Ep. 92 - Should you do a longer fast before bloodwork? | Will fasting lower your cholesterol? | Fasting effects on triglycerides, HDL, LDL | What is "remnant cholesterol"? | Free Intermittent Fasting Plan for OMAD
Dr. Scott and Tommy dive deep into cholesterol and how fasting affects bloodwork numbers in the short and long term. There are many misconceptions and evolving guidelines for cholesterol and determining risk for cardiovascular disease, which also vary in different parts of the world. These topics are discussed with a focus on optimizing health through fasting.
https://www.health.harvard.edu/blog/farewell-fasting-cholesterol-test-201606169784
https://betabios.com/debunked/cholesterol/remnant-cholesterol/
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Show Transcript: www.thefastingforlife.com/blog
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Fasting For Life Ep. 92
Dr. Scott Watier: [00:00:01] Hello. I'm Dr. Scott Watier
Tommy Welling: [00:00:03] And I'm Tommy Welling, and you're listening to the Fasting for Life podcast.
Dr. Scott Watier: [00:00:08] This podcast is about using fasting as a tool to regain your health. Achieve ultimate wellness and live the life you truly deserve.
Tommy Welling: [00:00:15] Each episode is a short conversation on a single topic with immediate, actionable steps. We cover everything from fat loss and health and wellness to the science of lifestyle design.
Dr. Scott Watier: [00:00:25] We started fasting for life because of how fasting has transformed our lives, and we hope to share the tools that we have learned
[00:00:30] Along the way.
Dr. Scott Watier: [00:00:40] Everyone, welcome to the Fasting for Life podcast. My name is Dr. Scott Watier, and I'm here as always with my good friend and colleague Tommy Welling. Good afternoon to you, sir. Hey, Scott, how are you doing? Great, my friend going to have a good conversation today about one of the, I don't say, largest, but one of the most talked about, most thought about, most routinely discussed health metrics that we have in our current system. And last week, we did an episode around blood pressure and fasting. And today we're going to be talking about cholesterol and this this this question or conversation. And we thought it would be impactful to have a conversation around came up from one of our challengers who had asked in our continuity group who asked about the fact that their numbers were elevated after they went and got routine blood work at the doctor's office, which is the complete opposite of why they join the Fasting Continuity Group and started fasting. And they've lost a bunch of weight and they're seeing all these improvements, but they're like, Wait a minute, what happened? Like now they went into freakout mode and there was concerns there and whatnot. So we wanted to make sure we have a robust conversation around this. So we should probably share first what happened in that situation and then we'll talk a little bit about cholesterol, what our recommendations are. If you are living the fasting lifestyle and how you should lead up to going to have some routine blood work done or blood work done for life insurance, right? Or for the health care premiums at work through your job, et cetera. And then we're actually going to shed some potential light or some shade on the system that we currently have and put some food for thought out there in terms of some indications that maybe we're doing some things wrong when it comes to cholesterol. And there's also some really good long term benefits with fasting related to healthy cholesterol numbers.
Tommy Welling: [00:02:41] Yeah, there absolutely is. And I thought it was interesting where this conversation came from, because like you alluded to, it can almost feel counterintuitive where you get a recommendation, potentially for a fast for 12 hours, maybe before you go into bloodwork to get a physical
Dr. Scott Watier: [00:02:58] Or or standard operating procedure, right?
Tommy Welling: [00:03:01] Yeah. And and so that can feel like if you've been fasting for a little while, you go, well, 12 hours like that's child's play, right? Like I can do better than that. And so it can almost be like if I do, more more has got to be better. That's kind of where the thought process.
Dr. Scott Watier: [00:03:16] I really want my numbers to be good, like I really want them to be great. So yeah, I'm going to do 50 hours.
Tommy Welling: [00:03:23] Yeah, because I know how to do that. I can do that. So let me let me outpace the competition, right? Like I'm going to I'm going to game the test. So, so but but coming from that, we can have counterintuitively, we can we can actually make the numbers. We can throw the numbers off, at least in the short term, right? And that's what we're going to we're going to kind of dive into.
Dr. Scott Watier: [00:03:42] Yeah, and that's what the situation happened was, hey, and this happened a few times. And that's why we we, you know, we go over this in all of our challenges that we do. It's in some of our emails that you guys get if you're on our email list. And it's something that we talk about because a lot of people want to lose weight because they know it's better for their health, right? So looking at the current state of the United States, you know, 50 percent obesity, we're approaching that number by 2030 right now, or 42 to 43 percent. Seventy five percent of the population is overweight. We know that carrying that extra weight around with us has long term detrimental health effects on it. And one of those things can be heart cholesterol, blood pressure, those types of things. So yeah, most people come to fasting because they want to lose weight, and they've struggled with the other programs they've tried and dieting mentality and the 20 years of the yo yo diet regain train. Yeah, kind of experience and fasting as I, well, cool. Have you been listening to the podcast for a while? You know, kind of how we apply fasting into our life and we want to break it down into some research, but most importantly, some actionable things and and some education along the way and kind of push the status quo a little bit. But when we're looking at these few situations where people came back and said, Yeah, I did longer fast, well, in the short term, that is going to make your numbers look worse. And then we're going to actually put some question into should we be fasting before we do our blood work anyway. And there's another kind of nuance level into that as well. So Tommy, I want to start with the basic outline of what happens, what happens specifically when you fast, longer, fast before you go into your bloodwork and.
Dr. Scott Watier: [00:05:31] To begin that conversation, I want you to know that fasting in the long term, the benefits of fasting in the long term, when it when it relates to cholesterol, we get these messages all the time and I've seen it in my own blood work and I was able to get, you know, the second from the top tier level, you know, health for your writing class. Yeah, yeah. For my writing class, for my, for my life insurance policy. So just shared some really private information there, but I'm proud of that because I never used to be there, right? So one time they came to do. And at home, you know, physical and your blood and whatnot, and the guy walked in, he goes, Oh, uh oh, he's like, Give me cowboy boots or anything you can put on. I was like, Yeah, he's like, Good, we need to make you a little taller because at that point I was like 240, probably like pretty like still in the powerlifting heavy CrossFit days, right? And I had a tank top on. He looked at me. He was like, Yeah, that's not going to be good for your ratings. So it's almost like we need to fit in this box. So back to the reason why this conversation and we thought it would be beneficial is long term. You should see a decrease in your triglycerides, a decrease in your LDL and a potential slight increase in your HDL, but a healthier cholesterol ratio overall. When you adopt the fasting lifestyle long term, which is the opposite of what happened with these people that did longer fast going into the blood work.
Tommy Welling: [00:06:58] Yeah, focus on the long term benefits there. And like as the as the weight comes off, the inflammatory factors come down and and rebalancing kind of takes place over the long term. But short term fluctuations, especially doing some longer fasts in there or if you get blood work right at the at the perfect wrong time during, you know, right after a longer fast while especially while the weight is still on right, like especially towards the beginning of your fasting journey or before you've kind of figured out what, what kind of rhythm works for you, your numbers could could appear significantly off. So sometimes we have to remember that long term perspective, right?
Dr. Scott Watier: [00:07:40] And this happened to me once when I was doing intermittent fasting and keto, and we're doing a challenge in the clinic. I think we like 40 or 50 people going on in the challenge. And I happen to have some blood work done during that challenge. And my triglycerides were like nine hundred and my wife was like, Are you like, Are you getting pizza like every afternoon or fast food? Or are you? Are you? Are you ingesting
Tommy Welling: [00:08:02] Triglycerides?
Dr. Scott Watier: [00:08:03] Yeah. Like, are you drinking? Like, What are you doing? And I'm like, No, I'm actually down 12 pounds and this is great and my energy is up and my sleep was still crap back then. But so I didn't know that back then. You know, this was years and years ago. But for overall perspective, when you break into your fat stores and your body starts burning fat, those get broken up into cholesterol and triglycerides, and the triglycerides are actually able to be used for energy sources. So those will eventually get burned down, burned off and use energy for the cells. But the cholesterol itself is not used as energy. Cholesterol is used for hormones creation, so testosterone, estrogen and cortisol, which is the stress hormone, is made up of your cell membranes. And this is something you said earlier, Tommy. It's also one of the first things that's released from the liver. When we're made in the body, I should say when you have damage or an injury, so like when you sprain your ankle, your body sends cholesterol to that area to help repair and insulate and allow those cells to kind of repair from the injury. So chronic inflammation, something we're going to be talking about. And the interesting thing is your body makes about three thousand milligrams of cholesterol a day. So the dietary guidelines for Americans, you know, the recommendation of consuming less than 300 milligrams of cholesterol per day, even though there was lack of evidence for that, that's been removed. So one thing we want to learn is that your body is in balance.
