Recover Your Blood Sugar: Fasting For Diabetes

William Hsu, MD

Joseph, thank you. It’s been quite a journey. I have spent four years in my current role. But this is about it; what a fascinating time, and the world has also changed in these past four years. Yes, I look forward to chatting with you.

Joseph Antoun, MD, PhD, MPP

Can you tell us a little bit about your life journey? I mentioned that you were an endocrinologist at Harvard. Tell us a little bit. You wrote about getting to that. But then what have you done after it? Did you have the courage to move away from that big name and do something else?

William Hsu, MD

We all hit it. We always joke about how it’s hard to leave Harvard because there’s an umbilical cord. When you want to sever that cord, you feel a little bit afraid of the outside world because, in such a protected community, it’s like what life will be outside of that.

Joseph Antoun, MD, PhD, MPP

What an amazing institution as well. Everyone there had the chance to also be at Mass General in Boston, and then I did my Masters at Harvard. This is an inspiring and lovely institution. Be courageous enough to take it out of it. Then we want to know why and how.

William Hsu, MD

It’s been 20 years of staying over there. Think about how, after 20 years, there’s got to be a strong pull to get out. It’s because I saw something pretty amazing, and I’ll get to that in a second, maybe just a little bit. Over the 20 years I was there, I learned that one of the top institutions in the world cares for people with diabetes, and I always wanted to do something different. I wanted to bring something new to the world of medicine. So I did the classic thing: I taught, won the teaching awards there, and published. and I was specifically curious about why people develop diabetes even when their weight is not very high. So I was looking at Asian-American diabetes and how there was a unique physiology to something different about it.

I always love something quite different. So I did the classic thing. I joined the American Diabetes Association. I wrote national guidelines. Joseph, I thought that when, if, and if I write the guidelines, people will follow them. I thought that was kind of the ultimate contribution. Then, after the guidelines were published in 2015, I realized not everybody was following the guidelines. So I say, well, if that’s the case, then maybe we build centers. If you build a center of excellence around the globe or the country, maybe when you build it, they will come. Then we realized that you’re only touching very few people; out of the 38 million people with diabetes here, you’re still touching very few lives in these brick-and-mortar stores, institutions, clinics, or hospitals. then, so I went and worked with the MIT Media Lab, thinking maybe we should bring care from the hospital to homes. So we tested a digital care model where people didn’t have to come to the hospital, that people could just go online and we could titrate insulin and start insulin and get people better results than what they could receive at an institution. That was exciting because that work was then translated into a commercial entity, which was later acquired by Fitbit, which was later acquired by Google. It was a great journey. That’s when I opened my eyes to see the concept of capability. If you have a good idea, if you keep it just in academia, you will always become a paper, and people will debate it to no end.

But, patients may not benefit. It takes translation. It takes scalability. So about four years ago, a good friend of mine was looking at this technology called the Fasting Mimicking Diet. I’m like, okay, as a very conventional endocrinologist, I’ve never heard of it. I’m not very interested. My friend challenged me and said, You got to look into this. I began to read the paper on cells, about beta cell regeneration. I began to look at it in contrast to my everyday practical knowledge of patients with diabetes. The concept is very clear: we all preach about nutrition and how we have to get good nutrition every single day. But the reality is that most of our patients have trouble keeping up with their low commitment to lifestyle change. That was the thing that led them to develop diabetes in the first place. How is it that the solution to treating diabetes is the same? Like people always say, if you do the same thing and expect different results, that’s insanity. I feel like I was stuck in that model of doing the same thing. Tell the patients to do the same thing and expect different results, and we could talk more about it. But that was kind of my journey out of Harvard to join a fantastic company called L-Nutra.

Joseph Antoun, MD, PhD, MPP

Fantastic story. Was your frustration with not having enough within the current system or the current health care system to help people get out of diabetes? You were looking at a solution to kind of delve into the reasons why people have diabetes and something when they hear frustration about people not being able to be compliant, whether to their drugs or to their long-term lifestyle change. It seems you found a solution that could work at the essence of diabetes and, at the same time, be feasible for patients or induce change. Would you love to talk a little bit more about that first? Well, I’m always curious to ask you this question. I’m going to ask it live. How many of your patients have had 20 years of experience with diabetes at the number one institution? How many patients have the drugs that are available that you had to prescribe? How many patients get that out of diabetes? What’s the percentage of people who stay and live with diabetes for a long time?

William Hsu, MD

That question is so insightful because, like we don’t even as clinicians, we don’t even think about getting out of diabetes.

Joseph Antoun, MD, PhD, MPP

Is it just a disease you live with?

William Hsu, MD

We’ve been taught to believe that diabetes is here to stay. It’s a chronic, incurable condition. We, as health care professionals and even as patients, even as a community of people with diabetes, settle for just that.

Joseph Antoun, MD, PhD, MPP

We just want to manage glucose control. But you remain diabetic for the rest of your life.

William Hsu, MD

I feel like I’ve been thinking a lot about this, like, why is it that we, the healthcare community, do not talk about getting rid of diabetes? We talk about, “Oh, let’s just be okay with sugar under a certain level,” and we should uphold that that’s the end goal for 38 million people with diabetes. To me, that’s a travesty. What is the potential to bring patients to a better state? Why do we, as a community and as health care providers, right now ask for something better?

Joseph Antoun, MD, PhD, MPP

Probably it is like a side effect of policy focusing not on treating the disease like the current drugs to treat diabetes. They don’t treat diabetes. They just control blood sugar. If you have better blood sugar control where we’re settling, we’re happy. Rather than saying, well, I’ve been able to support you in decreasing the essence of the disease, whether it’s insulin resistance or pancreatic fatigue and failure.

William Hsu, MD

Yes, at the risk of sounding like an anti-movement person, I’m not an anti-movement person. I’ve always been prescribed medications. But the reality is, who’s going to advocate for not using drugs? Who’s going to talk about who profits from this? No one. The drug companies want our patients to be on their drugs indefinitely. There is this silence. There is this culture of silence around diabetes care. Now, we do not have enough data to show that, for example, if you truly can change your lifestyle and lose enough weight, diabetes remission is possible. We know, for example, from the data from bariatric surgery that if certain interventions are introduced, the potential to get off drugs is possible. I’m not saying that those are the most pragmatic ways, nor am I saying that they’re the most effective or safe ways. But it is possible. When there is a possibility, I’m just surprised at how silent the entire medical community, or even the patient community, is about wanting to get diabetes out of the way.

Joseph Antoun, MD, PhD, MPP

I remember when I was doing my rotations in a little bit of psychiatry as well, or our medical studies, there was this concept of learned helplessness. We all learned that this is the way it is. Then every five years, there’s a new drug, and we jump on it. That’s from drugs to lifestyle, or from drugs to solving the essence. But we jump on a new drug. It’s a new way of doing something. Everyone now is like, Oh, there’s Wegovy, there’s Ozempic. Then we jump on them. It’s another daily or weekly addiction that’s going to help you lose weight. Yes. For the first time, thank God there’s a positive effect. But at the same time, you’re losing muscle and getting into this vicious circle of being addicted for the rest of your life to these injections. Tell me now, with big anticipation, what made you leave, what is this technology you mentioned called the Fasting Mimicking Diet, and what does it do for diabetes, progression, and remission?

William Hsu, MD

I have to say that it had to be science. When I was reading this cell paper in 2017, we saw in animal models these factories that make insulin, called beta cells, in the body. Through prolonged fasting technology done several times, it’s able to perk up and regenerate. So your audience, who may not know the biology to be able to cause these factories of cells that make insulin to regrow back, is a tremendous, tremendous achievement. To me, while it was only an animal model, it was promising enough for me to say that, if you look at the risk and the benefit ratio, just by using a nutrition intervention for a few days a month and repeating it a couple of times, it’s able to cause amazing changes in the factory of the body that makes insulin. It piqued my interest at the time, but it also piqued my aspiration because what if we can somehow bring that to humans? What if we can somehow introduce, even introduce, the concept of remission, the concept of not settling with glucose control only?

Joseph Antoun, MD, PhD, MPP

Yes, what does the word remission mean? You’re using the words remission and regression. Can you define those words a little bit for us?

William Hsu, MD

So we know some illnesses apart from changing the organs altogether. Many of these conditions, such as obesity, relapse. We could lose our way. But if we don’t control it, well, it’s going to go back up. There is no technically valid cure because you can’t cure obesity. If you eat poorly for the next six months, you’re going to gain weight back. The concept applies to the condition of diabetes. It’s a chronic illness, and so many organizations like the American Diabetes Association, the Endocrine Society, and the Diabetes UK and European Group, all came together about two years ago. They define what remission from diabetes should be from a new angle. What that means is that you simply get your diabetes under a certain glucose level. By that definition, hemoglobin A1C is six and a half, but that’s a three-month average for sugar. But if you go three months without a drug, then you are in a state of remission. Now that’s very exciting because now we have a new angle to look for, and by setting that definition, it tells the world it’s possible.

Joseph Antoun, MD, PhD, MPP

Remission means I am without medication for three months as a diabetic, and therefore I’m considered in remission.

William Hsu, MD

That’s right.  that it’s a concept borrowed from other disease states, like oncology. like there’s no cure for cancer. You are in cancer remission. The experts love that term because they know that it is a lifestyle disease. But now we are given a new hope and a new promise. A lifetime of medicine is not the only way.

Joseph Antoun, MD, PhD, MPP

What does it mean? Regression.  There’s the word remission. We said no more medication for at least three months. What does the word regression mean?

William Hsu, MD

But regression simply means that you’re not totally off medicine. But you’re on a path to less medication burn. To me, Joseph is a gospel. A person with diabetes, and around the US right now, takes an average of six different medicines, including six medications, including injectables and oral pills. Can you imagine how many patients are sick every day taking these?

Joseph Antoun, MD, PhD, MPP

That would be fine if there’s a day when you stop that. I remember when I did my rotations at my role at Harvard, I used to sleep with the attendings as we were prescribing this drug. When is the day of the cure? When is the day off? They say, No, no, that’s a monthly refill. It was okay for everyone to do that. Probably, it is okay for certain conditions in which we cannot help with the remission. Alzheimer’s today doesn’t have a remission yet, but in diabetes, where 80% of diabetes is a lifestyle-induced health condition, maybe there are chances of remission. This is probably what you’re going to talk about now in terms of fasting and mimicking nutrition. As you mentioned, can you talk a little bit about why you started fasting? You started saying that you saw the science and that fasting could help you lose weight but also rejuvenate the pancreas. Can you talk about fasting mimicking nutrition or diet? What about.

