a bit about this, because my understanding is that the keto diet might not be that good for health-promoting? I might be wrong. But what is then the difference here if we talk about the keto diet and ketosis?

25:17
Dr. Alan Goldhamer:
Right. There’s a number of different ways that people can get into ketosis. Any time you stop consuming carbohydrates or sugar, you have a day or two of glycogen stores. When you think about glycogen depletion, when you go do a marathon run, part of hitting that wall around 20 miles is probably associated with glycogen depletion, which is why people do glycogen loading – carb-loading – trying to increase their stores so that they hit the wall later. The idea of eating say, for example, a high-fat high-protein diet and eating large amounts of animal food, it’s true it has no carbohydrate. So, after a day or two, you’re going to go into ketosis. Part of the fasting mimicking ketosis is a blunting of hunger. So, the way these keto or paleo diets are encouraging people to try to lose weight is by getting them into ketosis, and in ketosis, you’re not as hungry, so they can continue to function. The problem is what’s good for short-term weight loss is not necessarily good for long-term health. And particularly a high-protein high-fat animal-based diet is devastatingly awful for health. A lot of the reason – what happens to these patients is they do get sick. In saying that, if you get sick, you also lose weight but that doesn’t necessarily – that’s not a great way to do that. If you just want to lose weight quickly, you can just cut your leg off at the hip, it’s 40 pounds. If you want to lose 80 pounds, you can just cut both legs off. Again, that would be rapid weight loss and not necessarily healthy. You can go on the dead Dr. Atkins diet, and yes, you may even lose weight initially because of the hunger blunting effect. But you don’t want to end up dying of cardiomyopathy at 268 pounds either. So, one of the things that I’d suggest is that be careful about thinking short-term gain versus long-term benefit. The other thing you want to be careful about is sometimes what’s best for short-term performance isn’t necessarily good for long-term health. The use of anabolic steroids, for example, whether you’re injecting them or whether you’re taking them indirectly in the form of animal-based diets. Yes, you might get bigger and faster with that approach, but it’s not necessarily a good health-promoting benefit injecting steroids, for example. You have people get huge, but they get testicular atrophy and then they get cancer and have other problems. So, my particular in my practice is helping people live longer and live better, not necessarily, what’s best for short-term performance today. So, some of the advice that we give may not actually result in the quickest way to get the biggest whatever. But hopefully, it’s going to allow you to live the longest healthiest life possible. And so that you don’t spend the last 10 or 20 years of your life unable to talk or move in some nursing home bed waiting for people to come and change your diaper because you’ve ended up with some secondary health compromise from your short-term intervention. As far as the intermittent fasting mechanisms. There’s no doubt anything people do to modify the standard American diet, to get rid of the refined carbohydrates, all the greasy sloppy processed crap that people are eating, is probably going to be less bad than that. Something being less bad doesn’t necessarily mean it’s good. It just means it’s less bad. So, what we really want to focus on is what’s good. And what’s good is the things that actually deal with the causes of disease, not necessarily, for example, the leading causes of death. Today, the leading causes of death are heart disease, cancer, and stroke. That’s where we spend most of our money treating the leading causes of death – heart disease, cancer, and stroke. And nobody’s paying attention to the reason people get heart disease, cancer, and strokes, which are smoking, drinking, and eating an animal rich highly processed food diet. If we spent more time focusing on the actual causes of death, rather than the leading causes of death, we might actually be getting a little bit of bang for our buck. And it may be why even though we spend two and a half times as much money in the United States on healthcare, we’re not living longer and we’re not living better, for example, than our colleagues in the European Union that are spending dramatically less money per person. But what we’re spending the money on doesn’t necessarily result in increased health.

29:30
Dr. Maya Novak:
Yes, absolutely. You mentioned sports and athletic performance. Is there a difference in fasting approaches if we are comparing athletic performance and if we are promoting optimal health?

