149. Progress Note #17: Fasted Cardio & Training, Optimizing Nutrition, Workouts, Sleep, and Stress During Ramadan

Welcome to Medicine Redefined, a podcast focusing on helping you reclaim ownership of your health. I'm Dr. Darsha, and I'm Dr. Altamasharaja, where your hosts, hair to challenge conventional practices and uncover the stories behind pioneers shaping the future of medicine. Our conversations not only focus on the individual level to dissect common practices for health optimization, but also zoom out to enhance systemic change. Join us as we look to break the status quo, move the needle forward, and put the help back in healthcare. Hey everyone, real quick, we are excited to share that we launched our newsletter. It contains high yield insights from our guests and tips and tricks from us. We want to put the health back in healthcare and invite you to do the same by giving you the necessary information to live your best lives and provide value to those around you. Make sure to head to medicineredefined.com, where you can input your email and stay up to date. Okay, time for the episode. Alright, Altamash, what's up, man? Got an interesting topic ahead of us today. Yes, I think this is going to be a popular one. There's a lot of misconceptions, debate, strong opinions about this, so hopefully people enjoy it. Yeah, so we are going to be talking about Ramadan and essentially health during Ramadan. And, you know, why don't we first start off with what Ramadan is? I'm sure people may have a basic understanding of maybe how long it is and oh, there's fasting involved, but give us a little bit more context of what Ramadan is, why it's celebrated, just so we can put even a little bit more context into what we'll be talking about. Yeah, and just so, you know, hopefully we're not losing anybody. More than just Ramadan, right? It'll also be about fast-training, fast-to-cardial, all things of that nature. Of course, we're doing this because it currently is the month of Ramadan as we're recording it in mid-Barch, and so, you know, that just I think is only going to add because there are some nuances. But for those who are familiar or not familiar at this point, you know, Ramadan is a holy month in Islam, although there's nothing holy about this conversation, or maybe there will be, I don't know. But it's, you know, Muslims worldwide will celebrate this. It's typically a month long, and it runs on a lunar calendar, and so what that means is the lunar calendar is 354 days a year, as opposed to the solar calendar, 365. And so, it shifts back every year by about 11 days, right? That's why it changes. Sometimes you'll see it in the summer, other times, and it's in the winter after a couple of years. And basically, from a nutrition standpoint, from dawn to dusk, we do not, or anybody who's celebrating Ramadan and participating in it, is not supposed to ingest anything like nutrition, like food, water, even chewing gum, taking medication, things of that nature. And you're fasting from other things too, from the religious aspect of it, but we'll just keep it focused to nutrition for this conversation. And you know, along with that, people are involved more in their worship. And so sometimes they're worshiping and praying and things later into the night. And so the sleep quality and quantity is disrupted as well. Of course, you know, we mentioned fluids, and so dehydration is pretty profound. And so, you know, it also tends to be a cumulative effect as the month progresses. And so considering all that, you know, things that we've talked about, in fact, you know, one of my high school friends was also a coach, reached out recently talking about training modifications and optimal timing of training, which we'll get into later in Ramadan, considering all the things that I've already mentioned. And so, you know, with that, I thought it would be good for us to talk about just that and just fasting cardio, fasting training in general, you know, is that superior to performance and weight loss and things of that nature. Yeah. Sweet. So let's start off with your training regimen before Ramadan started, right? So we know with Ramadan, you're not eating from sunrise to sunset. How are you training prior to when this started? