Dr. Boz [Annette Bosworth, MD] - Autophagy Fasting: The Mystery Explained by Dr. Boz

Hi, I'm Dr. Bosworth, and welcome back. I have another video for you today and a blog post along with it that's about something very strange called autophagy. If you've never heard of that word, that makes you normal, but the Nobel Prize in Medicine in 2016 went to exactly this topic, and it couldn't be more appropriate for the timing of this information. I contend that every baby boomer needs to know this information, so tune in and put on your science caps, because this might be a little sciencey, but I'll walk you through it.

Autophagy literally means "to eat thy self." Autophagy: eat thyself. Sounds super weird, right? The Nobel Prize in Medicine in 2016 went to Yoshinori Ohsumi, who has been looking into this strange process for practically his whole lifetime. We've always known that the body has a way of cleaning up debris inside ourselves, inside our bodies, and keeping that level of junk, if you will, low. We knew that it worked better in some people and not so much in others, but we didn't know how it turned on, how it worked, or how to turn it off. This Nobel Prize in 2016 outlined how this works.

Baby boomers, pay attention. This understanding of autophagy might be medicine's saving grace for that generation, given the bad advice we've given you. Your generation has endured more procedures, more surgeries, and more chronic diseases that escalate in your lifetime, and has become fatter than any generation ever documented before. This might be the one thing in your lifetime that could rein in or hone in on the problems we've given your whole generation. So this message is specifically targeted at baby boomers and why they should care.

Brain biopsies tell the story best. We know that when brain cells and brain function are doing well, we can look at tissue from that brain under a microscope and find very little debris, very little junk, also called plaques or neurofibrillary tangles. Think of it as rusty leftover cell parts hanging out in your brain, where the dump truck should come along, pick them up, and scoop them away. For some reason, in your brain, that hasn't been done well. A little junk hanging out is no problem, but as it builds up over the years, it becomes a predictor for diseases like Alzheimer's, Parkinson's, and memory loss in general. Before you ever have a day where you miss a memory, where you glitch and can't think of a word, if we went back in your brain about five years, we could see that debris or these plaques were already building up. By the time you come to an office visit and say, "Doc, there's something wrong with my memory," we're usually 15 years into a whole pile of junky debris throughout your brain. Autopsies have proven that when we study how badly a brain's function is impacted, one of the predictors of function is how many of these plaques or neurofibrillary tangles are hanging out in the brain. You want those to go away.

That's autophagy. It is the cellular process that says, "Hey, this cell isn't working very well. Let's clean it up and see if we can make it function better." I want to compare that to another science word, apoptosis, which is programmed cell death. Every one of the cells in our body has a lifespan it's supposed to live for, but you can sell yourself short and have those cells not live as long, or have them live even longer than expected, based on the processes that ignite programmed cell death. If a cell is swollen and inflamed and living under chronic stress, we know its life is shorter; those cells don't live as long. I'm talking about heart cells, brain cells, lung cells. Every cell in the body turns over at a certain interval, but under times of chronic high stress, and specifically chronic inflammation, those cells don't live as long. Apoptosis says, "This cell's life is used up, it's over, throw the cell away." Compare that to autophagy, which says, "This cell has a lot of junk in it. We're going to clean up the different parts of that cell and recycle that nourishment for the rest of the body."

Why should you care? All this sounds way over most people's heads, and they don't care, but you should care if you're a baby boomer and you're overweight. The answer for why people should care is the flabby skin left over after weight loss. It's embarrassing, the number of baby boomers who have said these words to me: "Yeah, Doc, I know I should lose weight, but you know, it would leave me with too many wrinkles." Yes, they say that. I have good news for you: if you induce autophagy during your weight loss, your body will recycle those deformed cells that made those wrinkles in the first place. Autophagy is a process where the body recycles and uses unused or deformed cells for nourishment.

