not only did he fast for 5 days but he ran five complete marathons but not only that he was a type 1 diabetic I brought him on today to talk to him on how the hell he did it and how he survived I would argue it's more difficult to get into ketosis a type one because we have to inject insulin a fat burning body has to have low insulin levels in order to release the fat do they ever advise to go 5 days without any food I think you know the answer to that so I
have a fascinating interview today I mean this is going to be a bizarre interview because here's a person a doctor Dr Ian Lake who did some wild wild crazy things that he probably shouldn't even have survived this but what he did not only did he fast for five days but he ran five almost complete marathons 100 miles in five days but not only that he was a type one diabetic so I brought him on today to talk to him on how the hell he did it and how he survived welcome Ian thanks for coming on
Hello thank you nice to meet you nice meeting you so first of all you're a medical doctor you're a type 1 diabetic if we take a look at like the the main consensus of the medical community with type one um do they ever advise to go five days without any food I think you know the answer to that um it's very difficult to persuade um anyone to um ask us to fast and Skip one meal so um I was trying to work out a workaround for uh how we can convince people that one meal skipping
would be safe so this was an extreme version of skipping a meal really you know to to prove this point um you you went to the extreme and you did this with how many people uh eight people eight people did this so you you basically uh did a combination of a few things that were very difficult to do on their own let's first talk about how many calories you actually burned within 5 days was it roughly about what 20,000 calories yeah it was roughly 20,000 calories so we worked out how many calories we'd need to
if you believe in the glycogen storage depletion idea to exhaust our glycogen storage tfold to make absolutely sure we were in ketosis so we worked out about 20,000 calories would be required I think we used a little bit more than that from memory but we didn't actually physically record it um the the other thing we wanted to do really was to um show how safe um nutritional ketosis really is so we wanted to put ourselves into very deep ketosis so that was the rationale for doing this ready okay so so just to back up on
U just for those people that don't know what the word um glycogen is you depleted your glycogen that's just the stored sugar in your liver right so when you when you exercise you're going to use that as fuel and then after that's gone you're going to tap into your fat reserves right exactly yeah yeah so um typically first let's start with a diabetic what is the difference between a type one and a type two someone with type one diabetes cannot produce their own insulin in enough volume to maintain blood sugar because one of the key
features of insulin functions of insulin is to reduce blood sugar and keep blood sugar at at an even rate um and someone with type 2 diabetes has more than enough insulin in fact most people with type 2 diabetes have too much insulin and theirs is due to an overfueling issue such that their body cannot handle the amount of fuel that they're putting into their bodies mostly carbohydrates so there's a big difference between the two conditions type ones we need to inject insulin because we don't produce any and in type twos they need to adopt a
lifestyle strategy that naturally reduces the amount of insulin they're producing so they're not at all comparable conditions so if insulin lowers blood glucose and a type two has high insulin shouldn't they have low blood glucose they become insulin resistant this is the problem people with type 2 diabetes um the various ideas on it but their fat cells sort of stop the body sort of taking on more fat and they become resistant to the amount of insulin they've got because as well as lowering blood sugar insulin is a hormone that stimulates fat deposition so it's a
fat storage hormone as well as a glucose luring hormone and the two things work together so in order to lower blood sugar you either exercise or you you put it into your into your liver initially and then into your adpo tissue or fat tissues as fat so we think of is insulin as a glucose lowering hormone and a fat storage hormone primarily okay so when someone um is a type one they don't have the insulin to regulate blood glucose so what's what's going to happen when they start exercising and not eating they don't have fuel
they obviously they they have to tap into their fat reserves right um and um talk a little bit about that as well as a really key issue which is is um adapting to running on fat or ketones explain that process our body can multifuel so we can use sugars and we can use um fats for our fuel and of course fats will break down into Ketone bodies and we can use Ketone bodies as fuel as well so in the ideal situation our bodies can flick between whatever fuel they need for the requirements at the time
so whether you have type 1 diabetes or not if you're performing exercise as like a Sprint without any Oxygen you will have to use glucose for your for your energy source but if you're doing a more aerobic or more relaxed um uh amount of physical activity you're burning oxygen and you can choose really whether you're using um glucose or fat as your fuel however um you're limited a little bit as to how you can select your fuel because if you have too much insulin on board you're blocking fat burning so fat burning is impossible if
you've got too much insulin on board now people do burn fat when they are exercising and there's this fat burning Zone which is otherwise known as Zone 2 because there's a hormone that called hormone sensitive lipase which is which um enables fat to be burned and that is also stimulated by um uh lowering insulin or adrenaline cortisol growth hormone things like that so stress hormones will release that but if you have too much insulin it will override those hormones and block fat burning so then you become entirely dependent on on glucose so most people with