William Hsu, MD

I love to talk about it, but it’s one doctor who has put it this way. She said that this is the miracle of life—this process of fasting and how the cells respond to it. Let me explain. Now, throughout history, every living organism encounters times when food is not available to us. When nature was giving us stress, the body had to survive. The cells have to survive in the cells that have adapted to the stress by coming up with a mechanism of saying, Well, there’s no cell coming around; I need to survive, so I have to burn something within the cells themselves. You’re not going to go to the nucleus? Where is the brain of the cell? Because they’ll be suicidal, they’re going to look for more dispensable things; for example, things that are a little older and seem a little broken. It’s like in the winter when, when you run out of wood to burn or what are you going to throw into the furnace, the chairs are a little bit more broken, not going to give you your most precious table or the pillars in your house to burn.

You go with something that’s more dispensable; now, it turns out, in the cell during that time, they’re looking for more dysfunctional cells. It’s a structure we call an organelle. It’s going to be misfolded proteins. It’s going to be all the mitochondria—more dispensable things. So during tons of fasting, the cells shrink by digesting these more dispensable, older, and worn-out parts of the cells. Now, this sounds like, wow, that’s a sacrifice. But no starvation lasts forever. Rain will come through and become available again. When those foods become available again, the cells now have the nutrients to regrow. Now, when they regrow back, those parts become new. You’re replacing more old, worn-out parts of the cells with new ones. That’s amazing. Think about it. Without that mechanism, none of us would be here. No lifeforms can survive on earth, and that’s why they’re fasting, although it has created an existential crisis for our bodies. But nature was smart enough to respond with this miracle of life. This process is so important, Joseph, that the description of this process, called autophagy, was awarded the Nobel Prize in 2016. So now, with modern-day science, we can leverage that knowledge to improve our health.

Joseph Antoun, MD, PhD, MPP

You’re saying the secret of this fasting nutrition is that it mimics a state of fasting in the body. Every cell of the body thinks it is fasting and therefore does whatever it learned through human evolution or our existence on the planet. It’s shrinking; it eats the inside. Whatever is disposable, whatever is broken, it rejuvenates. When you feed it again, it’s growing back into a rejuvenated, better-functioning self. Is that the summary? So is the concept that this body coming out of rejuvenation is better functional, is like a younger, better functioning body, and therefore fights diabetes. I’m having a difficult time linking the rejuvenation of the cell to diabetes. Can you elaborate on that?

William Hsu, MD

That’s a really good comment. In the question here, you think about type 2 diabetes. It happens to young people. It’s a condition associated with aging. Typically, people develop into older people.

Joseph Antoun, MD, PhD, MPP

Do you mean older people?

William Hsu, MD

50 or 60 years old, you hardly see that. We’re seeing more childhood obesity right now. That leads to type 2 diabetes, but it’s still relatively rare. So it tells us the body must have some trouble processing, renewing, and and rejuvenating the cells, and therefore, the diabetes clock is ticking, right as our society gets heavier and heavier. But this process of cellular rejuvenation, this process of autophagy that we talked about, replaced the more worn-out parts of the cells with new ones. What it’s essentially doing is making cells younger, and it’s not only making the cells in the pancreas younger, but it affects every cell in the body. Because when there’s no food in the body, the brain has to respond. The heart has to respond. The muscle has to respond quickly. It’s the pancreas that’s responding. Every cell in the body, under the stress of fasting, rejuvenates itself. Diabetes is a condition that affects many organ systems, including the pancreas, the fat, the muscles, and others. Through the process of rejuvenation, they all get better and function better. That’s how potentially it has this effect on diabetes.

Joseph Antoun, MD, PhD, MPP

So you’re saying that diabetes gets more established with age because the body is pressing. The muscles used to burn the carbs fast when, even if you ate high calories when you were younger, you were able to process those. With age, we get slower, and the cells are less rejuvenated, less young, and therefore less efficient. Therefore, the body is establishing diabetes. Maybe this is how the body also gets into Alzheimer’s or cardiovascular disease. All these chronic conditions mean that 90% of us are going to die from cardiovascular disease, cancer, diabetes, and Alzheimer’s. That’s all age-related. This is so important today for everyone listening to us. Age is probably the mother of all these four health conditions. Of course, there’s the environment, the genetic predisposition, or, this lifestyle. But even when you have all those, you’re not going to get Alzheimer’s at age 20. You’re not getting your first heart attack at age 18. You’re still getting them at ages 60, 50, and 70. The essence of what you’re describing as fasting is playing with the essence of the youth of the cell and having better-rejuvenated cells to rejuvenate the entire body. Getting rid of a little bit of diabetes could also be a good intervention for the entire longevity of the body or the entire healthy aging of the body.

William Hsu, MD

This is where innovation grabbed me four years ago. That is the intersection of nutrition, fasting, and a little charity. Think about that triangle. For a long time, if you listen to podcasts out there, there have been endless debates about nutrition and what kind of nutrition you should eat. But that’s only one vertical, which is not only about what we should be eating but also the timing of our food. Or, conversely, when we do not eat, that has tremendous implications for our health. and so we answer, Yes, go ahead.