One more example. Let's take the tale of two people losing a hundred pounds. A hundred pounds is a lot of weight, and when you do that, you'll find that most people on today's low-calorie, otherwise known as torture, diets trickle food in at a low level of nutrition. As their body metabolism shuts down a little bit further every day, every month, they do lose a hundred pounds. But the difference between someone who has lost a hundred pounds on a low-calorie diet and someone who has lost a hundred pounds while igniting their autophagy is skin. A "skin curtain" is the word we in medicine use for the leftover flabby skin in the arms or abdomen when people have lost massive amounts of weight. The solution medicine has come up with for that is, of course, surgery. The surgeon goes in and trims off the extra skin, but under the skin there is much more to the story. The blood vessels, the connective tissue, and the places where all those fat cells were filled with stored fat still exist in these patients. They weren't recycled, they weren't gobbled up as they would be with autophagy. Autophagy ignites the process where the body absorbs not just the skin cells but the blood vessels, the connective tissue, and all the other material inside the human body that was filling space when fat was there and is now gone. In autophagy, the system uses those cells as a form of nourishment, and with that weight loss you can see the skin held tightly to the muscles.

Autophagy is a big topic of conversation around people losing a lot of weight, but it should be just as important for people trying to undo a chronically inflamed brain, heart, or other system in the body, where chronic inflammation has left junk and debris hanging out. The body simply didn't have the resources or the chemistry set present to go gobble up that extra debris inside the cells. So autophagy is a good thing, and inducing it means you need a certain chemistry set. What does that, in a word? Fasting. Yes, I know this word sounds like a curse word; when I first introduced it to patients, it did. But fasting sets up a chemistry set that allows the body to find resources throughout the system. It's really important to distinguish between a low-calorie diet, which is a trickle of calories coming in, and fasting, which is zero calories coming in. If I take a patient who's on a standard American diet with 100 to 300 grams of carbohydrates a day and I want them to induce autophagy, I will need to keep calories out for about 72 hours before their system induces autophagy. If you've ever tried to do that from a high-carbohydrate state, you won't like the person who's forcing you to do it. It's not comfortable. People have lots of hunger pains. The transition from a high-carb situation to zero calories is painful; it causes hunger and is very unsettling.

Now compare that to someone in ketosis, who uses fat as their fuel most of the time and has less than 20 grams of carbohydrates coming in a day. When we stop their calories, you can see autophagy ignite within as little as 12 hours. More often, ketosis status is reached by 24 or 36 hours, but you can see the process begin in as little as 12 hours. That can happen every day. Take one of my ketosis patients, with suppertime around five or six o'clock. If they fast until morning, which is eight hours while they're sleeping with no calories in between, you can see their bodies ignite a little bit of autophagy every day. This is amazing for what it does for the cleanup crew inside their 70-, 80-, or 90-year-old bodies.

I have a couple of patients who come to my autophagy support group every week, and they're in their 80s. They embarked on a seven-day fast specifically because they wanted to ignite what happens during autophagy. They had been in ketosis for several months, and they had done a 12-hour fast, a 24-hour fast, and even a 36-hour fast. They did these without much trouble and had a pretty positive experience with fasting. After reading and learning about autophagy, they wanted to do a seven-day fast. I wouldn't recommend this to most patients in their 80s, but they had quick access to me, and they were great about checking their biomarkers. They checked their blood pressure, their blood sugar, and their blood ketones, and they had quick access to me throughout. With that process, they made it through day four, five, six, and all the way through the seventh day without any calories. I can guarantee that inside their 80-year-old bodies, they awoke cells that had been dormant for many years. The cleanup crew was trying to take any little morsel of debris that wasn't being used. They ignited their cleanup crew to do things their bodies shouldn't have been able to do at 80 years old in today's world.

Going back a couple hundred years, this wasn't that uncommon. Times when food was scarce for seven days were not an unheard-of situation. Today's access to food has made autophagy almost a thing of the past, and I would contend that until this Nobel Prize came out, most of my colleagues didn't even know about the word.

I want to close by saying that autophagy is the scientific term that means "eat thyself." It is ignited when your body has been in ketosis and you go without calories for 12 hours or more. You can induce autophagy from a carbohydrate-loaded diet too, but it takes many more days and is very difficult. Using this newfound science gives us a great tool to guide patients in ways to help clean up the debris from their chronically inflamed brains, bodies, and tummies.

I hope this was helpful. It was kind of sciencey, but it's a really cool understanding of what happens inside our bodies. I'd love to hear your comments below, so send them to me and I'll try to answer them. If you'd like to learn more about the ketogenic diet and things like autophagy, you can check out the book I wrote, which is available on Audible or Amazon. Until next time, I'm signing off. Dr. Boz.