Enhance Your Sleep With Fasting-Mimicking Diet

William Hsu, MD

Dr. Wells. Thank you so much for inviting me to the program.

Audrey Wells, MD

Yes, it is fantastic to have you. Because there’s so much interplay between type 2 diabetes and sleep problems, especially sleep apnea. I want to start with a couple of statistics that I hope will be grounding for the audience. One is that about 80%—some estimates say 90%—of sleep apnea out there is currently undiagnosed. Another statistic is that more than 50% of people with type 2 diabetes have sleep apnea. Some studies even show that three-quarters of people with type 2 diabetes have sleep apnea. Let’s start with how these two conditions interact.

William Hsu, MD

These are amazing statistics. First of all, if we were to think about how many people live with diabetes, that’s around 38 million people right now here in the U.S. If you multiply that number by the percentage, it’s truly astounding. If you don’t ask your doctor, your doctor probably will not bring this up at your visit. I think that, well, first of all, I just wanted to thank you for this program. I think it’s such a timely topic that many people need to listen to, learn about, and learn more about. But in terms of the directions that it’s truly amazing to, they are codependent or interdependent because they lead to one another and because they have a shared ideology or shared cause of both conditions, and that is likely the culprit would be the obesity rate, the obesity epidemic hitting our country right now. What we’re thinking is that 70% of all Americans either live with obesity or are overweight, which is slightly lower, so it’s a lower body mass index, and it’s 70% of the population. In other words, only 30% of the US population is considered to be of normal weight. a common driver brings in sleep apnea, but at the same time brings in diabetes, and they’re tied almost at the hip.

Audrey Wells, MD

Yes. and I want to help people understand more about the pathophysiology of diabetes. This can lead to a condition like obstructive sleep apnea.

William Hsu, MD

Yes. Certainly, if you think about people with type 2 diabetes, what’s happening there? Well, the body doesn’t produce enough insulin, even if that is true in people with type 2 diabetes. not making enough insulin, so the body doesn’t have enough hormone to get rid of the glucose that’s flowing through the blood. that’s one. and that that reduction in insulin production, unfortunately, is dependent not only on our general health but also on the amount of body weight that we have. and then also a process of aging. Even as we age, our ability to make insulin decreases over time. That’s one problem. A lot of people know that, for example, people who are 65 and older have about 25% of the prevalence of type 2 diabetes. so aging is a major problem. But on the flip side, the body also does not use insulin effectively to gain weight. You can think about, for example, insulin sensitivity, or the body’s ability to use insulin effectively. You can think of it almost like fuel efficiency for a vehicle. For the same matter of gas, a car that is fuel efficient can run low miles and run many, many miles, whereas a car that is inefficient in fuel efficiency can only make very few miles. By the same token, people who have high insulin sensitivity can use the same amount of insulin to do a lot of work, meaning they get glucose out of the system. Unfortunately, people who have insulin resistance or low instances of activity with the same amount of insulin can only work a little bit in terms of their ability to get rid of insulin. Obesity is a major problem that leads to this insulin insensitivity, or insulin resistance.

Audrey Wells, MD

The reverse is also true. People who have untreated obstructive sleep apnea are more likely to be diagnosed with type 2 diabetes mellitus. So there’s tons of metabolic overlap between these two conditions. Not only can they coexist with the same person, but they also tend to aggravate each other.