Joseph Antoun, MD, PhD, MPP

Dr. Valter Longo, who’s the father of this entire concept of fasting and feeding cycles, is one of the top 50 most influential people in health, and in his longevity diet book, which describes what you’re talking about, this simplicity of eating and not eating, which carried, as you mentioned, every organism in the world from it historically and from a small to a human. We lost that over the last four years. We’re eating all the time, and therefore we’re getting spoiled, aging faster, and getting health conditions sooner rather than later in our lives. What you’re saying is that bringing back fasting to our life cycle is going to help us to alternate between feeding and fasting, rejuvenate the cells, maybe decrease the weight, protect the muscles, and keep us a little bit more efficient to fight the onset of these chronic conditions.

William Hsu, MD

Well, that’s exactly right. It is the union of our lives. You cannot just exercise every day without rest. You cannot just eat without fasting; it seems like it’s such a novel concept, but now we all fast; everybody fasts while you say, I don’t fast. Well, you do. When you sleep, you fast. It is an extension of that, giving the body a little bit of a break in a 24-hour cycle. That’s helpful. But every culture and every religion also has these fasting components for the spirit, not only for spirituality but also for health or mental clarity. But that’s kind of passé. That’s like the past knowledge of fasting and nutrition. After all, every religion and every culture practices it. What I need, at least for me, and maybe your audience has heard about this, is the link to healthy aging. To me, this is where 21st-century science has begun to reveal the impact of nutrition and fasting.

Joseph Antoun, MD, PhD, MPP

Dr. Hsu, you explained very well the cellular effects of fasting. Are you saying it’s even more relevant and important than diabetes? Because, by the way, you’re fasting, so you’re losing a lot of fat. Can you talk about it? But from a metabolic standpoint, not a cellular standpoint, what happens to the body, and how many days of fasting do you need to achieve what you describe or how many hours? Because I hear a lot about intermittent fasting, I also hear about ProLon fasting. Can you talk a little bit about the metabolic impact and how many days ideally people should do it?

William Hsu, MD

Such an interesting question. We know what happens to the body when the body fasts. And I’ll just take you through a quick journey here. We know that when we fast, our minds change. By the way, I’m on day six of my fasting-mimicking diet, I just experienced five days of fasting. I can tell you there is a clarity of mindset, and this is something that every culture and religion practices. There are changes to your food. Number 1: There are changes to your liver because you are not feeding the liver with everyday food. As you can just imagine, do you know how we make foie gras? We take these poor geese and feed them incessantly so that the liver becomes fat. So what is the way back?

Joseph Antoun, MD, PhD, MPP

Foie gras is a fatty liver.

William Hsu, MD

How do we reduce the problem of not feeding? There are benefits for the liver. There are benefits for beta cells. I share with you the 2017 cell paper on beta cell regeneration. That’s the factory that makes insulin. There’s an impact on muscle. The muscle is the most important organ where the glucose blood flow in the blood goes when you have less muscle. That often happens with low-calorie weight loss. If you lose weight for six months, you’re going to lose some weight, but you’re also going to lose some muscle. That is terrible. That’s the wrong way to lose weight. Fasting is the opposite. You lose central fat. Your visceral fat, your belly, and your belly tire out the entire belly, I should say. The beer belly is the worst part of the body when you fast; that’s the first part to go for you to preserve lean body mass and muscle.

Joseph Antoun, MD, PhD, MPP

This is critical because I’ve never heard of a weight loss regimen unless you exercise and take proteins that only selectively melt fat and don’t impact muscle, including the injections now and maybe soon to be oral and on Ozempic and Wegovy. Even those drugs induce fat and muscle loss. They’re saying that by fasting and mimicking nutrition, you’re preserving lean body mass, and you’re the only body that focuses on unburdening the fat.

William Hsu, MD

Yes, your audience may not know this, but a lot of the low-calorie weight loss plus the GOP, one drug like Ozempic, and others lead to up to 30 to 35% of muscle loss as well as weight loss. As we lose muscle, we also lower our metabolism, which makes weight maintenance even harder. It is a difficult weight, but the fasting is different. Think about this. Like a tiger in the wild, right between the hunts, the tiger gets hungry if the tiger’s muscle just gets down because there’s no food. The muscle is going to get weaker. That tiger will never hunt again. The species will probably be gone a long time ago, but it is the opposite during a short-term fast. The mind is sharp. The tiger’s mind is sharp. It is focused on hunting. The muscle is maintained because there is stress on the body, and the body produces growth hormones, which are the hormones that maintain muscle mass. Now, if you fast for a long time, like months of starvation. Starvation is never good for the body, a short-term fast turns out to be the opposite in terms of keeping muscle.

Joseph Antoun, MD, PhD, MPP

You’re saying that because fasting works more not as a calorie but as a stress on the body, the growth hormone and other hormones that the muscle loves to rejuvenate, plus the fasting, stimulating rejuvenation of the muscle together, are leading to preserving muscle, which in the short period, maybe that’s natural selection, human evolution, or the way it is genetically if God created us, has been built into us as a first reaction. If there’s no food, be sharp, be a better machine, be rejuvenated, and keep your muscles because you need to go and hunt. That’s what you’re trying to simulate with the fasting-imitating diet. to reawaken the cells and the body, rejuvenate the muscles, and help the body get rid of diabetes.

William Hsu, MD

Yes, we’re trying to go with nature’s design. It doesn’t go against nature.

Joseph Antoun, MD, PhD, MPP

But I love that it’s a natural intervention. You’re just mimicking what our ancestors were doing naturally.

William Hsu, MD

You’re tapping into these ancient survival genes. Yes, you can’t fight against that. But we are also not leveraging that in modern medicine. This is where I saw an opportunity in one of the biggest challenges, Joseph: our patients. Many of them are your listeners here. I always remember their struggles. It’s not that they don’t know they need to eat well. But to be a saint, eating well every single day is impractical. It’s something that cannot be done. Yes, we do encourage people to live a good lifestyle, and we’re all about that. But I’ve always, as a clinician, always thought about: are there pragmatic ways? How can we give an intervention rather than a lifelong recipe of commitment? That can still drive results. That’s why my eyes turned to this technology called the fasting-mimicking diet.

Joseph Antoun, MD, PhD, MPP

How many days are you saying it’s practical and feasible because it’s shorter than changing your everyday lifestyle? What is the number of days that you’re recommending this fasting goes for?

William Hsu, MD

There are about 70 publications that look into this fascination between fasting, nutrition, longevity, and disease conditions. Specifically, there’s been about 14 clinical trials there that have been published—eight clinical trials. They have published a look at this five-day meal kit called the Fasting Mimicking Diet. It’s what a lot of people say is an oxymoron. How can you fast, and how can you have food? We should go into that in a second. But in just five days, it repeated itself a couple of times in the course of a few months, because similarly, activating these ancient genes is survival. It is a powerful lifestyle medicine tool, and it’s truly an innovation.

Joseph Antoun, MD, PhD, MPP

You’re saying it’s five days, not a month. you fast for five days. You eat normally for 25 days, and you repeat it every month. That’s the period that allows this weight loss, the fat loss, and then the rejuvenation of the cells. Can you help us? You’re mentioning the word fasting-mimicking diet, and we’re confused a little bit with that oxymoron. Is it fasting, or you’re mentioning nutrition?

William Hsu, MD

The original studies have always been done with fasting alone, and so we know fasting does a lot of good. The problem is, again, pragmatism. I’m a clinician, and I’m also a researcher. But the idea of how feasible it is to implement it matters a great deal to me. You can have great theories. fasting for five days. You ask average Americans who can fast for five days. I can tell you, you know, as doctors, we go to medical conferences if they’re on serious lunch with a terrible, that’s a terrible conference. Even doctors have all this knowledge. But this speaks to how the solution needs to be pragmatic. so fasting for five days. Yes. Directly is great. It cannot be done. This is also why a very bright mind by the name of Professor Valter Longo, as USC University of Northern California Director of the Longevity Clinical Longevity Institute, 20 years ago began to think about, well, is there a way to hack this? Can I somehow come up with an innovation that gives you the benefits of fasting without the burden of fasting?

Can I provide the body? body with a little bit of nutrients, not enough to cause the sensors in the body to say, Oh, there’s food actually below the radar of these detections. The cell says, Okay, there’s no food, but in fact, we’re sneaking some nutrients into that. Now, that’s not a DIY project. It’s 20 years of research, 36 years of $36 million in National Institutes of Health funding, and dozens of publications to support that.

Joseph Antoun, MD, PhD, MPP

So you’re saying that Professor Longo and the University of Southern California invented or figured out the formulation of plant-based, healthy nutrition that goes for five days? The body is consuming the food. Is that like a box you ship to people with this formulation? They eat the food for five days, and their cells are not figuring out that they’re being fed. You’re fasting while you’re eating. You’re getting the benefits of fasting while you’re eating.

William Hsu, MD

This is what I call it. We have the inspiration from nature Which is fasting, which is not voluntary as a force upon us by nature forces fasting to power all lifeforms. But we are using the knowledge of biochemistry and molecular medicine. Come up with a five-day plan-based kid nutrition kit.  when you consume this, you get some basic nutrients to support you so you can withstand the five days and yet at the same time get almost all the benefits of a five-day fast to me is the best of both worlds it’s pragmatic because just five days now, what do you do for the rest? 25 days we say you got to you will exercise. But the reality is, in all the clinical trials, people just go back to doing what they used to do without thinking about what to eat, or what to do. Just give us five days, give you a body, five days of this intervention. You will see the results in a couple of months.

Joseph Antoun, MD, PhD, MPP

You call this fasting-mimicking nutrition or fasting-mimicking a diet for five days. I received my box at home. I eat every day. Whatever you send me, it’s a special nutrition formula. Is it plant-based?

William Hsu, MD

It is plant-based, limited in calories, and specially formulated.

Joseph Antoun, MD, PhD, MPP

Is it for people with reactions is it gluten-free? 

William Hsu, MD

Is it gluten-free? It is plant-based and especially formulated. It has micronutrients in it, and it tastes great. It’s got bars and soups. It’s not like you take a pill. Okay, I enjoy the soup and the chewing. This is all designed with the mindset that, hey, we don’t want to treat sickness as if you’re sick. We want you to live life by experiencing these five days. Even going through fasting, there is enjoyment, there is food, and there are nutrients.

Joseph Antoun, MD, PhD, MPP

What is a typical day? What would I get for breakfast, for example?

