Fasting’s Impact On Skin Health

Jonathan Carp, MD

Yeah, my pleasure.

Joseph Antoun, MD, PhD, MPP

Do you want to do a little bit more elaborate introduction so the people get to know you and your story and how you got into fasting and longevity?

Jonathan Carp, MD

Yeah, sure. So, you know, I grew up in a family of doctors. Father was a very traditional family doctor who had did House calls. I remember as a kid going up to farmhouses, carrying his doctor’s bag. And I actually from him really realized he was one of the sort of the longest in his community in terms of seeing the patient not just as a specialty, but, you know, seeing the entire patient and that got me into medicine and went through to become a dermatologist. And in 2004, I had a patient by the name of Karen. She had horrendous lupus. I had her on, of course, all kinds of organ transplant meds. And nothing was nothing was working. And we stopped all those meds and she disappeared for around four months. And she came back. She was completely clear. And she came with a whole stack of literature, you know, a whole stack of studies as well as books telling me how she did it. Remarkably, like other doctors, even though I had an interest in health, it actually took me a month or two to pick those up because there was unfortunately a little bit of resistance. Yes. By medical doctors, just the way we’re trained to sort of go deep into looking at some of these things. So a couple of months later, I was sitting there on my stack and I brought it home with me for the weekend and pretty much devoured everything in there once I started reading it and actually, there were some studies in there for lupus, specifically fasting that I was introduced to. But also she left a book with me called Fasting and Eating for Health, which was written by Dr. Joel Furman back in 1995. He wrote this book, and while concepts like autophagy and such I don’t think were mentioned in that book, there were some really interesting case reports with lupus as well as psoriasis in that book. I really got into looking at lifestyle interventions and really became obsessed with that and started recommending diets specifically for patients with psoriasis and then over the years developed sort of a focus on psoriasis and lupus specifically when it comes to lifestyle interventions. And that’s sort of the medical kind of part of my history.

Joseph Antoun, MD, PhD, MPP

It’s fascinating what you said about us doctors, right? The way we’re trained is so focused on categorizing a symptom to a disease and then giving it a pill solution. Right. And a lot of us are resistant to change and we don’t know what we don’t know. Right. And this is why this summit exists, because many of us and I always say this is you know, I’m an M.D. and Ph.D. and two masters and I only got one hour in nutrition. And this is from top universities. And so we’re less trained on this topic then we get a little bit scared or deterred with like, I don’t know what I don’t know. And nutrition and lifestyle are just, you know, a little bit of I would say the charlatan’s interventions. It’s true. And we still see it today with the, you know, it surprises me because I think I mean, it should be malpractice today. If you’re especially an endocrinologist and dealing with diabetes. I mean, it’s a food-borne disease. A lot of the autoimmune diseases, you know, Alzheimer’s now is called type three diabetes, cardiovascular disease. It should be close to malpractice if you don’t consider these interventions that actually are the true treating the true root of the disease. Right. We get a lot of those chronic conditions. We get them with age and unhealthy aging and then lifestyle and in autoimmune, obviously leaky gut and other lifestyles that are increasing the rates of these chronic diseases. So it’s fascinating. I did this intervention now just to see if there were doctors here yesterday and our patients go to your doctors and please inspire them so that they go and read a little bit more about lifestyle medicine, because this is behind probably 60, 70% of the things that we’re suffering from today.

Jonathan Carp, MD

It’s true. And I mean, there’s the philosopher Maimonides, who, one of his one of my favorite quotes of his is and he was a doctor as well, that, you know, any diet that can be treated by a diet essentially shouldn’t be treated any other way is sort of this you know, this goes back to the 12th century or whatever. So this concept. But one thing I’d like to point out, since there are doctors that are probably listening that maybe haven’t done lifestyle interventions, you know, as you kind of inferred, you can feel a little bit uncomfortable in the beginning when you start this because you almost feel like you’re going against, you know, against the grain in a sense, even though, you know, that it’s sort of.

Joseph Antoun, MD, PhD, MPP

Learning from scratch. Right. You’re the expert and you’re learning from scratch again.