William Hsu, MD

Yes, that’s for sure. For example, in people who have uncontrolled diabetes, their body’s ability to keep glucose in the system decreases. That means they’re prone to urinate out of this glucose, along with the fluid in their body. So we call that Allyl urea, meaning that they are always excreting urine. The term diabetes mellitus has this connotation that you’re always passing through the urine. In the old days in India, China, and ancient civilizations, how did the physician diagnose people to have type 2 diabetes? They just look at the urine and where, for example, the dogs will go and drink the puddle of urine or congregate around the urine. That’s truly how people came to understand that diabetes is truly a condition of the elderly type of blood glucose where the body cannot hold down to these glucose levels and they pass this urine out with lots of glucose in the urine. What does that mean? Well, it means that people with type 2 diabetes are not sleeping well and have interrupted sleep. With interrupted sleep, their energy level goes down. Dr. Wells, you’re the expert at this, but with disturbed sleep. Every organ system suffers. That means people have less energy. People have less desire to exercise because they’re so fatigued during the daytime. so that compounds the problem, not to mention those of people with type 2 diabetes. Many of them are on insulin or on drugs that cause weight gain, like sulfonylurea and other types of medication. then that exacerbates the underlying obesity. It makes the person even bigger, more insulin resistant, and more upset around the neck area, which makes sleep apnea worse. So it’s such a major problem in a bidirectional relationship.

Audrey Wells, MD

I see folks all the time coming to me for sleep care, and a lot of them don’t have diabetes. That’s very well managed, despite their best efforts. There’s always a dietary component, and there’s an exercise component. then you have the medications available for diabetes management. I would even suggest that sleep needs to be included there because it’s very clear that interrupted or dysfunctional sleep because of untreated sleep apnea or other conditions affects blood glucose. especially since the continuous glucose monitors have come out. People report that all the time, I had a bad night last night, so I’m seeing a lot more variability.

William Hsu, MD

That’s right.

Audrey Wells, MD

A trend higher for blood glucose.

William Hsu, MD

We see that in clinical practice all the time. When people are not sleeping well, you just see that it’s added stress, especially when you’re gasping for air. When you’re experiencing sleep apnea, it’s stressful on the heart. It’s a stress on the hormonal system. The body is stressed, period. With stress, your glucose goes up. So it’s not unusual to see these spikes in glucose when people first wake up in the morning, and as you can guess from the fact that in the morning your adrenaline level is high to begin with, Because of that dawn phenomenon, You’ve been sleeping all night. You need to wake up. The body naturally gives you a little bit more stress hormone to push the adrenaline up a little bit to wake your body up. Waking up every cell in the body to be ready for the day. But think about if that happens on top of a disrupted or disrupted night with sleep apnea, where your body is gasping for air, which just doubles up on the stress level. That has in turn turned into higher fasting blood glucose. That means your blood glucose level in the morning. A lot of people will come to us as physicians and say, Well, doctor, I didn’t hear anything last night. How come my sugar is so high? This is also a chance where you might want to nudge your physicians and ask, well, could this be a sign of sleep apnea? I think that would remind the physicians to look for this very hidden condition.

Audrey Wells, MD

Yes, right. Overall, I recommend that people have a low threshold for sleep testing because it’s an insidious sort of condition. After all, the person who’s affected by sleep apnea is unconscious. That’s when the condition is active. Having a low threshold for testing makes sense on many different levels. Now, I want to shift gears a little bit and talk about dietary management for type 2 diabetes, because this is so beneficial for people who may otherwise feel that they don’t have a lot of control over their condition. Changing the way you eat, changing what you eat, and changing the quantity can all help you improve your diabetes status and even start to gain some ground on the condition. There’s some talk out there about the benefits of time, restricted feeding, or intermittent fasting. There’s always sort of this asterisk for people who have diabetes. Yes. I want to get your thoughts on that and how you talk to people who are considering intermittent fasting or time-restricted feeding.

William Hsu, MD

It’s interesting. For over 20 years, I took care of patients with type 1 and type 2 diabetes, and the debate has always been around what food to eat, but certainly not to eat. But it’s not until recently that the medical clinic community has begun to ask the question. I think another relevant question there is: when do we eat and when not eat? While the debate still rages on the type and quantity of food, and we will put that aside for now, I think the idea of when to eat and when not to eat is so timely now. Think about it. When you think about the human body, it starts every day. Think about that. Yes. When we sleep, we don’t eat unless we sleep. For however many hours you sleep, that is the time when the body is tossing in a lot of nutrients. I think this is by design. The body cannot constantly process nutrition. It’s almost like a machine you cannot always be beyond. There’s got to be times when the engine’s going to heat up too much. The body cannot exercise for 24 hours a day. It needs time to rest, in fact, health, and comes in a package of the opposites. 