William Hsu, MD

Yes. There’s a bar it’s specially formulated with; the same thing with the fasting-mimicking technology. Okay, in the bar you see, there is taste and texture, but it doesn’t spike your glucose; it doesn’t spike your insulin.

Joseph Antoun, MD, PhD, MPP

You’re saying I’m eating the breakfast bar, and my body still stays fasting.

William Hsu, MD

In fact, we have a publication looking into that. That was published to show the same glucose alert level for the number of hours after you consume as if you’re drinking water and your teeth level just keeps going up. That’s exactly the physiologic state when the body is fasting. What would I have, for example, on a typical day for lunch? You have soups, you have balance, and there are snacks there, like crackers. Okay. It’s not going to be a three-star Michelin gourmet. You should not be thinking about that either. It is an investment. Like when you go to the gym and you’ve got this coach yelling over and you’re pumping iron. But we can make that as tolerable, acceptable, and enjoyable as possible.

Joseph Antoun, MD, PhD, MPP

Okay.  Is dinner the same soup and some snacks that go with it?

William Hsu, MD

That’s right.

Joseph Antoun, MD, PhD, MPP

So you’re saying it’s a box of food. You should send it to me. I’ll consume it over five days. My body stays in a fasting mode and then rejuvenates my cells, getting a little bit younger to fight diabetes better. On the other side, I’m losing fat, protecting my muscles, and metabolically getting better. You’re saying, How many times do I need to repeat it? Every month, it’s five days, only per month. But how many times do I need to do it?

William Hsu, MD

It depends on your background and health. Studies have shown publications that reveal that if you are a healthy individual without conditions or with health conditions, you only need to do it three times a year. You’re talking about 15 days of engagement now. Is it a little bit of hard work? Yes, there is a little bit of investment. But think about the cellular rejuvenation effect you can get. We’re talking about three cycles of a five-day fasting-mimicking diet.

Joseph Antoun, MD, PhD, MPP

If I have diabetes, say, after six months, I do it every month for six months. What do I expect? Because it started, we started talking about regression and remission, and I wanted to know because that was my frustration. I left medicine for mainly telling patients that they have to take the same drugs for the rest of their lives. What is the science showing if you do fasting and nutrition, and how many things do you need to do if you have diabetes? Let’s say you don’t have diabetes three times per year. But if I have diabetes, what should I expect from that? Let’s say six months.

William Hsu, MD

This is the most amazing result I’ve ever seen from a nutritional intervention. We published a paper in JCEM, the Journal of Clinical Endocrinology and Metabolism, about a year ago, where we took two groups of people. One is just standard care; the other is that we give them this FMD, this fast-moving diet, five days a month and repeat it six times, six months straight. Six months sounds like a lot, but you’re talking about 30 days of effort in six months.

Joseph Antoun, MD, PhD, MPP

Five, six, six times five. every hour the patient needs to do as the 30 days within six months of eating that special nutrition.

William Hsu, MD

That’s right.  So for the rest of the 25 days, they go back to living their normal, regular lives.

Joseph Antoun, MD, PhD, MPP

You’re not telling them to participate in the trial; you didn’t tell them to take other medications, exercise, or eat healthy in between cycles.

William Hsu, MD

You do distress people with type 2 diabetes. They are about 14 years old, and there are all kinds of medicines. What we told them to do was not to take more. We let their doctor decide on their medicine. and see what happened after six months?

Joseph Antoun, MD, PhD, MPP

I see a lot of lifestyle medicine interventions, and I see the lipid sheet in the paper they like. They change your lifestyle. They ask you to exercise, and then they do two things, and they say, You see, it’s a great result. They just want to know in these clinical trials: did you ask the patient to change their lifestyle in 25 days, or did you just give them the fasting-mimicking nutrition?

William Hsu, MD

For the restriction of about 25 days, we ask them not to change anything.

Joseph Antoun, MD, PhD, MPP

Okay, so it’s the only impact of the five-day fasting-mimicking diet by six times. What were the results like? How much weight did they lose and insulin resistance? HB 1C: Can we talk a little bit about the results?

William Hsu, MD

After six months, it was very clear at the end of the study. Now the group that used the FMD had a 1.4 A1C drop rate. That’s very meaningful for those of your listeners. For every percentage drop in A1C, one point in A1C is equal to about 30% reductions in complications in the long term.

Joseph Antoun, MD, PhD, MPP

I remember from my medical studies that if you drop HB and C by point five, 0.5 means it’s meaningful thinking; it’s almost a druggable e level. So now that you’re doing triple, you’re saying 1.4 decrease in each HB1C, and you said every point of decrease is equivalent to 30%. decrease in complications.

William Hsu, MD

Complications in the long term. That’s why the FDA will allow drug claim approval. A drug has to have at least 2.51 C. Here we’re talking about triples.

Joseph Antoun, MD, PhD, MPP

Yes

William Hsu, MD

But what’s more amazing is not just the drop in A1C; a lot of the drugs could get you where they want you. 1.4 right. a lot of the expensive drugs, but at the same time, two-thirds of the people in the study were able to stop or reduce their medicine.

Joseph Antoun, MD, PhD, MPP

That’s the remission and regression you were defining when you started.