Dr. Scott Watier: [00:09:25] So the more cholesterol you eat, the less your body makes and the less you eat, the more your body makes. But it's not exactly a 50 50 split, so that's meaning like endogenous versus exogenous. So the stuff the exogenous cholesterol is, the cholesterol comes from our diet, known as dietary cholesterol, and the endogenous cholesterol is the cholesterol that we produce in our body. The cholesterol that you see on a blood test is the balance between those two things. So you can't have one without the other. And what a lot of people worry about is the food, the dietary type cholesterol, right? The stuff that's coming in. And so when you're eating more, your body produces less right? But the outside cholesterol does not influence the total blood cholesterol all that much. It's a very small piece of that balance, right? So we worry about. And this is where I think the fasting lifestyle comes into play, too, because it reduces the amount of opportunities you have for consumption and making those bad dietary changes and giving in to those cravings because your hormones are out of balance. So you know, things you want to look at are saturated fat intake, body fat percentage, physical, physical activity, lean muscle mass, those types of things. But more importantly, with fasting is, you know, yes, in the short term, we're breaking down those fat molecules and causing more triglycerides and more cholesterol to be produced. But in the long term benefit, getting that weight off is way more important.
Tommy Welling: [00:10:57] Yeah. So just understanding that the process of tapping into those long term fat stores breaks it down and actually raises some of those levels that are. Are going to look bad like they they might look like, oh my gosh, like why are my numbers up right? Like if you get your blood, work back and you're you're reviewing it. But at the same time, you've been going through the process and like, that's deliberately doing just that, at least in the short term. But, you know, like think of those extra pounds that long term fat store as inflammation like the body doesn't want to hold on to it, to excess fat like we have. We have basically like infinite ability to store more fat, but that doesn't mean it wants to do it. That's a that's an inflammatory state. Your body is throwing off red flags all the while.
Dr. Scott Watier: [00:11:42] Yeah, and so again, chronic low-level inflammation can cause increases in cholesterol production because that's your body's natural process. So we always come back to that concept of balance in the long term health metric and looking at before we get into the portion of today's conversation, that is going to be more of kind of questioning the status quo and whether or not we are indeed doing this right. Mm hmm. Interestingly enough, there's a piece of research that we've come across recently, and I learned about this until in the last few months, and this is not something that your doctor is probably going to know about unless they really, really specialize in, you know, congestive heart failure, cardio, cardiovascular disease, but more from a holistic standpoint, not the standard operating kind of medical procedure standpoint or medical system standpoint. Excuse me. And that's not to say that, you know, the doctors and the people that you have in your on your team right now, so to speak, are bad people. It's just that they might be operating in a construct that they, they don't know is not absolutely accurate. And I'm going to say a few things here that might kind of push the status quo a little bit. And one of these conversations that's newer is this concept of remnant cholesterol. And a few things to know overall about cholesterol is it is a minor player in heart disease, which is a misconception because you said, Tommy, that people get afraid of these numbers, right? Yeah, I'm going to do fifty four hours because 12 hours fasting is better.
