Often, treatment for patients with type-two diabetes or for those who are headed toward type-two diabetes focuses on medication designed to lower blood sugar. Dr. Brian Mowll wants to reverse the unhealthy mechanisms that led to high blood sugar in the first place.

Based on decades of research and his own practice in functional medicine, the book The ProFAST Diet: Burn Fat and Reverse Type 2 Diabetes in Only Six Weeks, not only provides a plan to get your body back in healthy, working order, but also explains what’s happening in the body that led to dysfunction and how this plan can reverse it.

On Author Hour today, we discuss insulin resistance, visceral fat and its dangers, and why most diets are not only ineffective but can actually make your health even worse.

Jane Stogdill: Hi Author Hour listeners, I’m here today with Dr. Brian Mowll, author of The ProFAST Diet: Burn Fat and Reverse Type 2 Diabetes in Only Six Weeks. Brian, thank you so much for being with us today.

Dr. Brian Mowll: It’s my pleasure. I’m very excited for the conversation, thank you.

Jane Stogdill: First of all, can you tell us what you do for a living? Why is this your topic?

Dr. Brian Mowll: Sure. Well, I’m a functional medicine physician. I’ve been practicing for a little over 20 years. I opened my practice in 1998 and shortly thereafter, started really specializing in helping people with diabetes, mostly type-two diabetes and metabolic dysfunctions–so people who are overweight or obese or hypothyroid or need some help losing weight and improving their metabolic health. We help people in a variety of ways, we use a functional medicine model so that means we’re more after the root cause than just lowering blood sugar with medications.

This particular program that I wrote the book about is sort of a unique program that I use with some of my most challenging patients, people who either really want to make quick, positive changes or sometimes need to. I’ve had patients over the years that, for example, have very high blood sugar or their doctors are sort of threatening them with, “Get your blood sugar down or you’re going to need to go on insulin,” or they’re starting to develop problems like eye issues or kidney issues or numbness and tingling in their feet. They’re highly motivated to do something more aggressive to lower their blood sugar quickly and most of the time, lose a significant amount of fat as well.

This is a program that I have called my secret weapon for many years and I’ve used it with hundreds of clients. Eventually, instead of describing it over and over, I decided to write a book about it, and also, it’s a great way to share it with others.

You don’t actually need to have type-two diabetes to do this program. It’s for anybody who really wants to lose weight or burn fat. I got motivated to put it all together in a book. I spent years doing lots of research into it and I think the finished product is something that is a bit of a manual for people who really want to make significant lifestyle changes in a short amount of time.

Losing Visceral Fat

Jane Stogdill: If it’s designed for people with metabolic issues then presumably, we’re talking about losing weight fast but in a way that’s not unhealthy as so many diets tend to be?

Dr. Brian Mowll: Definitely, we can talk more about what makes certain diets unhealthy versus what we’re recommending, but in particular, it’s about losing visceral fat or the dangerous fat that accumulates in the mid-section of the body around the stomach, particularly underneath the stomach muscles that gives the belly that round look.

People who have a wider waist that’s more than half of their height, which is a measurement of waist to height ratio. When that’s the case, then there are some metabolic fats and visceral fats and deep fat that is inflammatory and causes problems like fatty liver disease, type-two diabetes, and cardiovascular problems, and that’s the fat that we’re really after here. This is particularly for people who have that midsection fat, that visceral fat, or that apple body shape.

Jane Stogdill: Okay, before you get into the diet in the book or the plan I should say, you dedicate a lot of ink to explaining why these problems exist and why they are problematic–insulin resistance and metabolic disorders in general. I want to get into all that, but why is it so important for a reader to understand that before digging into a plan like this?

Dr. Brian Mowll: Well, I think it’s important for many readers, probably not all readers, and some people may just want to skip to the how-to section, but I do think for most people reading the book, number one, it’s motivating to understand why I’m recommending certain things in the book and how this works. I think when you have a good understanding of what’s going on, on the inside, and not only how the solution works but why you ended up with the problems that you have, why you have a hard time losing weight, and why you have a hard time burning fat, why this approach works and is better perhaps for many people than just cutting calories for example.

I think the why is really important and there is a ton of research behind this approach, what I’m recommending here and what I wrote about in this book. I wanted to share that for people who are interested in the evidence-based behind the recommendations.

Jane Stogdill: You write that diabetes is largely misunderstood even by healthcare professionals. What do you mean?