29:46
Dr. Alan Goldhamer:
Yes. Most of the things are parallel. Most of the things you do to improve health improve performance. But, for example, you wouldn’t necessarily have a person do a long-term fast immediately before a high-level athletic performance because there’s a recovery time in fasting. It takes about the length of the fast to recover fully from the fast. [inaudible] And so initially, for example, you’ve gone through a long-term water-only fast, you’re going to have a certain amount of disuse atrophy from not being physically active, although you won’t be losing any muscle cells per se. The cells become smaller because you’re using protein. And so you have to allow for recovery after a period of fasting before engaging in high-level athletic performance. Just like you don’t go from long-term fasting to full eating on day one. There’s a transition that takes place. It takes about half the length of the fast. So, if you have a 10 day fast, it’s going to take about five days of carefully restructured feeding in order to avoid very serious consequences – post-fasting edema, refeeding syndrome, food shock and potentially even more serious consequences. So, fasting needs to be done well, under rest, in appropriate candidates, with proper monitoring. And then recovery needs to be done also well, and that’s actually where most people make mistakes. The calls that I get frequently from people in trouble with fasting are not the fasting itself. It’s a too rapid return to activity or too rapid return to refeeding, or appropriate refeeding – particularly they’ll go out and have what they think is some health soup at a restaurant that’s so high in salt that they get some post-fasting edema secondary to too rapid reintroduction of high dose sodium intake. So, there’s a lot of ways to mess up long-term fasting. But what’s exciting about it is it’s one of the most effective ways, for example, of mobilizing not just fat, but specifically visceral fat. So, for example, we’ve recently been using DEXA scanning at people that are fasting. One of our subjects recently underwent 10 days of fasting, lost 4% of body weight, 10% of fat, but 20% of the visceral fat in his 10 day fast. So, the visceral fat, the fat inside your organs and vessels seems to be mobilized disproportionately, and that’s kind of an exciting way of actually giving the body a chance to get rid of the least desirable fat first so to speak.

32:18
Dr. Maya Novak:
We'll continue in just a moment. I wanted to quickly jump in for two things. First, thank you for tuning in. And second, I’m sure you have at least one friend, colleague, or family member who would very much appreciate this episode. So share it with them and help us spread the word. Now let’s continue…

32:39
Dr. Maya Novak:
Yes. You mentioned that if you get then a huge shock of sodium after fasting, and you mentioned edema. So, it’s basically very important that after a fast that you go on the SOS diet so that there is not a huge shock, especially if we talk about injuries and if someone would like to also treat so to say, swelling. So, if you go and then you introduce salt back, it can be …

33:10
Dr. Alan Goldhamer:
Yes, it would be counter-productive, certainly.

33:12
Dr. Maya Novak:
Yes.

33:13
Dr. Alan Goldhamer:
So, the good news is also a lot of injuries heal slowly because there is a lot of dependent edema and other issues. That diaresis that occurs in fasting oftentimes is very helpful at giving the body a chance to get better circulation into an area. So, let’s be clear about what healing really is. I think we should start fundamentally there. You have an injury. You overextend a joint. You overextend the connection of a muscle so you develop a tendonitis, whatever it is. How is the body going to heal that? It’s going to heal it by bringing in components to remove the inflammatory factors and facilitate healing. It does that largely through circulation and neural input. So, sometimes circulation is limited because you’ve gotten the swelling that’s designed to limit you from damaging the joint further, which introduces the limited mobility. We want to get the body to heal quicker, so we want the swelling to away. We’ll do bracing and casting and things that protect the joint but allow the body to get rid of this response that in the natural setting would great, but it’s we’re in the way because we don’t want to take six weeks to recover from this thing. So, what else can you do to increase circulation into an area? Well, you can do hydrotherapy. You use heat an ice or alternating heat and ice to cause the body to dilate, constrict, move more blood flow into the area so that it heals faster. You can move mechanical impediments by doing manipulative therapy, that’s what chiropractors and osteopaths are doing, getting joint play back, removing inter-joint adhesions. You can do physiotherapy to increase circulation and lymph flow, etc., get receptor feedback, get neural input into the area. On the outside of the nerves, it’s called axoplasmic flow; a lot of the nutrition that comes to heal the tissue actually comes down your nerves. If you have swelling that’s causing your compression or joint dysfunction, that’s interfering with proper nerve input, you may not get as good nutrition into there as quickly just because of that pressure that’s limiting axoplasmic flow. And what you eat profoundly affects what’s in the blood that you’re trying to get into the area. If you’re on a pro-inflammatory, dead decaying flesh rich diet, you’re going to be bringing in a lot of inflammatory factors rather than the anti-inflammatory factors. So, one of the reasons why people heal faster on a whole plant food SOS-free diet is because the blood itself that you’re circulating has components that are more conducive to healing, and less conducive to promoting inflammation. That’s why we get rid of the dairy products and all of the things that tend to make people congested and lead to inflammatory responses that may slow healing. So, what you eat, how well you’re maintaining hydration, the mechanical factors – like what do they talk about? Ice, elevation, compression – all of these factors are designed to improve circulation into the damaged tissues to get more blood flow, more of the healing factor so that it can heal more thoroughly, it can heal more effectively, you can minimize scar tissue formation, and you can actually get full functional recovery. Of course, what happens after an injury? You don’t just go back to full athletic performance. You have to go through rehabilitation. You have to go through retraining and conditioning. And if you go too quickly, you can actually have a setback. It’s just like after fasting. What you’re going to see is the parallels between fasting and exercise are almost amazingly corollary. You do exactly the same principles as you come off a fast as you do when you come off an injury.

36:51
Dr. Maya Novak:
I so agree with you. Earlier you also mentioned protein. Many times people, even if they are not injured, they are afraid that they are not getting enough protein. But then when the injury happens, so either soft tissue or a broken bone or whatever it is, people hear you need more protein because your body is building soft tissue and bones, and so on. What is your point of view in regards to protein and…

37:25
Dr. Alan Goldhamer:
Well, sure. Protein is an essential nutrient. If you don’t get enough, you develop protein malnutrition and you’ve seen the pictures of children that don’t get – or they get calorie protein malnutrition and they get all kinds of difficulties. You don’t see that a lot in industrialized countries because it turns out all of the protein you need is bountifully supplied by a calorie sufficient diet of whole plant foods. If you ate nothing but brown rice and broccoli and you got your 2,000 calories a day, you’d have over 80 grams of protein and all the essential amino acids that you need. You don’t need meat, fish, fowl, eggs, and dairy products in order to get an adequate protein intake. It’s interesting; recently there was a movie by James Cameron that came out called Game Changers. And in Game Changers, they talk about and really show some of the world’s most competitive athletes that are eating plant-based diets. And trying to put to rest kind of the old wives tales that the only way to get enough protein to heal from an injury or to perform athletically at a high level is to eat large amounts of animal-based foods, which, of course, it turns out is just not true. Getting enough protein is important. Getting too much protein though can be very health compromising. It’s one of the contributing factors, certainly, to kidney disease, cardiovascular disease, some forms of cancer. We know that too much protein and too much animal food intake is definitely health compromising. So too little certainly is an issue, but you get all the protein you need from a whole plant foods diet.

38:52
Dr. Maya Novak:
Yes, thank you for this explanation. So, what is your number one advice that you would give someone who is recovering from an injury?

39:02
Dr. Alan Goldhamer:
Well, healthy results from healthful living, and healthful living involves diet, sleep, and exercise. If you don’t sleep enough, you don’t heal as well. A lot of the anabolic cascade of hormone that kicks in for healing happens during non-REM deep sleep and some of the deeper phases of sleep. So, getting enough rest, it turns out to be really important to maximize in healing. Getting enough, but not too much activity. In other words, just sitting around isn’t a very good strategy for most injuries because you get disuse atrophy and other problems. It makes healing from the injury a problem, and it can make recovery a problem because you have to overcome your atrophy. So, getting the right amount of activity, taking into account the limitations that are imposed by healing. Obviously, if you have a fractured limb, you want to brace it and support it, and you want to avoid – but that doesn’t keep you from using other parts of your body in an effective way. Some people, maybe they have to be even resting to a great extent, but they may be doing chair exercises or other things that can work the parts of the body that aren’t limited by their injury. That can be an important part of healing even a lower extremity injury, even just maintaining adequate upper body movement and function. Addressing diet, sleep, and exercise and activity, I think, are all really important. Appropriate therapy can also be helpful. So, working with physical therapists, chiropractors, osteopaths, or physiatrists that are familiar with the concept of doing everything we can to speed – not just the speed of healing, but the quality of healing. That you heal with the most functional tissue restoration possible. Unfortunately, that’s not always the fastest. So the thing that gets you back on the field the quickest, isn’t always necessarily the thing that’ll get you back with the highest degree of recovery. So, you have to always weigh it, and value that. That’s particularly different for athletes because they’re competitive juices are trying to get them back into competition as quickly as they possibly can. And sometimes – and we’ve seen examples of that recently in professional sports – sometimes trying to rush back, you end up with a greater deficit in the long run.