William Hsu, MD

That’s amazing because to get 1.4 A1C dropped, what the doctors typically do is tell you to increase your drug, increase your insulin, increase your Ozempic, and increase your pills. But here is one intervention where you’re receiving better glucose with less medicine. This is something I hardly saw in my practice. It’s nutrition, and it doesn’t require it every single day. Just to round out the results here, there’s a 59% drop in insulin resistance. Many patients struggle with insulin resistance. By the way, the beneficial side effect was 22 calorie losses in the study. By the way, the muscles were preserved. There was no loss in muscle mass. That’s the right way to lose weight. By the way, a 50% drop in this protein leakage in the kidney is called diabetic nephropathy. Microalbuminuria: these are protein leaks. These are diabetes complications. How do you see all these for five days of nutrition—all-natural, less drugs, less payment? They don’t have to pay for these drugs.

Joseph Antoun, MD, PhD, MPP

I want to take a moment here because this is exactly why you left Harvard. This is exactly why I left the clinical practice of medicine to focus on nutrition and longevity. This is exactly why this summit exists on fasting and longevity, and we’re talking about medical fasting. It is all the drugs combined with the trillions of dollars that governments have spent on diabetes throughout the years that have not solved the disease. When the science of nutrition was able to figure out the value of fasting, we put more technology into developing a diet, and nutrition helps you fast for five days. Suddenly, we see these amazing results you’re talking about. You mentioned a two-thirds drop in medication. In six months, we’ve never seen this in the practice of medicine. I did start the call or the interview by asking you how many of your patients you’re able to reverse. You said it’s a lifetime disease. You’re saying 22 pounds of weight loss. You’re saying a 1.4 decrease in HB1C-preserving muscle, which is key. I cannot stress enough for everyone how much muscle is important in aging, especially in diabetes, because you can drop 22 pounds by eating healthier and being on a diet, or you can drop them even more with those Ozempic, Wegovy, and the others.

But you’re losing muscle, and the day you stop, that has been the failure that has been the secret that no doctor or others want to tell you: you lose it, you lose muscle, you’re a weaker engine, and you metabolize glucose more slowly. Then, the day you stop dieting, you gain back fat first. It’s a vicious circle. Every time you go on a diet or go on injection cycles, you end up losing a little bit of weight. I see a lot of my patients, a lot of consumers today, who tell me the same thing: I dieted all my life, and I cannot just get it tried. Every time you’re dieting, you’re going through that vicious circle of losing muscle and fat. Then, when you eat back again, you get the fat first, and you go back even worse. This is why this learned helplessness exists today in weight loss and in diabetes: the key is muscle. It seems a company called L-Nutra, which we’re going to talk about, has uncovered the secret to losing fat while protecting the muscles from the stress of fasting. You put nutrition in it to make it compliant and feasible.

William Hsu, MD

Just as you’re talking, the images of the faces of patients came back to me. In my 20 years of practice, how many times, when the glucose level goes up, do I have to talk to the patients? My only options are to: “Well, Mr. Smith, I’m sorry, but we need to increase your medicine. We need to add another drug, another injectable, and another pill.”

Joseph Antoun, MD, PhD, MPP

I see you’re getting emotional about it as well.

William Hsu, MD

I remember the reaction and the emotions of the patient. It’s not just, “Oh, I have to take a lot of medicine.” There is a sense of personal failure on the part of the patient. They feel like, “Oh, my goodness, I failed again.” You know what? Often, what comes next is a series of negotiations. “Doctor, give me two more months. I will eat better, and I will lose weight.” Sometimes I knew they could, but I had to give them a chance. I give them; okay, let’s not increase this. Let’s wait for three months. They come back three months later and get the same story. But there is a deep sense of personal failure, struggle, and putting more chemicals in the body. That’s not the natural way. But the challenge was that we, as doctors, did not have a better tool. We only have drugs. Now, I can send them to the dietician, which I do. I can send them to assess this young physiologist, which I wish I had done.

Joseph Antoun, MD, PhD, MPP

At least you tried. Most doctors don’t even have a nutritionist next to them or look at diabetes as a genetic predisposition and get the pills. Then, once your pancreas fails, I’ll give you an injection of insulin. At least there was a trial with nutrition, but those frustrations that you mentioned—we see them everywhere—people are progressing. It’s always been a progression. The budgets that the insurance companies and governments are paying are a progression. Medicare is getting close to bankruptcy. All governments around the world are saying that diabetes is just a heavyweight for everyone, and guess what? It’s a food-borne disease. I remember one time I had a post talking about diabetes being a food-borne disease. So they say, Watch out. This is how you’re defining the day. 80% of diabetes type 2 is a food-borne disease. What is its magic? Do you think fasting and popping food is the best way to reverse or induce remission? It took medicine decades and decades, and it’s taking doctors, debates, etc. to figure out the essentials of it. You overate these; take a little bit more fat. You developed insulin resistance; you became diabetic. Guess what? If I fast to the opposite of what you were doing, you’re going to be fairly fast and hopefully free of your medications. What a simple story. But how long did it take us to reverse that, brainwash the status quo that we were all kind of, learn to practice, and then accept it?

William Hsu, MD

Clients to show that the difference is that now we have clinical results. We have science to show that this can be done and is not just old-fashioned. Just look; don’t let the hunger bother you. No, there’s innovation. Yes. This is why, four years ago, I joined L-Nutra because I saw this technology and how we could take it into the clinic and into health care to give our patients with diabetes new hope.