Dr. Brian Mowll: Well, I think most people, including doctors, think of diabetes as high blood sugar. High blood sugar is the cardinal sign of diabetes. They go hand in hand but they’re not equivalent, so high blood sugar doesn’t equal diabetes and diabetes doesn’t equal high blood sugar.

High blood sugar is known as hyperglycemia–medically, that’s the term. Hyperglycemia can come from other things in addition to diabetes. For example, someone could be prescribed prednisone for an autoimmune disease and that could raise their blood sugar. That’s not diabetes but it is high blood sugar. There are other situations where people can have high blood sugar. Likewise, diabetes certainly in its early stages is not always associated with really high blood sugar.

Technically it’s diagnosed when the blood sugar starts to rise. But the underlying mechanisms of type-two diabetes and pre-diabetes relate more to the hormone called insulin, which regulates our blood sugar. The mechanism behind type-two diabetes can be present decades before the blood sugar really starts to rise precipitously, and starts to really rise to where we catch it on a blood test.

I think just looking at diabetes as the same thing as high blood sugar puts us in the situation where oftentimes, doctors will play the wait and see game. “Well, let’s just watch, your blood sugar’s a little high but not that bad yet so let’s just not do anything.”

Five years go by, 10 years go by, and then finally the blood sugar jumps up and then you’re put on medications. What I think would make more sense is to say, “There are some signs that something might be going on here, let’s investigate and fix this problem now before the blood sugar jumps up too high and you need medications.”

That’s where a functional medicine approach comes in and an approach that looks at the root cause and tries to understand why the person is developing signs of diabetes, including perhaps the blood sugar increasing.

There are other signs as well like high blood pressure, weight gain around the midsection as I mentioned, sometimes swelling in the feet, sugar and carbohydrate cravings, and these signs indicate a problem with the way this hormone insulin is potentially working.

If you address them early, then you can stop yourself from ever becoming diabetic. Having a better understanding of what diabetes really is and where it comes from, I think allows you to open the door to earlier lifestyle changes, which can help to prevent diabetes in the first place and help people avoid having to spend the rest of their life on multiple medications or even insulin.

Modified Fast

Jane Stogdill: What is the protein-sparing modified fast? Let’s get into it.

Dr. Brian Mowll: The protein-sparing modified fast is a therapeutic eating strategy, a therapeutic diet if you will–and by the way, the term diet has gotten a negative connotation. The word literally just means what you eat. Everyone is on a diet, every single human being on the planet.

It just depends on what your diet is composed of. The idea of, should you go on a diet or not go on a diet, that’s not really a valid argument because we’re all on a diet. Every living thing is on a diet. The idea is, what does our diet consist of? There are therapeutic diet strategies and that’s what the protein-sparing modified fast was originally. It was created in the 70s by two doctors from Harvard University, doctors Bistrian and Blackburn.

They were doing work with parenteral nutrition, which is what they feed people who can’t eat. It’s basically liquid nutrition in the hospital, and at the time, parenteral nutrition was composed mostly of dextrose, which is basically glucose with sugar and some micronutrients. They were noticing that people were losing a lot of lean body mass while they were in that sick state, and they didn’t know, was it what they were feeding, or was it just that they were withering away because they weren’t healthy?

They decided to infuse amino acids, which are basically the building blocks of protein as part of the parenteral nutrition and they found that these people actually were able to maintain their lean body mass, their muscle mass by doing that.

Then they took it a step further and said, “Well, people who are put on weight loss diets oftentimes will lose lean body mass also. What happens if we keep their protein levels nice and high and restrict calories, will they lose weight without losing lean body mass?”

They found that also was true. They did multiple experiments, clinical trials and created this program called protein-sparing modified fast.

It’s not really fast, it’s what we would call an energy-restricted eating plan. You are eating fewer calories than you would normally eat but the key is that you’re eating adequate, if not elevated levels of protein. The protein keeps your lean body, your muscle mass protected so you don’t metabolize that.

The problem with an unhealthy crash diet, let’s try to match it with what most people are doing, let’s say you’re eating 60 to 70% carbohydrate, 10 to 15% protein and, whatever the rest is, 20 to 30% fat. That’s about the average standard American breakdown for what’s considered a healthy diet. So, let’s say you’re eating about 80 grams of protein and you cut that in half, now you’re eating 40 grams of protein if you keep the percentages the same and that’s not enough protein to protect your lean body mass for anybody. What happens is you do lose weight but you’re going to lose a lot of lean mass as well as fat.