type 1 is will be dependent on glucose because they're not encouraged to burn fat so we tend to have too much insulin on board so our bodies are multifuel we can flick between fuels as we need them and if we if we're fat adapted all that means is that your your fueling choice for your for your just your food will be low carbohydrate so low carbohydrates um require less insulin in to to either be injected or for your own body to ruce insulin because because as type 1es we're exactly the same as people with with
no diabetes and our insulin requirements except we just know how much insulin a non-diabetic body would need for the same for the same requirements so a fat burning body um has to have low insulin levels in order to release the fat am are you still with me that yeah so basically um in order to get into the fat burning we must lower insulin that's really the key factor right exactly so then then we can free up the fat burning and and when we're adapted and takes about 2 to three weeks to fully adapt some people
would say it takes even longer and then the your body will naturally burn fat quite happily produce Ketone bodies and have a very low requirement for sugar the important thing about glucose or sugar is that we don't need to eat sugar in order to produce it our body will produce more than enough for our requirements and obvious example of that is those poor people that get pulled out of disaster zones like earthquake zones and they haven't eaten for six or seven days but they haven't expired because they are producing enough energy for their body requirements
some of which will be sugar so we we we respect the fact that our body is multifuel and we wanted to show in this um 100 mile run that we can safely use um Ketone bodies and fat as fuel and have no requirement for insulin uh sorry no requirement for sugar at all incredible okay so um there are a lot of people they're trying to um lose more weight they're plateaued you know I've been telling people the most you can lose per week is two pounds of fat uh that's if you're healthy but this experiment
that you did if I'm not mistaken correct me if I'm wrong but I think um on average um all of you lost about what almost almost seven pounds of fat in five days right yes okay so um to get into this keto adaptation obviously you're going to have to either lower your carbs and of course fasting is lowering your carbs yes and um and then on top of everything else you're exercising so if someone were even to think about doing a fast do you have to um work up to it I mean you're not going
to just start running and not eating right away I mean you're going to have to you said it takes um weeks to get into the keto uh adaptation more or fat adaptation um tell us a little bit about how someone can work on getting themselves into the keto adaptation state is it just a matter of low carbs or do you have to maybe combine fasting at the same time both are very useful to do um the only way you're going to produce ketones being ketosis is to burn fat and and and ketones are a natural
product of fat burning so in order to fat burn you have to lowerer your insulin in order to lower your insulin you have to reduce the the main fuel that stimulates insulin namely carbohydrates so carbohydrates are the prime driver in our diet for insulin production so cutting down your carbohydrates is is very important and severely restricting your carbohydrates to what we call the ketogenic zone so your body has then to burn fat you have to force your body into fat burning that's around about 30 to 50 gram of carbs a day which is about a
tenth of what most people would naturally eat right it it's not difficult to do but you have to sort of you have to concentrate on it especially if you're um you you like sugar or you're a little bit addicted to Sugar it takes a little bit more willpower um don't forget when your insulin levels drop um naturally as a result of not eating carbohydrates you will actually um urinate a little bit more because your your insulin will enable your body to excrete salt or sodium and with the salt goes the water so it's important to
replace the fluids and just drink more some people say constipation is an issue fluids are very very good for that and it doesn't last it only lasts a few days if if at all and the other thing is you may need to think about replacing some of your salt magnesium sodium you know table salt or whatever because of this salt excretion caused by the the lower levels of insulin and after that it's pretty straightforward you go into ketosis within within days um type ones we can go into ketosis after the first meal because we have
to inject our insulin so we don't have to wait for it to reduce in some ways um and fasting is is useful because it makes you much more insulin sensitive so if you're fasting you become more sensitive the insulin you've got so you'll naturally be be more able to get into ketosis and that's it really um one of the big breakthroughs I had so when I learned about the ketogenic diet just completely by accident thank goodness through the internet you know I'm a medical professional I've never heard of it in in the training materials that
we're given um I started doing a half marathon a month I thought that was good for me because I'm not really an athlete in many ways I'm just an enthusiastic jogger and I thought well if I do a half marathon a month as Keo that'd be a great experiment so the first two I actually fueled up with with with protein bacon eggs or whatever and I thought well you've got to have some energy before you start running you know that's what we're all was told you got to carb up you know you got to have