Dr. Scott Watier: [00:13:13] Well, no, no, no, right? So before you go into blood work, if we haven't said this already is give yourself a few days of more of an intermittent window, have a few smaller meals and a couple of snacks in between. I wouldn't go that far unless you're due to fasting, but maybe maybe two meals and you know something else in between. Limiting the alcohol, limiting the complex process, carbohydrates, those types of things. But yeah, that's again, something you can do proactively. Cholesterol is a minor player in heart disease. Cholesterol levels are a poor predictor of heart attacks. Half the people with heart disease have normal cholesterol. Half the people with elevated cholesterol have healthy hearts. And lowering cholesterol has limited benefits. And you ask me a question, Tommy. So where do you think this came from? And I'm not going to go down the conversation of, you know, conspiracy theories or or heresy or like these random flying off the thoughts right off the top of the head thoughts. But there is research, and we're going to share some stuff with you guys here from Harvard in a minute. That actually came out of Europe, not surprisingly enough. But when the National Cholesterol Education Program lowered the optimal cholesterol levels in two thousand four, eight out of nine of those people had financial ties to the pharmaceutical industry. Hmm. And we're one of two countries on the planet, right, tell me,
Tommy Welling: [00:14:43] Yeah, one or two countries on the planet that you can actually directly advertise pharmaceuticals to consumers, right? And yeah, yeah, there's there's there's some fundamental things, you know, fundamental issues there with with that system. And you know, so like you said, it's not surprising that that in other parts of the world, they're they're seeing that that we might be focused on some of the wrong things here when we're we're looking at blood work and health metrics and things like that.
Dr. Scott Watier: [00:15:12] Yeah, and actually a good example. So an example of exactly that in Japan. In 2007, the Japan Atherosclerosis Society stopped using any tables related to the diagnosis or treatment criteria and its guidelines in regards to total cholesterol numbers. Mm-hmm. It completely removed it. Now, if you look at the city of Okinawa, I mean, there's thousands of people that have lived to one hundred. Right? They have less heart disease, weight less heart disease than we do. So clearly they're doing something right. Right, right. So here's where we get into a little bit of expanding our knowledge and expanding the framework that we can stand on that we know that what we're doing is right for us in terms of getting healthy and the fact that a short term rise in cholesterol is, in our opinion, not necessarily a bad thing. Because the benefit of getting the weight off, decreasing that inflammation and allowing the body to balance naturally without having to use medications, there's a time in place for all of that, but that's where the conversation of the remnant cholesterol comes in. And this is a simple calculation that you can do in remnant cholesterol is defined by total cholesterol minus your LDL minus your HDL.
Dr. Scott Watier: [00:16:33] And I'm not going to use the words good or bad because cholesterol is all necessary, right? But that remnant cholesterol is a much better indicator and you want that to. There's a study out there and it's in the show notes you want that to be lower than fifteen point five milligrams per deciliter. And anything really between 15 and 20 seven shows a very slight increased risk of having cardiovascular issues. So it's not total cholesterol, it's not LDL, it's not necessarily the ratio. It's in Japan, it's not any of it. They've removed all of the charts. It's this this piece of remnant cholesterol and it's relative risk to heart disease. So long term benefit of fasting, once again, is that you're going to allow your body to balance, you're going to get the weight off and you're going to adopt a lifestyle that is going to allow you to keep the weight off so you never end up with that increased risk or feeling like you need to fit into the puzzle.
Tommy Welling: [00:17:31] Yeah, I mean, and that's that's part of the issue here is that, you know, fasting in and of itself. When you when you start, it can feel like you're going a little bit against the grain. But you know what, if you've
Dr. Scott Watier: [00:17:41] Already, yeah, you've already swallowed the red pill, right? Like you're already, you're already the outlier, like the person that won't talk to you at the cocktail party because they know you don't eat right like you're already the weirdo. Can I just say it?
Tommy Welling: [00:17:51] Yeah, you're the weirdo, right? So what's what's one more weird feather in your cap? What's one more like little little badge of honor in your fasting? Lifestyle is kind of looking at your, your blood work or your markers just a little bit different way with a little different perspective, right? Or maybe like zooming out a little bit for at least to pause it for the long term benefits and give it a chance to kind of rebalance?