Jonathan Carp, MD

Yeah. And I’ll just share one brief story. I had a kid. Well, he was around 17 bodybuilder. His father was a bodybuilder. These are two humongous guys in my, in my room. And he had seen probably 15 dermatologists, really bad eczema. And it was pretty clear that he had, he was basically living off of chicken and fish. You know, he was taking a little bit of a fish oil supplement, but it was pretty clear he had an essential fatty acid deficiency, or at least a disorder because his diet was so restrictive. So I you know, this was sort of one of my first like active, you know, and I felt very uncomfortable doing it. I said, listen, you know, you probably have an essential fatty acid deficiency. So, you know, I’m recommending that you take a tablespoon of hemp seed oil because that has a good ratio of essential fatty acids. And even when I did that, again, this is very, very early on, I felt a little uncomfortable about it. And I think other doctors would feel the same subsequently. There are all kinds of studies showing hemp seeds. Oils actually good for eczema regardless. At the time there wasn’t. And when he came back, I was scared to go into the into the room because it was, again, sort of going against the grain. And I walked in and they actually didn’t look happy. They were and they said, you know, we’re really angry because he’s all better. And no other doctor, you know, ever told us about these sorts of things. So I’d say for people, doctors who are listening, who feel a little uncomfortable with it, you know, don’t, you’re not making anything that’s going to harm the patient necessarily. So anyway, just leave with that sort of anecdote.

Joseph Antoun, MD, PhD, MPP

That’s fantastic. So my next question to you is how did you get introduced to fasting? When did you meet this concept of fasting? And what got you to believe in the science and bring it to your patients? And then as a transition, what kind of patients do you use fasting with? Here we’re going to focus on skincare and then which kind of fasting you would bring to them and what are the results.

Jonathan Carp, MD

Okay. Well, I learned about fasting right from the beginning because Karen left me that book by a doctor, Joel Furman. But I did not implement that. And one of the reasons is because and I still believe this, that for people who are doing water-only fasting if you’re, you know, the toxin load that the people have just going right into the water only fast without any fiber to sort of re-help absorb some of those toxins that get shed in the initial phases of water only fast. It’s probably not a good idea. And for people who are doing who want to do a water-only fast, I usually refer to them to you know, a center like True North or one of those types of places. I think that if people want to do a water-only fast, then they should go on an incredibly high and nutrient-dense diet for probably three to four months before doing a water-only fast. So my start with fasting actually was when I find out found out about ProLon fasting mimicking diet, which probably goes back to almost the beginning of ProLon. Well, actually, I’m not sure when ProLon first came out, and ordered it for myself. I did it for myself. I had my sister do it. We did it sort of together, had incredible just results in terms of how I felt, and was pretty impressed by the science. And I should mention that I have a company called Miracle Noodle, which makes what’s called the Konjac shirataki noodles and the noodles are 97% water and 3% plant fiber. So they’re virtually no calories and no carbs. So my sister and I sort of combined the noodles with the ProLon. It wasn’t a difficult process and we had an incredible result. And I realized that here we have a way of introducing fasting in a safe without it being all that difficult. And that’s when I sort of decided that I would start to implement using protein for people who want to take up sort of a lifestyle intervention process in my practice.

Joseph Antoun, MD, PhD, MPP

And so this, is this coinciding with the publications by Dr. Valter Longo and USC and the science of fasting and the Fasting Mimicking Diet?

Jonathan Carp, MD

Yeah, yeah. No, I think it was actually when his book came out, more so than because I’m sure the publications came out. I would imagine.

Joseph Antoun, MD, PhD, MPP

The book is right here behind me, actually. The Longevity Diet is probably one of the most read books now in nutrition and a top seller for international top seller for Amazon and others. And this is just to shed a little bit of light to people listening here to us, Professor Valter Longo, the head of the longevity insurgency, is probably like Dr. Carp said, there were a lot of books on fasting historically. In the 1920s there was a wave that tried to bring fasting, then in the sixties, but the science was never like fully done in a randomized clinical way. There were all these clinics talking about their results because nobody makes money when you fast. So nobody’s investing. Nobody used to invest in fasting trials. And then when Dr. Longo tried to do the water fasting clinical trials as Dr. Carp, as you mentioned, they’re difficult, the drastic change to the body. And this is when the National Institute of Health donated over $20 million now to develop the Fasting Mimicking Nutrition so that patients can eat food over five days and at the same time get the benefits of the water fast. So you get the benefits. We are getting a lot of the side effects and the product is called ProLon. And it seems this is what you use in your clinic. Can you tell us a little bit about what cases you use it for? What is the protocol, and what are the results?