What I mean by that is that you need to exercise. You need to rest. You need to exercise. You need to be active. You need to sleep in it and have great nutrition. But you also have time when there’s not a lot of nutrition around so that the body can rest. This is where the concept of fasting came in. Now it sounds like it’s a new concept, but it’s been around as long as humanity. Think about every culture and every religion. There has always been a component of fasting, whether it’s a day or two of three or going to the monastery to try a connection with, with, or with God, or it could be waking up to eat when the sun is up and then stopping eating when the sun goes down. Because, frankly, they just did not have refrigeration or illumination soon enough. There was the concept that it was a natural consequence of just rising with the sunlight and sleeping with the sun going down. And now, in more recent studies, we are seeing that with fasting, and we could go into the different types of fasting later, both with fasting, we’re seeing an impact on insulin resistance. We’re seeing an impact on weight loss. We’re even seeing an impact on beta cells themselves. So it’s truly a new aspect of an old debate on diet.

Audrey Wells, MD

I couldn’t agree with you more. This kind of brings up a sore point for me, which is that sometimes when people think about going to see a sleep doctor, they kind of assume I’m just a sleep apnea doctor. But I like to point out that the work that I do spans 24 hours because I’m just as concerned about how people are awake, alert, and having energy as I am about their sleep. To your point, we need to create opportunities for more contrast between daytime and nighttime and more balance between these two different periods of the day. This speaks to me on a circadian level. this idea that the daytime is for eating, and then you stop, and then there’s a period where there’s no eating, and then you have your window open up again.

William Hsu, MD

It’s not surprising that in 2016, the Nobel Prize in Medicine in Physiology was given to researchers who looked at the benefits of prolonged fasting and survival. What Professor Toomey from Japan uncovered was that when people and animals fast, especially for a prolonged period, they enter this phase of extensive extension of crisis. What I mean by that is that the cell says, Hey, where’s is food coming from? I’m starving. I don’t know whether food will come tomorrow or the day after, but to survive, I need to find sources of food. What the cells generally do is look inwardly to see inside the cell components what can be used, what’s like, and what’s disposable. It’s like when you’re stranded on a desert island with no food; somehow, you’re stuck in a rather hard place where you would sacrifice your arm to survive. The cells go into these extents—the potential crisis—and look around and say, What’s more disposable? I mean, it’s certainly not going to be the brain, the cell, which is the nucleus, because then they would just die once in a while. By burning and digesting parts of the cells that are disposable, it’s often they turn to mitochondria. There are more dysfunctional, misfolded proteins. You think there are broken, older ones. Like it’s like in the winter when you have to heat your home before the furnace is around, what do you do? I mean, you will certainly not look for your grandmother’s heirloom furniture that you’re going to throw away. The chair that was broken So it’s a heat up in the night, right? that you can survive. The cells go through cellular autophagy, or self-cleaning, to survive. Little do we know today, with the 2016 Nobel Prize, that recognition that this cellular autophagy occurs in every organism looks down to earth, from simple single-cell organisms from yeast through fruit flies to mice to mammals. That’s how we survive days and sometimes weeks of starvation that happen to occur in nature. Little did we also know that when the cells go through that digestion to survive, if they survive, they expand back when food becomes available again. Think about that. If it shrinks 20%, it’s going to grow back 20%. When food becomes available in a few days. What you have essentially done is replace the older parts of the cells with new ones. Now, give me one medicine that can do that. None. It was so substantial and so important to recognize that when nature deals us with the hand of disaster, it would not assume that life forms respond to this mechanism of autophagy. It not only survives, but it also becomes younger. Think about that. That’s the miracle of life. So that’s why this whole conversation around fasting is so founded on this foundation, and that is the survival mechanism for all living things on Earth. and that’s why I’m so excited to talk about that.