41:14
Dr. Maya Novak:
Yes, it’s then this war with our ego. We are just pushing, pushing, pushing, but the setback then can be for months, or sometimes it can be even longer than just a few months.

41:28
Dr. Alan Goldhamer:
Well, so always try these decisions intellectually rather than emotionally.

41:32
Dr. Maya Novak:
Yes.

41:33
Dr. Alan Goldhamer:
And there’s also an atmosphere, unfortunately, in athletics that you’re supposed to push through pain and ignore injury and all that, and without really taking into account the long-term consequences. Unfortunately, most athletes have relatively limited careers. If you look at professional athletes, it’s measured in months. So, they’re not thinking in terms of what’s the long-term consequence going to be. From our perspective with our patients, our whole goal is not only helping people try to live to their full potential, but avoid that decade or two of debility that often happens. That’s really what our focus is. I don’t think you can make – let’s look at it. There’s 109 billion modern humans that have been born on the planet. There’s 7.5 billion alive today. But there’s only been five people that have been well documented to live past 117. So, the odds of you living past 117 are about 1 in 20 billion. You know you’re probably going to live less than that. [inaudible] Now, the question is of whatever time your
are going to allow you to live, how much of that’s going to be fully functional and how much of it’s going to become debilitated? And really reducing that debility is what our particular focus is so that you will not only be able to be functional now, but you can continue to be competitive and functional in your athletic endeavors when you’re in your 40s, 50s, 60s, 70s, and hopefully longer.

43:00
Dr. Maya Novak:
Yes, I’ve been following your work now for years and years, and I’ve watched your videos and read many articles. In one of them, when I was reading, I was like, oh, maybe that’s a typo, but it was actually saying that you have like a 50-year follow-up appointment with a person. So, can you explain a bit about this 50 year?

43:23
Dr. Alan Goldhamer:
Well, we have two things. One thing is we require our patients when we see them – so, they often ask, okay, they’re willing to do this to overcome their injury or to recover their health, but do they have to do it forever? And so we began to realize that people were worried that they would have to forever give up their greasy, fatty, slimy, processed foods, coffee, alcohol, and everything. So we said, look, we’ll make you a deal. You don’t have to do it forever, just for 50 years. So, we track our patients for 50 years. After 50 years, then whatever, that’s up to them. What I had mentioned though is I recently had a 30-year follow-up on a patient who I’d seen 30 years ago who was 55 at the time. He was a painter, and he came to see me because he couldn’t paint the ceilings because he had some injury in his right shoulder that was limiting his ability to raise his arm and so to roll the ceiling it was painful. So, he was having to have his son do the ceilings. And he didn’t like that, so he came into see me as a chiropractor to see if I could rehab his shoulder. I explained to him that if he really wanted his shoulder to get well, he was going to have to make some changes. He had to quit smoking. He was going to have to quit drinking excessively. He was going to have to adopt a healthy diet, as well as do his exercises. He’d asked me do I have to do it forever. That was the first time I thought, well, no, just 50 years. He thought, oh, you think you’re funny, you know. The good news was he actually did. He quit smoking. He stopped drinking alcohol. He made the dietary changes. He got some treatment and he had a great recovery. So, now I’ve lost track of this guy. He comes into the office; it’s been 14 years since I’ve seen him. He’s now 85 years old. He came in, I said what’s wrong? He’s no, he’s coming for a checkup. He thought, you know, it’s been a while. I said, okay, and I’m looking at him. He says, you know, doc, this diet I’m doing, it seems to be working because I’m still working. I’m still painting. I said, wow, that’s amazing. He said, all the people in his crew are dead, including his son who died at 60 years old from cardiac arrest because he wasn’t willing to do the diet. I said, I’m sorry to hear about your son. He goes, it’s okay, I do the ceilings myself now. And I said are you telling me your shoulder or arthritis got better? He says, well, not so much but I got an airless paint sprayer. He made an appointment in 14 more years when he turns 99. He says he’ll come back when he’s 99, but if anything comes up, he’ll let me know.

45:49
Dr. Maya Novak:
What a lovely story! Some injuries, they take days or perhaps weeks. Some injuries more serious take months, sometimes even years, and sometimes people start losing hope when this happens. What would you say to someone who is losing hope about their healing?