Jonathan Carp, MD

So I usually do it in a group setting, actually. We usually get several people together to do it. We have essentially share info on WhatsApp and have a call together and that’s how I have done it. So but I’ve also had people who decide to embark on lifestyle intervention along with a whole host of other things. So it runs the gamut. But as I mentioned, sort of my specialty or I should say my passion is, is lupus and psoriasis and psoriasis, especially because the data on psoriasis and systemic inflammation is has really over the last, say, six, seven years, really been dramatically demonstrated that when you have psoriasis, there’s quite a bit of systemic inflammation. This doctor by the name of Dr. Gelfand at the University of Pennsylvania showed aortic inflammation in people who have not even just a little bit of you know, you don’t have to be covered with psoriasis. So we know it’s a systemic disease. And if you can sort of quell some of that inflammation which happens with an FMD then you’re going to see some improvement. But I think a lot of the effect is the fact that overall metabolic parameters are overall increasing. And that has been studied independently just with lifestyle interventions or even just weight loss to show improvement in psoriasis. So while my experience is sort of a hodgepodge of patients that are deciding to go on some sort of lifestyle intervention. Generally, though, you can see some you see some improvement just in looking at the skin, the decreases in inflammation pretty quickly.

Joseph Antoun, MD, PhD, MPP

It is then decreases happened between like day one, and day six, they’re starting to, or day seven they’re like the skin is starting to look different already or it takes longer time or how?

Jonathan Carp, MD

Yeah, it’s usually subjective too, because I don’t necessarily see it. I’m getting a self-report. I’m not seeing them exactly at the end of a fast necessarily because it’s sort of an online group type type of thing. But when I see them, it’s when I see them back at sort of variable intervals and for sure there’s a decrease in inflammation in the skin. But ultimately, I consider it sort of one pillar of trying to get people into improving their overall lifestyle. And so along with that comes dietary coaching in between the FMD, you know, in the interval period of time.

Joseph Antoun, MD, PhD, MPP

And to clarify, FMD is Fasting Mimicking Diet for those who are new to the concept. What is the protocol that you use? How many times do you recommend they do the FMD or ProLon?

Jonathan Carp, MD

Yeah, I try to do it once a month for three months following sort of the standard protocol and then and then every three months or every quarter thereafter. Yeah. And oftentimes I, you know, because I do it myself every quarter, I’m often doing it with them, you know, as you lead people through this, you each day has its unique challenges for a lot of people. And as you work with people who are going through a Fasting Mimicking Diet, you really can help coach them in a way that is both educational but also inspiring. Because I have to say, one of the greatest things about I think, getting people into a Fasting Mimicking Diet for their overall improvement in lifestyle is that they have an incredible sense of accomplishment when they finish it. And that in and of itself and the fact that they’ve lost, you know, four to seven pounds or whatever the case may be that really is one of the greatest things, because, for the first time, they’ve done something for themselves. They feel incredibly empowered. And any kind of intervention afterward is they’re more motivated to do it. It can really be a turnaround for patients. And just if you’re a patient, I recommend giving it a try just for that sense of accomplishment. And not only that but of course, everyone feels better the week, the week after. And there are all kinds of realizations about your body that happen as you go through the process and your skin tightens, by the way, after you do a Fasting Mimicking Diet. There’s definitely, a physical improvement in the skin as well. So there are a lot of things going on there that are pretty impressive.

Joseph Antoun, MD, PhD, MPP

And Dr. Carp, let’s talk a little bit about the science of why fasting how fasting works on somebody with, you know, you mentioned psoriasis or lupus. What happens why the spots on the skin or why the disease is tapped at its root cause?

Jonathan Carp, MD

Several reasons. Obviously, there’s a downregulation of certain pro-inflammatory T cells as well as pro-inflammatory cytokines. That’s one thing that happens with fasting you’re getting along with that you can get some visceral fat reduction, which many of you probably know is sort of not just sitting there. It’s incredibly, incredibly inflammatory. In terms of other sorts of skin types of things, there’s increased insulin sensitivity, lower IGF-1, that happens, which can help with a whole host of things like acne for example, you’re getting stem cell growth later on in the fasts, you actually have activation of stem cells which are going to help. There’s the skin sort of gut axis that is improved here. You’re getting a better balance of your microbiome that is going to overall help with systemic inflammation. So those are just some of the amazing things that are going on that happened during sort of this process.

Joseph Antoun, MD, PhD, MPP

And you were mentioning to me before we started recording the autophagy and you’re discovering when it happens a little bit and which days can you talk a little bit about? Are the theories that the damaged organs also are trying to heal and trying to rejuvenate? Is that part of the reason now?

Jonathan Carp, MD

No question about it. I think part of the misunderstanding of autophagy, I guess who knows how it’s actually scientifically pronounced but is twofold. One is it takes a long, long time for you to actually get autophagy happening. So at stages 3 to 5 of your Fasting Mimicking Diet, let’s say. And second, it’s not necessarily recycling the entire cell. It’s recycling components inside the cell. So those cells are essentially the machinery of those cells is being updated. And as a result, the cells that were not functioning the way they were supposed to function and were sort of, you know, old, tired and degenerated, are now sort of upgraded with you kind of think of it as, you know, a new software almost and new machinery inside the cell. So all of these things certainly for skin, there’s no question that’s going to lead to just physical improvements in the skin but overall some of the changes that happen when these cells start to degrade is there is an inflammation that can take place because the cells are not really functioning the way they’re supposed to.

Joseph Antoun, MD, PhD, MPP

And do you see any difference between, you mentioned the protocol is you do five days of ProLon the Fasting Mimicking Diet on month one, five days on month two, five days on month three, and then once every three or four months. Right. The protocol that was tested by a lot of the clinical trials is they were called the three plus three, three in a row. Then once every three or four months afterward. Do you see improvements and specifically cycle one, two, or three, or is it incremental? There’s already cycle one and see benefits?

Jonathan Carp, MD

Yes, absolutely. You see benefits in cycle one. And I might add, that cycle two for people is a lot easier, not just because they’re capable of not because they’re understanding necessarily what the process is about, but also because they essentially are more metabolically flexible. They’re essentially upgraded in the sense that they can switch from burning sugar to burning fat a little bit easier the second time around. It’s yeah. And your question was, what cycle do I see the most improvement.

Joseph Antoun, MD, PhD, MPP

Do you see it right away? Like in medicine, typically, you know, okay, you’re going to go especially in autoimmune medicine, right? You get away. There’s a lag time in effect to get results. And I was trying, I was curious to know if a lifestyle change can co big and fast in palliative medicine. And by the way, that’s the other question. Do you stop any of the medication or do you just add ProLon to the medication?

Jonathan Carp, MD

Okay. So if someone’s on high blood pressure meds or diabetes medicines, I usually talk to their primary care doctor and get their approval or have them talk to their primary care doctor. So the improvement is pretty rapid. I mean, if not just the subjective feeling of confidence, feeling better, and visible signs of decreased inflammation, you see it right away. It’s pretty dramatic. And it’s one of the most dramatic things that part of. And the fact that it is so safe for the right patients is really an impressive thing.

Joseph Antoun, MD, PhD, MPP

That many of us talk about. Also, the linkage, because I think it’s important for everyone with autoimmune. And again, autoimmune is more of a medical language. There’s always a lower level of inflammation that we as allopathic doctors or traditional medicine would not call it inflammation, but actually, you have a certain level of inflammation. But I think it’s important to clarify to everyone listening to us today how important that is in accelerating aging as well. And we have the word that we call it Inflammageing. Right? And when we intervene with fasting, even though we’re helping a short-term health condition is always in the back of our minds as physicians, it’s like, okay, I’m also contributing to the longevity of that person. I’m also contributing you mentioned that you said it is multisystem improvements that are happens and there’s a lot of it in the physiopathological current condition, but there’s a lot of it also that is preventative and helps the body to stay healthier longer. Can you elaborate a little bit on if this is in the back of your mind when thinking about those patients and how you can help them with lifestyle changes so that they actually decrease that side effect of being an inflammatory status?