Audrey Wells, MD

Yes. Your explanation makes it more palatable for people who have a fear of starving or going too long in between meals. Sometimes I like to point out that it gives new meaning to the term dining in. You’re sort of dining in on your energy stores, and that is something that the body is physiologically capable of and even meant to do. If somebody is looking to get started with fasting, what do you typically recommend as a starting point?

William Hsu, MD

Yes, so different types of fasting have different biological impacts. You can imagine that one of the most popular fasting patterns is called intermittent fasting, or time-restricting eating or feeding. That means simply that you restrict your daily food consumption to a certain number of hours during the daytime. Typically, you can do an eight-hour consumption, and then in six hours you would be fasting, or you could do ten, 14-minute eating within a ten-hour window, or 14 hours of eating. Some people advocate more circadian fasting, which is 12 to 12 hours of eating. Make sure that you don’t eat for the rest of the 12 hours. That has its benefits. It’s great for metabolism. It’s great for weight loss. It’s also, I mean, one of the worst things we can do to our bodies. It’s probably not very good for sleep anyway. It’s so true before you sleep. It has its purpose. But what I talked about was that the 2016 Nobel Prize was devoted to this financial crisis when food was not available. It cannot trigger this kind of alarm system every night just because of six hours of fasting. Typically, what we’re seeing with these longer fasts is that when we’re seeing them and we’re going to have an Asian effect on humans, it’s likely to be greater than three days or four days of fast. Okay. Because that’s when the cell says, My goodness, how am I going to live through another day with no food? It begins to look for that internal source of energy.

Audrey Wells, MD

That’s when you’re burning the broken chairs.

William Hsu, MD

That’s right. That’s exactly right. So now we are facing a conundrum. while intermittent fasting is great for metabolism, that kind of entire aging, the kind of healthy aging cellular rejuvenation only occurs when it’s longer, fast, three hours, three days, or four days fast. This is where the challenges are for modern people. I mean, fasting a day may be okay, but in three or four days now we’re talking about a real challenge. This is real. This is a real challenge. not to mention that people with sleep apnea often carry other comorbidities. People with type 2 diabetes may also find it unsafe to fast for three or four days in a row, especially if they’re taking medications like insulin and other pills. So this is where I think super-medical supervision needs to take place. This is also where I think we need to have a 21st-century solution for something that truly works. But this is where innovation lies.

Audrey Wells, MD

Yes. I want to sort of underscore that point for the audience watching. If you are taking insulin and have a complicated medical picture, these are scenarios where you should consult with and have your physician on board. They tend to sort of supervise and respond to any complications resulting from a fasting plan. There’s this, which is a good time to pivot into a fasting-mimicking diet plan. Can you tell us what that is and what sort of solution this provides for people who want to get the benefits but maybe avoid some of the challenges?

William Hsu, MD

This is exactly the kind of solution we will try to solve here at L-Nutra. We recognize the challenges of people wanting to do long fasting, but also may not be in they may also be taking medications, or they may simply not be able to tolerate a three or four-day fast. The founder of the company, Professor Valter Longo, who is a faculty member at the University of Southern California, invented the fasting-mimicking diet. So let me explain what that is: fasting, mimicking diet, and shall we call it FMD? It’s precision medicine or precision nutrition, I should say, that gives you the benefits of fast food but with nutrition. That’s why it’s called position and nutrition. It comes in a five-day structured meal plan that provides nutrients that just fall below the sensors of all of the cells so that each cell does not pick up the fact that you’re eating nutrition. The way it’s able to do that is because these nutrition components are calculated and instinctively designed to fall below the detection threshold of these nutrient sensors. Now, this takes a little bit of explanation. Every cell in your body has these sensors. They are like the eyes and ears and the nose of the cells; the sensitive nutrients are coming to your body and your bloodstream. So if there is glucose coming in, amino acids and proteins are coming in, and these ears and eyes are going to say, Hey, there is food. 