Joseph Antoun, MD, PhD, MPP

I see it behind you on the screen. L-Nutra is good for diabetes. Can you tell me what the L is?

William Hsu, MD

Yes, L means longevity. We talk a little bit about the trifecta of fasting, which is longevity. and longevity, which drives longevity through new nutrition and being healthy. It’s just a new effort. L-Nutra is focused on health care and brings the gospel of good news to people with different conditions.

Joseph Antoun, MD, PhD, MPP

 It’s longevity through nutrition for your health and the focus is on diabetes.  is that the website? Like if people want to go, if I have diabetes today, what should I do? I just listen to this and if I’m a doctor 10% of the summit attendees are physicians.  this is a big call for doctors to take action. But if I’m a patient or my dad or my mom or my cousin, I know somebody with diabetes. What should I do coming out of this summit?

William Hsu, MD

Because of the signs that we’ve talked about, we have put together a medically supervised diabetes remission regression program. That’s under the flag of L-Nutra Health. If you want to find out more information, go to that website, l-nutrahealth.com. You can find out how to call us and how to reach out. The program is a 12-month diabetes remission program. The idea is again to tap into those ancient mechanisms of survival, the powerful ones that Mother Nature has designed to allow your body to rejuvenate through a 12-cycle, 12-month program.

Joseph Antoun, MD, PhD, MPP

Fasting-mimicking diet is for, as we talk about six months, what happens between this 12-month program between month six and month 12.

William Hsu, MD

On average, we believe that people will need about six monthly cycles of FMD, and they will go into a maintenance phase where we will continue every three-month cycle.

Joseph Antoun, MD, PhD, MPP

Okay.  I’m doing eight cycles within the year; in total, eight times five is 40. the entire 365 days, you’re telling me you’re going to give me just 40 days of food out of 365, and there’s a dietician who says supervise. There’s the doctor that I supervise.

William Hsu, MD

Your doctors may be interested in this program. They can certainly talk to us, and they could be the ones to supervise you. If you don’t have your own, doctors will provide a healthcare provider to support you through this journey. Remember this: technology works. That means that you’re going to need less medicine. We don’t want you to just manage those medications on your own. That’s why it’s simple; it’s a medically supervised program.

Joseph Antoun, MD, PhD, MPP

I’m glad you do it this way rather than just going straight to it, just like many lifestyle programs where they just want to, with less science, and then more commercials are trying to just get into people and change their lifestyle.

William Hsu, MD

No. Patients are first. In our hearts, I have the heart of a clinician. It has to be patient safety first, with a lot of hand-holding. There was a lot of support throughout this 12-month training.

Joseph Antoun, MD, PhD, MPP

So to describe it, theoretically, if I go to my doctor or if I contact you and need your health, you have your doctors, and I’m expecting to be put on a program, a monthly program. I’ll get five days of food a month. One, two, three, four, five, and six. Then, once every three months, I’m getting eight months in total. I have a dietician with you, a program that will help me if I need to do more between the cycles or check in with me and maybe check in on my blood metrics and help my physician reduce my medication. We said that in six months, the data shows that two-thirds of people would reduce their medication. That means it’s fantastic. Hopefully, within the last hour, we will have learned a lot about this amazing journey of years since leaving Harvard for this. It seems fascinating to me about nutrition technology. We learn about the value of fasting, not just weight loss or the tradition of intermittent fasting. You need to lose weight. You talk about rejuvenating cells in the body, and I’m pretty sure there’s a lot of emotional benefit there. The mental clarity you mentioned, the performance, the energy—and you said this is essential for the treatment of diabetes because you’re making the body the engine younger, you’re preserving the engine and the muscle, and you are losing fat and reversing insulin resistance. This is leading to diabetes being very critical, leading to reducing medication for the first time to talk about the regression of the disease, using a new tool in clinics, and encouraging people to talk about when they are going to get out of diabetes. Rather than, how am I going to add more drugs to my diabetes, and what’s my next complication? This is amazing. You’re referring people to l-nutrahealth.com to go and subscribe to this program. I hope that in the last hour, it was planned to be 30 minutes. But this is so disruptive to medicine. This is so disruptive to the way we practice medicine and to the lives of patients that it probably took a full hour. But hopefully, we change the lives of thousands and thousands of people. Even if you don’t have diabetes, the entire summit is going to talk about the value of fasting for aging and longevity. If you’re fasting and if you have diabetes and your wife does not have it, it’s okay to do it together for her on aging, and vice versa, if you have it and your spouse doesn’t have it, it’s okay to do it together so that people benefit from the rejuvenation and healthy aging. I, Dr. Hsu, cannot thank you enough for showing up today and explaining this disruption that’s happening now to diabetes disease management and medicine. Any final word before we close here?

William Hsu, MD

Joseph, I appreciate the platform you provided for me to talk about my life journey thus far and my encouragement for your audience. But we achieved diabetes remission. your new end goal. And hopefully, we’ll be a partner for you on this journey.

Joseph Antoun, MD, PhD, MPP

That’s fantastic. I appreciate you so much, Dr. Hsu, and thank you very much for this wealth of information. I’m pretty sure we’re going to see you again at some point. I appreciate you and have a great day.

William Hsu, MD

Thank you, Joseph.