Dr. Scott Watier: [00:18:17] Yeah, and so. I want to make sure that we land the plane with an actionable take home message here, and the conversation again started with somebody doing extended fasting going into work, right? The recommended amount of fast. So whenever we have somebody ask about, Oh, I have a surgery coming up and I can speak to that because I've had one over the last 12 months on my arm. Mm hmm. Oh, I have an infection. Oh, I have this medication like, OK, do what is recommended for that situation. If you need to take an antibiotic, take an antibiotic, but know that your blood sugar levels are going to go through the roof. If you need to take a steroid, know that your blood sugar levels can go through the roof and that you can increase cravings like so. We always say do what is pertinent to the situation in that moment for the individual and not giving medical advice. Right? So right. You actually got to do so. If it's a 12 hour fast, then do a 12 hour of fast leading up into the blood work. Give yourself a few days of more of an open window, a couple small meals, maybe a four or six hour eating window. And that will decrease your fat cells being dumped into triglycerides and cholesterol levels that you'll see over a seventy two hour, three to five day kind of time period leading up to the test.
Dr. Scott Watier: [00:19:26] But here's where we push the envelope a little bit more. And Tommy, there's a couple of really good quotes out of this article out of Harvard Health publishing Harvard Medical School, where it says farewell to the fasting cholesterol test. Hmm. And this was written by one of the MDS, and this was the takeaway here. We'll get to in a second. But this came out of international guidelines that were published in the European Heart Health Journal, and it had to do with the fact that maybe we're actually doing this whole cholesterol testing thing wrong, and you brought up a good point. You know, going in one time and having. A high number can cause fear and can cause trepidation and can cause like a Oh no, I'm going to end up where my mom and dad were. Oh no, I'm going to have to take a medication, right? Right, right. The reality is, is that that's a snapshot, right? So it's if you've had a test and you've done the fasting wrong leading up to it, then go have your blood test run, you know, in three months. And if your doc says, Well, no, we're not going to do that, then I'm going to encourage you to find someone in that is willing to work with you.
Tommy Welling: [00:20:35] Yeah, yeah. You know that knee jerk reaction, especially if you have like a family history that you're concerned with or something else like that, like you could go in all that. Yeah. But you know, just just doing that, that fifty four hour fast versus the recommended 12 hour fast like an important thing to remember is that they make that recommendation for a reason, like the baseline parameters were set from people that they studied doing those 12 hour fast. So when you start to go way outside of the guidelines for the same test that they've run on hundreds of thousands of people, you're going to start to have very potentially different processes happening within the body. And that could be just a big red flag. You could look like a big outlier, and the knee jerk reaction might be, well, let's let's put some medicine to that right, which which may not even address what's going on or there. There might not be a problem to solve yet.
Dr. Scott Watier: [00:21:28] Right, and it's so it's not just you're fitting within the box, right? That's why we love the fasting for life approach, because each one, each and every one of you has a little different preference on the foods you eat and a little different way that you like to rotate your fasting schedules and the things you like to do on the weekends and your activity levels and your relationships. And God knows everything else that falls in between. So a couple of cool things that came out of this article was these are I'm just going to read the quotes. This is the segment I like to call. Reading guidelines for lipid panels have evolved over the past decade, supported by evidence from studies involving hundreds of thousands of people. Most recommendations now support non fasting cholesterol tests for routine testing. Oh wow. And the reason is because the populations we're studying typically eat two to three meals a day plus snacks, never mind the Starbucks Frappuccinos, right? And it goes on to say, in fact, post-meal measures are thought to strengthen the ability of lipid levels to predict cardiovascular risk, because right now we know that is a low correlation, right? This observation may stem from the fact that most people eat several meals, et cetera.
Tommy Welling: [00:22:38] So hold on, hold on. There's one more thought in there. That means we spend most of our time in a fed state, not a fasting state. And so lipid levels after eating may best reflect our normal physiology right there. So it might be the body's reaction to the foods and to the intake of cholesterol and other macro and macronutrients that we need to be looking at, not what we're what our body is doing at a baseline non fed state, right? Like how well are we reacting to the influx of food?