your pasta and your bananas or whatever if you're carbing up so I thought well I'll have that and then I got involved in the bulletproof coffees which were a bit of a fat at the time in the sense of butter and coconut oil in your coffee and then on the third one finally finally you know stupid me I thought well why am I actually giving myself energy before I'm running filling my stomach up and they diverting blood flow away from my muscles if you like when I'd worked out that with my body fat Mass I
had 85,000 calories of fat and I have a body mass index of 23 uh plus I have um so 85,000 calories I have 17% fat Mass so it worked out about 85,000 I think so that's our average sort of fat mass and um so I thought well why can't I just burn the fat that I've got or I take it in if you see what I mean so it took a while to get out of the habit of doing physical activity for pH doing s sorry fueling up for physical activity I thought well I've got
the fuel all I all I'm doing is just burning it at probably you know my slow jogging speed twice the rate that I've burning it when I'm walking so it wasn't a big deal to think well you can fast actually when you're doing physical activity of course that that that was wonderful from the point of view of type 1 diabetes because there's none of this complicating worry about injecting insulin when you're having carbs so that really freed things up so on top of that I well let's just extend the half marathon and try to just
sort of nudge the envelope to to put Beyond doubt this concern that type ones need insulin U need car carbohydrates if they're taking insulin and put Beyond doubt the fact that if you're in nutritional ketosis it's not a risk for what's called diabetic keto acidosis which is a very severe complication of type 1 diabetes and the two aren't the same thing but they're often confused by by clinicians as as as nutritional ketosis will lead to diabetic keto acidosis oh okay so let's talk about this because this is a complex topic we'll simplify it tell us
in simple terms to a fifth grader what is keto acidosis okay so if your body is not producing insulin at all um you cannot then um put glucose anywhere so any food that you eat or any sugar that your body is producing natur natur Al um cannot be put into cells actively so you can't get rid of sugar in the blood so if the sugar can't be removed from the blood into the cells the cells are relatively starved of energy so then because insulin is not existent so this is a type one problem it's it's
purely a type one problem if insulin is not existent then you you cannot store fat you have to burn fat so not only do you get build up a blood glucose but you get a runaway fat burning now ketones normally feed back on all of this process and stop the KE stop themselves Rising all the time but if you've got no and they make the body produce more insulin but if you got no insulin you can't stop that process so you get a combination of high blood sugar high ketones which the body tries to vent
by getting you to breathe them out or pee them out and and also you pass a lot of urine because your your sugars in in your kidneys is so concentrated it drags the fluid out with it and that makes you thirsty so um that becomes a medical emergency um even people like myself who are in nutritional ketosis are a risk because sometimes if you get a septicemia or a very severe infection it means you need a huge amount more insulin and a lot of us are a little bit resistant to taking that so for example
when I had covid which was only like a cold for me luckily uh my insulin requirements went up from 20 units a day to 60 units a day if you mean so so person with no diabetes would have the same insulin requirement and but they would not go into keto acidosis because they've got natural insulin on board to protect themselves we have to inject it so it's totally different to nutritional ketosis which is just a a lowering of the natur of the insulin that you inject or your natural insulin and and it's just a regulated
process if you got insulin in your body sufficient you will not going to diabetic keto acidosis so the risk of getting keto acidosis really is if you're diab IC and you do forget to take your insulin yes an average person a healthy person starts a ketogenic diet and someone mentions well usually you're G to see this in the news oh yeah you're gonna you might develop keto acidosis that's pretty much a myth yes 100% it doesn't it doesn't um it doesn't work with the science got it yeah I know I I've seen that so many
times um now as far as um this adaptation into just keto adapted or fat adapted you work with patients I'm guessing you probably help them with their getting on a ketogenic diet I'm guessing um do you find that some people have a harder time fasting for a longer period of time than others or is that dependent on insulin resistance and it's just a matter of time and and and doing it over a period of time where they can go longer and longer without eating or what's your experience on that my personal experience of fasting was
that it was quite difficult in the early stages it's difficult getting through the first 24 hours because I think psychologically you you're you're geared to have a hard time you think you're going to have a hard time uh and and I think when your body suddenly gets this shock of not eating um you know it makes you want it makes you hungry and and but I think most of it is psychology um and certainly when I did my first fast I was lying around in the afternoon you know I started my fast in the morning
think oh pull me I'm hungry I must drink and I'm feeling weak but after day two and three you get used to that effect and it becomes it becomes normal and from day two onwards um with subsequent fast there's no hunger at all and the choice to break the fast was just really you you got to eat at some point if you see what I mean so subsequent fast became much easier to do um and um because you were aware of the changes in your body the trick was to dial down your insulin because you