You’ll lose weight but ultimately what happens is your metabolic rate slows down because muscle is one of the primary drivers of your resting metabolic rate–the amount of energy that you are burning at rest–so your metabolic rate slows way down. Then what happens is when you go back to eating 2,000 calories a day, or sometimes more because people with these types of diets they’ll eventually crash and then start consuming 3,000 calories a day because they’re starving.

What happens is now you’ve got an extra thousand or two thousand calories that you weren’t eating before, but your metabolic rate is slowed way down and you’ve lost your lean body mass so now you gain weight and you don’t gain muscle back. You gain fat back because you’ve got all of that extra energy. This is what happens with yoyo dieting and it creates a problem, and research shows this, the people end up getting fatter.

Not only do they gain weight, but they gain the wrong type of weight back, and oftentimes, unfortunately, they’ll lay down this visceral fat that we talk about, this angry fat, especially when they gain weight quickly because they’re laying down so much extra fat that some of it gets laid down around the liver and the organs and in the muscles and that is one of the things that leads to diabetes and pre-diabetes.

The protein spare modified fast on the other hand, while it is a calorie or energy-restricted eating plan because we’re eating adequate or even elevated levels of protein, we have that built-in lean body mass protection, so we don’t metabolize our muscle. Therefore our metabolic rate doesn’t slow down in any significant way and we’re also satiated because protein is the most satiating or filling of the macronutrients. Most people know this intuitively or at least can reason this.

If you were to sit down with something that is high in carbohydrates or something that is high in fat or something that is high in protein, we’re going to tend to eat more of the fatty and carby foods than we will the protein foods. You know, if you sat down with some lean chicken breast in front of you, you’re probably going to eventually just get tired of it and stop eating versus a bag of potato chips or a box of french fries or something like that.

Those you can almost eat infinitely, and the worst combination of all is carbohydrates plus the fat and this is where most people get into trouble. Those are called highly palatable foods, and these are foods that make us want to eat more and more and more. When you add oil and sugar and salt together, that becomes a deadly combination.

Whole Foods

Jane Stogdill: So is the ProFAST diet of your book what we’ve just been talking about or did you take their work and modify it in some way?

Dr. Brian Mowll: Yeah, so it is an adaptation of the protein-sparing modified fast. The story with protein-sparing modified fast doesn’t end there. This has been used in various adaptations over the years. For example, at the Cleveland Clinic, they use a variation of the protein-sparing modified fast for people who are overweight or obese. It is oftentimes used in pre-bariatric surgery for people to lose weight quickly to prepare them for weight loss surgery, and oftentimes, those people actually don’t end up getting the surgery because they lose so much weight using this type of approach.

There was a version of this used by Dr. Roy Taylor in the UK, who did groundbreaking research on diabetes reversal. He showed that diabetes can be reversed in as little as eight weeks with this type of approach. Now, he used a liquid protein type of diet and that’s not what I recommend. I do recommend using whole foods because it’s actually more satiating and helps with compliance, but he showed that it could be done even with liquid meals and that was done within the past 20 years.

There have been variations of this. I’ve been using this program for about 10 years with hundreds of clients, and I’ve learned about it over the years, so I took the best of all of that and created something that is very doable that uses real food and whole food, which I think is important. There are a few key supplements, which are important when you are doing this type of energy-restricted eating plan, but outside of those, everything is real whole food and it’s very satisfying.

We’ve had people go months on this, we typically recommend six weeks but people have gone months on this without any problem and find it surprisingly easy to stick to.

Jane Stogdill: That’s good to hear because that’s often one of the biggest problems. What are the challenges people might face when implementing this and how can they overcome them?

Dr. Brian Mowll: I think it’s really important if you’re going to do this to go in with the right mindset and that is another reason I think it’s important to read the book cover to cover because it will get you mentally prepared for the program. It will help you again, with your big why, understanding why all the recommendations are there, what’s actually happening in the body, and then how to do it of course. By the time you get to the end, we have a whole chapter with questions and answers that walks people through potential challenges, but once you get to that state, you are usually mentally ready to start.

I would say that’s the first hurdle. I don’t recommend doing this program by dipping your toes in the water. I would read the book, get a sense of what is going to be required of you to be successful with it, and then commit to seeing it through for at least six weeks. If you do that, if you get your mindset up properly ahead of time, that’s really the biggest thing. I think starting from that point is really important.