Jonathan Carp, MD

Yeah. So I would say that the concept of Inflammageing is, is important to understand only in the sense that all of the, the chronic diseases that we’re suffering from all have an aspect that is inflammation-based. Also, the fact that some of this reduction in inflammation and some of the results are persistent, even after a five-day Fasting Mimicking Diet is really pretty powerful. But if you can combine that with giving people a lifestyle program, diet, whatever the case may be during the interval, it’s even more powerful. So it’s one of the reasons why I always recommend people, not necessarily people who have an autoimmune disease, but getting a high sensitivity C-reactive protein is important for everyone. I think it’s one of the sort of seven or eight blood tests I think everyone should be familiar with. And this gives you a general indication of your overall inflammatory level, I guess you could say. So it’s one of those things that one of those blood tests that I think every patient should be conscious of. And if they have to even order it on their own. But thinking about just overall, the chronic diseases that we have, you know, everything from heart disease to high blood pressure, you know, just obesity in general. If you have an intervention that can help with that, that’s pretty quick. That’s a pretty powerful intervention.

Joseph Antoun, MD, PhD, MPP

And Dr. Carp, I’m just curious, how many patients historically have you seen at your clinic that you have done certain kind of fasting or the ProLon Fasting Mimicking Diet?

Jonathan Carp, MD

Probably a couple of hundred.

Joseph Antoun, MD, PhD, MPP

Okay. So that’s a pretty sizable one. Yeah, that’s a pretty sizable.

Jonathan Carp, MD

And that actually, I should say that some of them have come to me through my newsletter at Miracle Noodle because I have sort of a health newsletter over there. So I have run some online groups or I guess you could call them. Yeah, groups, I guess you could say. So it’s sort of a mixed bag between practice and sort of my virtual group of people that follows me.

Joseph Antoun, MD, PhD, MPP

And that’s a, it’s a first I’ll call it a cheat sheet, that I’ve heard with the throw line. So basically some of your patients, you’ll tell them, hey, you know, add a little bit of medical noodles to the soups and within ProLon..

Jonathan Carp, MD

Yeah. So I, as just personally speaking, since I do it pretty frequently, I add the noodles and the miracle rice to the soups, both for lunch and for dinner. And it just makes it a lot easier. And of course, on the miracle noodle side, those people are all using it. And I just find it a lot easier. And the reason it is easier is because you get a greater sense of satiety from those soups. When you,  when I look sometimes when I look at the soups before I put my noodles in, I think, oh, boy, if I just were only to have that, I probably wouldn’t be all that happy. So adding, you know, adding a big bowl of having a big bowl of noodles inside your soup just makes it a lot more filling. Also, the fiber that the noodles are made from is called Glucomannan. It’s been extensively studied and just just adding a couple of grams of that per day to your diet, which you get in a serving of noodles is going to lower the glycemic load of your diet. It’s going to lower your cholesterol, your your weight. You know, you can lose 2 to 3 pounds, just not doing anything but adding a couple of grams of that fiber. And it’s one of the most potent prebiotic fibers. So adding it to ProLon it is a no-brainer for me and makes it a lot easier for both me and of course for my patients as well.

Joseph Antoun, MD, PhD, MPP

Right. So I really, really appreciate you for your time today. Dr. Carp. Anything as a final word to say before we part today?

Jonathan Carp, MD

I guess, if you’re interested in learning more about some of the things that I do, I give a free class every Wednesday night for my miracle noodle customers and for my patients. And you can just go to miraclenoodle.com and we send out notices for the classes in the newsletter.

Joseph Antoun, MD, PhD, MPP

Well, I appreciate you very, very much. Thanks for your insights today.

Jonathan Carp, MD

Thank you.