were not requiring as much insulin when you were fasting so the trick was to get the insulin levels down to to a safe level for you to not have high pose when you're exercising but it was not difficult to do okay and then what about so then we put this layer on top of fasting this exercise um you know people are they have this idea that they have to eat like like you mentioned they have to eat to get the energy to exercise but once your keto adapted after some weeks you probably can then exercise
and fast at the same time and um get your fuel from fat that's exactly what I do all the time it's so much easier to to manage physical activity when you're fasted I mean if you think about it the wild animals I mean you never see an eagle uh flying to hunt if it's if it's not hungry I mean we tend as humans to go and get our food when we we're hungry because there's more of a desperation to go and get it so and then we will eat our food satiate ourselves and then and
and then you know we we're just naturally lazy aren't we humans so we wouldn't actually go out if we've got a covered full or if if our tum is are full so I I don't think it's unusual to be exercising when you're fasting and because you have such a store of fat in your body you know it's it's 85,000 calories compared to say 2,000 calories of of stored sugar which is there more for uh you know sudden energy requirements um it it you don't need to worry about burning you know a couple of thousand calories
of fat which will be around 20 miles of of of walking or running and you'll put that back on again when you when you get your food source so you're not talking of depleting your energy source to any significant amount so I think that is the key to it you just have to understand that nothing's going to happen in in a two three days five days of fasting the reason we didn't go further than five days was because we were starting to worry then about are we going to start breaking down protein because at some
point you're going to run out of your sugar stores and you're going to start to need to burn another fuel to get the sugar that your body naturally needs to produce so we wanted to restrict it to 5 days so we were we were pretty sure we wouldn't be burning any any protein because at some point you're going to be burning your muscle mass or your protein stores and and we we generally think that muscle mass is is is use useful to have have more of than less of so we didn't want to get into
the situation where we were criticized for starving ourselves because this wasn't star it was sort of starvation because we weren't eating but it wasn't what I would call serious starvation because we were controlling the fat burning and not encouraging protein um degradation we had some breath testing to to show that we're in fat burning mode our our respiratory quoti test and it showed that all of us were in fat burning mode all of the time so was quite good and then you also tested your Ketone so typically I know there's a couple different values um
um but the the values that they use in in the US would be probably a little more helpful but if you're just doing a low carb diet you're going to be within a certain range what like maybe3 to maybe one to maybe two and then you start fasting you're going to be higher if you had exercise you're going to go higher can you can you just tell me roughly kind of how that works a little bit yeah so 75% of people with type 1 diabetes are in the range 0.5 to 1.5 that's the blood ketones
be that's that's pretty average I would argue it's more difficult to get into ketosis a type one because we have to inject insulin and we tend to have to use more insulin because we put it into the skin and it doesn't act as as naturally as it does in some of no diabetes so that does tend to block a bit of fat burning but we can get safety into ketosis when we did the run my ketones went up to six five and a half six or something like that for a couple of days and my
other friend John the other type one who was running with me uh he's went up to around about the same we wanted to test ketones twice a day for 5 days and we wanted every one of the the eight uh participants to do the same because we wanted to show that you don't go into deep diabetic keto acidosis if you're in nutritional ketosis so when we pulled the graph of eight people twice a day for five days and just did bar chart you could not tell the type ones from the non-type ones out of that
group of eight so we we we were confident that we were in the same nutritional ketosis State as our non-diabetic peers the other interesting thing that I I heard or I read in your your website that um as far as you would think that uh people would get extremely and very very have to you know really have to spend more time recovering wasn't there a point about there was there was not much soreness going on which is very unusual it was unusual when we started we were we were pretty confident that we'd be okay when
we started um it was a bit tricky in the early stages but not one of us had any injuries at all and none of us had recovery problems uh we all managed every single day to to complete our task and none of us had any aches or pains the next day which was remarkable but last year about this time of year I did a 150 mile run in a week it was along the canal network of Britain so it was flat and and equally it was keto is I was on a keto diet then I
wasn't fasting but equally I had no injuries or no soreness at all it seems to me that the anti-inflammatory effect of ketones is is is very powerful with in sport and I've met lots of people I've interviewed a professional Rugby Union player uh in the UK and he said when he went keto he was a type had type 1 diabetes he had his best year as far as injuries went in the year after he started his diet so there's something about keto which is is anti-inflammatory and and good for Recovery fascinating what's the uh longest