Whenever the cells get these signals of food, it tells them, Hey, it’s time to grow. It’s not the time to go into that rejuvenation, that autophagy. The cells are constantly looking for that signal now. If you’re constantly eating 24 hours a day, eating during festive times of the year, and so on, then the cells never rest. The cells are constantly growing. In a society like ours, where we are 70% overweight or obese, I mean, how much more do we need to grow? I mean, there is time for growth. But as I mentioned earlier, there’s also time to rest and rejuvenate. With a fasting-mimicking diet, the amount of nutrition is just below the radar and right below the thermostat. It doesn’t trigger these nutrient sensors. The cells, oh, there are sea nutrients, the supports, they’re there, their functions, but essentially doesn’t let the cells go into their growth mouth. Now, this technology was developed with 25 years of research and AI funding of $37 million because the federal government recognized that there was a need for innovation like this. So, in short, this structured meal plan of a five-day fasting-mimicking diet can give people the benefits of a five-day prolonged fast without suffering and challenges.

Audrey Wells, MD

That is so fascinating that my curiosity is piqued because my brain immediately wants to ask, What are you eating?

William Hsu, MD

Yes, that’s a good question. I mean, we have a choice to make it into powder suspension drinks. But the reality is that people want to eat. You see, people want to feel like they are living a normal life, and they’re not fasting for five days. This was designed in a very familiar form for factors. The fasting diet includes six bars and has all those crackers and multivitamins to support you for these five days. They’re informal factors. They’re familiar to your listeners, our consumers, and our patients. It could be acceptable to almost everybody who wants to experience the benefits of a five-day fast.

Audrey Wells, MD

It sounds like you buy this package of foods that are going to sort of fly beneath your metabolic radar while you’re doing this program. Are there any changes that you need to accompany the diet in terms of exercise, adjusting your medications, or even keeping your eating window within a certain time frame?

William Hsu, MD

No, it’s very simple. You don’t eat anything else other than what’s in the box. All you do is add water. You add water to the soups. You drink a lot of a lot of water. You drink the herbal tea that comes with it. You can have one cup of coffee; otherwise, it’s going to cause a lot of people to not be happy. Also, some people may experience withdrawal headaches, so a cup of coffee is easy. You don’t have to be within a certain window because the stress of fasting already has a much bigger impact on eating since you’re assimilating fasting for five days. This is also the time when you don’t need to overstress yourself. Fasting itself is already triggering some of the most powerful survival mechanisms. You don’t need to add too much exercise. On top of that, if you want to do some simple walking and stretching, those are all welcome. But fasting is not the time to max. Your exercise is not to intensify your exercise, but to take it easy over those five days. Let the body experience what nature has designed for millennia. and I think a good time to exercise would be after the five-day fasts. When you go into that refueling phase, this is when the body wants to grow back. All the cells want to replace the old parts with new ones. That’s when you want to exercise. That’s when you want to give the body nutrients. Remember, it’s the cycle of shrinking and rejuvenating, shrinking or rejuvenating through that process. You’re replacing all the parts of the cells with new ones, not the old ones. to also bring it to relevance to sleep apnea, when you fast like that, you also burn visceral fat. You better burn subcutaneous fat. This is very different from a slow weight-loss diet with low calories. Well, what’s the difference? Well, you can imagine that losing weight slowly is like turning on a faucet. It’s a small, small kind of drip, drip, drip. When you’re fast, it’s like a fire hydrant. I mean, it’s a force of nature. Is that something that triggers stress in the body? The body then secretes growth hormone. The growth hormone then supports your muscle integrity. It is probably the most natural way of losing weight: from period to period and fast from period to period. If you look at all the large animals in nature, like cats and lions, for example, the lion doesn’t hunt every single day. It hunts, eats, and fasts until the next time. It could be days before the lion hunts again. Think about it. In between the fasting phases, if the muscle decreases in size or strength, the lion is probably going to be set to hunt next time. The species would never have lasted on earth this long. This is all part of the design. When we fast, the muscle gets preserved. This is not a 30-day fast. You’re talking about a couple of days. You preserve lean body mass, you burn visceral fat, and you burn a certain subcutaneous fat that’s very different than a low-calorie diet, where there’s an equal opportunity for fat burners and tissue burners. The body in a low-calorie diet is not under enough stress to trigger these growth hormones, so what the body does is just, Hey, I need energy, so I’m going to go to the muscle and burn the muscle, the source of energy, or I go to the fats and burn the fats, the source of energy. That’s why I think that’s where the differences are fantastically explained.