Now there are some challenges that people can run into. It is an energy-restricted eating plan, so the first two or three days, you’re going to have to break some bad habits. And one of those for many people is nighttime eating, another one is snacking. Sometimes those are one and the same, but you’re going to have to break what I call physical cravings or addictions. You know, these are addictions, using that term loosely here, but referring to this overwhelming desire to eat something even though you may not even really be hungry.

We’ve all had that feeling where we have dinner and an hour later, we’re looking for a snack, right? We’re looking for some ice cream or we just want a piece of chocolate or something like that. You are not doing that because you’re hungry. You ate an hour before that so your body is fine, but we have this sort of desire to eat and there’s a big difference between hunger and desire to eat. In the book, we talk about different types of hunger.

One of them is habitual hunger and habitual hunger is like if I had a snack every night while watching TV at 10:00, well, at 10:00 I’m going to feel hungry that’s because I’m used to eating at 10:00. We have to break through that. It takes actually only about three or four days but once you go through three or four days without feeding that habit and you create some new habits like maybe going for a walk or having a nice conversation with your spouse or partner or playing a board game or something like that if you create a new habit at that time, then after about three or four days that hunger will fade.

There is also something called hedonic hunger, which is essentially eating for fun. There are foods that most of us enjoy eating even if we know they’re not the best things for us and so we’ve got to break through that habit also. There are a few things like that that within a week will be gone and then most people find its smooth sailing after that.

There are a few supplements that we recommend, one of them is a fish oil capsule, because you’re eating pretty low fat for this six-week period or however long you end up doing the ProFAST diet, it is an energy-restricted plan, so we are reducing fat intake so that you can burn your own body fat.

Sometimes the skin will get a bit dry and having some good quality omega three fats from fish oil can be really helpful. We also recommend a good quality multivitamin and I’ll also say that this is a version of a ketogenic diet, it’s not the ketogenic diet that is popularized right now, and has been hot here for a little while, but you will go into nutritional ketosis on this program because you are in an energy-restricted, calorie deficit.

Your body is going to be producing ketones, I have a whole chapter on what ketones are and why they’re important and those ketones will fuel your brain. It takes a few days for your ketones to start to rise. The first few days, people sometimes will feel a little bit of brain fog or feel a little bit off, maybe be a little agitated because your body doesn’t have the glucose that it once did if you’re eating a lot of carbohydrates.

Once your liver starts making and releasing those ketones, then your brain gets really happy again, and everything kind of levels off. One of the things that happens with this type of approach though is that you will oftentimes lose a lot of fluid.

Your insulin levels will start to come down, which is a good thing, you’ll start to sort of dump some fluids so you’ll be going to the bathroom a lot over the first couple of days and you can lose some minerals. We often recommend an electrolyte product as well. Those are the three supplements that we recommend everybody takes while on the ProFAST program is a good quality fish oil and electrolyte product. I’m not talking about Gatorade, I’m talking about a healthy electrolyte supplement and then a good quality multivitamin.

If you do those three things, put the time into breaking through those hunger habits and you see it through until your body starts shifting from a sugar burning priority to a fat-burning and ketone burning priority, once you get through those first few days, it’s usually smooth sailing. Most people feel really good actually after that for the rest of the program.

Jane Stogdill: There’s a lot to think about here and I’m eager to check that out because of my own personal issues which are the topic of another podcast on a different network. It’s been such a pleasure speaking with you, Brian. Thanks for the information and for all of your work and research.

Again, listeners, the book is The ProFAST Diet: Burn Fat and Reverse Type 2 Diabetes in Only Six Weeks. Brian, in addition to reading the book, where can people go to learn more about you and your work?

Dr. Brian Mowll: Well, there’s a website for the book called profastdiet.com and I’ve got some nifty calculators there, people can use to help them figure out their macronutrients and help when they’re first getting started with this eating approach, there are recipes and there’s also 50 recipes in the back of the book that will help you figure out what to eat while on this program.

My main website is drmowll.com. I’ve got a blog there and lots of other helpful information. I have a podcast called Mastering Blood Sugar which has been rated as high as number one on iTunes in health, so check out the Mastering Blood Sugar podcast on Google Play or iTunes as well.

Jane Stogdill: Great, thank you so much.

Dr. Brian Mowll: Thank you for having me.