Dr. Scott Watier: [00:23:11] So the insulin index, we have an episode on the Insulin Food Index, the way your body responds to food in terms of insulin response, right, which is the on and off switch with fat burning. So what you just what we just uncovered here is. Mean, you said it. That means we spend most of our time in a fed state, not a fasting state, so if you're going into a blood work with an extended fasting state, you're actually pushing yourself way past the normal state of physiology, which best reflects our normal physiology, which is what our body does with the food after we eat, which is why we focus on the insulin index of food and not necessarily the glycemic index or the glycemic load. A steak can spike insulin just as much as a carbohydrate. Right? So we are actually in a place now where you're trying to do something great, you've been fasting, you're like, oh, 12 hours is good, I'm going to go to 50 for you, go in now, you're actually future pacing like. And part of this article says, Is this an end to the dreaded overnight fast? Because for most people, like you mentioned the beginning 12 hours, you're like, Oh my god, what am I going to do the dreaded overnight? Yeah, the dreaded overnight fast, right? So some fasting lipid tests will remain necessary, especially in people with very high triglycerides.
Dr. Scott Watier: [00:24:31] Mm hmm. So there are still reasons for that. But what we're trying to do is piece together a long term plan here and give you guys the tools so that you're ready to be able to have the conversations to know that what you're doing is right and give take off some of the pressure when it comes to, you know, things like these health metrics that are so heavily relied upon in our day to day health journey. So I love the conversation. I love these types of conversations. Tell me, because for me, this is where the veil was kind of removed as as a young. If you go back and listen, if you haven't listened to the beginning of our stories, my journey with health issues started as a teenager, so I've always tried to think outside of the box and OK, well, if I'm doing it, everybody else is doing it. It's not working. But wait a minute, what's what's the problem here? So let's dive into it a little bit more. And I just love that fasting can fit so many different lifestyles, different food choices, different ways of living. And you can still get those long term benefits, especially in terms of cholesterol reducing your triglycerides balancing. I'm not going to say reducing cholesterol while balancing your cholesterol and potentially seeing improvements in those ratios as well as the HDL.
Tommy Welling: [00:25:50] Yeah, it's like thinking about the body working at its optimum efficiency, its optimum processing for all of these things. And it does that when when those inflammatory markers are down, when there's balance, when it's not having to worry about 10 or 20 or one hundred extra pounds of long term fat that it's been carrying around for years and years and years. That's that's been throwing out all these false hormonal signals and and increasing numbers and throwing them off on the blood work and then causing the need for more insulin to come out. Every time I do eat more insulins having to come out right, it's like it's a it's a vicious cycle. And if we can, if we can just just focus on on the issue there. And and if if you're having trouble, you know, actually like getting the weight off, then it might be time to just to push some boundaries to create some, some new boundaries. It might be time to refocus on on your time or maybe maybe push to a little bit more of an extended fast than what you've been doing, or if you've been doing more of like a 16, eight or twenty four. Maybe it's time to go to A-MAD and you know, we have a resource for that on on the web page. You know, go to the fasting for life, go to the resource page is a few resources in there. Check out the insulin assessment. If you still don't feel like you can, you can kind of get a handle on it and, you know, use the tools and and push your boundaries a little bit and watch things start to come into balance.
Dr. Scott Watier: [00:27:10] Yeah, absolutely couldn't echo that sentiment more. If you guys are new, go back and listen to your original episodes. We appreciate all of your comments, questions, the reaching, all of y'all that reach out to us with questions. We really appreciate five star reviews. You know those are our favorite. The podcast, the people that control the podcast platforms that were doing good work. And we just absolutely want to continue to bring you actionable things that can really create that long
Tommy Welling: [00:27:39] Term health
Dr. Scott Watier: [00:27:41] Outcome that we're all looking for. We may be on different journeys, but all heading in the similar direction. So, Tommy. Great conversation today. I know we've been thinking of talking about doing blood pressure and cholesterol related episodes for quite some time. So we're here, we've done it. Hopefully, you guys find some valuable outcomes in it. Appreciate the conversation, sir, and we will talk to you.
Tommy Welling: [00:28:02] Thank you. Bye. So you've heard today's episode, and you may be wondering, where do I start? Head on over to be fasting for life and sign up for our newsletter, where you'll receive fasting tips and strategies to maximize results and fit fasting into your day to day life.
Dr. Scott Watier: [00:28:18] Why are you there? Download your free fast start guide to get started today. Don't forget to subscribe on iTunes, Spotify or wherever you get your podcasts. Make sure to leave us a five star review and we'll be back next week with another episode of Fasting for Life.