Audrey Wells, MD

I want to tell everybody out there that growth hormone is like a fountain of youth, and growth hormone is produced during sleep. If you’re getting your vectors aligned nutrition to do this kind of this and reset this autophagy-stimulating program, it makes a lot of sense in my mind to get your sleep vectors aligned with that too, so that you can come out on the other side of the five days with energy, with vitality, and with this new appreciation for what it takes to be healthy. I love that explanation, and I’m glad you mentioned caffeine because the joke is all about sleep. Dogs are addicted to caffeine. I was wondering about that. That’s great news that you can still have some.

William Hsu, MD

Know that because people with diabetes always ask, “Well, can we use the FMD? Can we use a fasting-mimicking diet? I always say that it’s always safety first. And now we have a recent study that we published in Germany involving just six cycles of the study. Just think about it as five days per month, and you do it for six months. Now, that’s always under research protocol, under medical supervision. I just wanted to make sure I emphasize that there are specific protocols where medications are adjusted and so forth. But just five days per month, for six months, we saw a 20 to 22-pound weight loss with lean body mass preservation. We’re talking about losing the fat and preserving the muscle. We also saw a 1.4 A1C drop, which is very meaningful. It’s as powerful as a drug, just with these dietary interventions. What struck me as a clinician is that two-thirds of the people going through these dietary interventions were able to reduce their medications by six months to two-thirds. Low A1C is not horrible. You increase the amount of medicine, but when you reduce the A1C at the same time, lowering the amount of drug use, it’s horrible. This program we have now made available to consumers through what’s called a L-Nutra health program for diabetes. It’s a diabetes program using the core technology of the fasting-mimicking diet layered on top of that medical supervision, we partner with telehealth companies where they have physicians who are interested in lifestyle medicine, using nutrition, and using FMD to help you get rid of your medication and reduce your burden from taking medications. that program is available. It’s a social dimension for the rest of the 25 days when you’re not on the FMD. We also have dieticians who hold your hand and provide tailor-made personalized meal plans to help you achieve one single goal, and that is getting you towards diabetes remission. That’s simply defined as getting your glucose back to a normal level with no medications. That’s the program we’re offering right now. 

Audrey Wells, MD

That makes so much sense. My five-year-old would say that, even if you are somebody who’s been diagnosed with diabetes and you’ve got a long haul ahead of you for weight loss, how do you lose weight? He would say, Don’t eat. This is a great program for people who want to experience the benefits of fasting while avoiding some of the challenges and even some of the pitfalls that are more likely if you’re a Type 2 diabetic. Now, as we wrap up here, I wonder if you can tell where they might go to learn more about the fasting-mimicking diet from Prolon. even these supportive measures that you’ve just described.

William Hsu, MD

The diabetes remission program, and you can find it at l-nutrahealth.com. L dash NUTRA HEALTH dot com. For people without diabetes, once a few months to lose weight, and if you want to use this five-day fasting-mimicking diet as part of your nutrition support, you could go to prolonlife.com. That’s PROLONLIFE.com.

Audrey Wells, MD

I love that because it’s almost prolonged, isn’t it? prolonlife.com. Thank you so much, Dr. Hsu. It was great to talk to you today. You brought a wealth of information for people who are looking for some changes, not only to their sleep but to their nutritional needs. Thank you so much.

William Hsu, MD

Thank you, Dr. Wells.