46:12
Dr. Alan Goldhamer:
Yes. Well, of course, it depends on the nature of the injury. So, it’s always good to get advice from a sports medicine related doctor that can give you realistic expectations of how much recovery is possible and what kind of time range they would expect. What I can tell you is that injuries that you can feel from, things that are going to resolve, resolve better if you address diet, sleep, and exercise aggressively as a part of the treatment component. Some people that are told that it’s not going to heal, sometimes it still will heal but it takes a higher degree of intervention and that’s where things like fasting or more aggressive kind of treatment can be sometimes effective. I see a lot of people, as a chiropractor, that have mechanical problems, but they’ve been going to doctors that are treating them strictly chemically with drugs. Sometimes we find that the best way to heal people is to just stop doing all the pill, potion, and powder stuff and give the body a chance to heal. In fact, the chiropractors at the TrueNorth Health Center often say you better treat people right away, because if you let them fast, they may just heal well completely on their own. We have that happen a lot. Before we can even get into the treatment component care, the body just heals itself up because the inflammation goes down and things start to resolve. So, again, it depends on the type of injury and where the problem is.

47:33
Dr. Maya Novak:
Yes. I so enjoyed our conversation. I do have one more question and it’s not about fasting or anything, but it’s a bit more of a fun question. It’s imagine that you’ve been injured and you know that the recovery is going to take you some time, and perhaps even more than a year and it’s not going to be always super easy. But in that moment, you can choose one of two gifts. Gift number one is that you go through your recovery doing all the necessary work to heal in the best possible way and when you are done, you will have the gift of preventing any future injuries. Or gift number two, that you back in time and prevent the accident from happening, but then you take your chances. So you might get injured the next day or never. Which one would you choose and why?

48:32
Dr. Alan Goldhamer:
Well, I’d actually ideally pick both because on the one hand you already have an injury, so you can’t really go back in time. That’s not a possibility. And so if I already have an injury, the focus is to get as good a healing response as possible and then adopt the habits and practices that’ll minimize future injury. If you can do prevention, that is the ultimate cure. And so whether it’s injury, cancer, or anything else, we should always be thinking that the development of these problems is proportional to the risks that we’re putting ourselves under. If we’re going to engage in high-level athletic performance, injury is a part of that process. So, doing what you can do to minimize the likelihood by maximizing prevention - using appropriate warmup and cooldown activities, adopting a healthy diet. All of these things, you’re still going to see injuries. So, ultimately then what can you do to maximize recovery. And, again, the same things you do to do prevention are the same things you do to treatment, and I think that’s kind of the big message. It’s true for illness. It’s true for injury. Health results from healthful living. And so adopting healthful living habits is going to be the critical key component to improving the quality and the quantity of somebody’s life.

49:50
Dr. Maya Novak:
Beautiful. Can you share where people can find more about you and your work?

49:56
Dr. Alan Goldhamer:
Yes, we actually have a nice service for your viewers. If somebody was interested and they’re wondering about is fasting something that they should be thinking about or could it help them, we offer a free service. If they go to our website www.truenorthhealth.com and fill out the registration forms, which is basically their medical history. They can call me and I’ll be happy to have a conversation with them to discuss if fasting is something that they should be considering. We also have doctors around the country that we can refer to if they’re someplace that’s not accessible to the TrueNorth Health Center in California. And also, whatever advice that we can give them that might make sense, so, truenorthhealth.com. If they’re interested in these principles, they can read our book The Pleasure Trap. And so it’s a disturbing book that tells you what you need to know, not necessarily what you want to hear about getting and staying healthy.

50:52
Dr. Maya Novak:
That’s usually how it is. The important information we need to hear, but many times, we don’t want to hear it. Yes. Dr. Alan, it was a pleasure. Thank you so much for being here and for sharing your knowledge.

51:08
Dr. Alan Goldhamer:
It’s my pleasure.

51:10
Dr. Maya Novak:
This wraps up today’s episode with Dr. Alan Goldhamer. If you haven’t done it yet, subscribe to the podcast on whatever platform you’re using to tune in. Of course, also remember to share this episode with your loved ones and help them out. To access show notes, links, and transcript of today’s talk go to mayanovak.com/podcast. To learn more about The Mindful Injury Recovery Method visit my website mayanovak.com and find my book Heal Beyond Expectations on Amazon. Until next time – keep evolving, blooming, and healing.

Love and gratitude xx
Dr. Maya

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