you ever like I know um you know we're talking about 100 miles or 150 miles what's the most you've ever ran and uh over period of days I guess in a row well that was the uh in a the longest distance I've ever run is 35 miles that's the longest I've ever run that's in one day one day that was a run walk rather than the run more like an ultramarathon type of thing uh mostly I just do 10K 15K I'm not I'm not a great fan of long distances in that sense um you know
I I'm not worried about doing 20 miles a day it wouldn't worry me but um it takes a lot of time to keep practicing for that so I'm a bit lazy in that sense I mean you're pretty a lean guy right yes so you and and you still had how many calories of fat on your body with your lean body mass well I had a normal body fat mass for for my type and and it was 85,000 calories 85,000 calories and someone who doesn't have a weight problem so that's plenty of extra energy to be
able to you know do this activity I think that's exactly it isn't it it's just getting the mindset right and as I said it was a it took me quite a long time to realize that I can actually do physical activity without without fueling it first I could fuel it when I was doing it and not have to worry and that is so freeing especially anyone here have type one diabetes you don't have to worry so if someone came up to me said now would you like to go for a run or would you like
to go for a cycle ride and say yes let's go I wouldn't say oh my goodness what am I doing with my insulin I'd obviously check it and I'll carry sugar glucose if I needed it but I wouldn't I could go I wouldn't need to prepare for it and it's that spontaneity certainly in type one that is so freeing for people wow when people do marathons I know they um they consume I guess it's called is it called goo or this gel it's some type of starch or or glucose that creates a lot of uh
digestive issues and a lot of side effects when they're running I I've heard anyway I don't know if you've observed that certainly I mean before I went into the ketogenic lifestyle diet I I used carbs the same way as everyone else because no one had told me and obviously the conventional way of managing diabetes with physical activities to manage your insulin on board which is the big problem so if you got too much insulin on board which most of us have most of the time because of the way we inject it under our skin not
into a natural space um You're vulnerable to host so the the protocol for managing type one sports is to reduce your insulin even the night before and add carbohydrates to your fueling regime 60 grams of carbohydrates per hour is recommended and imagine trying to eat that much when you're trying to to do physical activity because you know as stomachs really should be empty even my mom told me you know when I was eight that I shouldn't go swimming after after a meal because our bodies don't we can't exercise as well when we've got fuel uh
in our gut really it needs to be in in the right place so it's so much easier yes and and you don't have that anymore that's not an issue if you do happen to go hypo it's it's six grams of carbs or something it's absolutely nothing there's a lot of different versions of Keto I'm just curious what kind of um plan are you on now or in the past yeah I I I go from different ideas to different ideas at the moment I'm more carnivore than I have been for a while um I will eat
green leafy vegetables and salads I do eat fish and dairy nuts I'm a little bit wary of because I think they cause insulin resistance some of the nut oils in in me personally um and probably some of the oxalates cause joint pains a little bit wary of that um I I avoid all seed oils of any sort and um obviously I don't I don't eat sugar or or anything like that I I do take Dairy I find that milk and cream aren't very good but cheese is okay and and for some reason yogurts seem to
be okay so it's a mixed diet at the moment tending to carnivore I can never make my mind up on protein I'm still the jur is out for me on protein I've been doing the Burnstein type of more protein than fat type of thing for a while and then I felt that I don't know I mean I've gone more fat than protein for now but I always stick roughly within I'm 75 Kg and I last time I I estimated the amount of protein over a week it was 100 grams of protein per day so 1.2
uh grams of protein per kilogram of ideal body weight most people would say .75 to one so it's on the higher side but um yeah that's what I do I I find that some foods certainly the leafy veg can be a little bit Carby and you have to be a little bit more careful with your with your blood sugar control I do find that meat fish eggs um are the easiest foods to use there's no doubt about that but but you know but but I do eat um a variety of foods as well um alcohol
I've gone off it Strangely I used to drink like red wine prco I love beer but I can't drink it anymore I'll have probably two two glasses if I'm out on a nice summer's day with friends or something because that's just what you do you know especially in the UK take a h you have to live your life that's right sunny in the UK yeah and um but alcohol I find just my body tells me I don't need it but I have drunk it in the past and I I will drink it but it's not
something that features heavily in my in my diet anymore you used to more five six years ago probably yeah me me too I I I can't tolerate any any more than a sixpack on a weekend I can't tolerate any more than that but um no I don't I don't drink at all anymore but uh wow this has been fascinating I think um um I want to send a lot of people to your website I'm going to put your link down below but thank you for coming on and I really appreciate this these insights on this
crazy thing you did which actually is not very crazy you know it goes against what's called what medical wisdom which I don't even think is wisdom right it's just again the certain fixed ideas that the medical profession has that end up you know not being 100% true so uh this has been fascinating thank you so much thank you very much thank you
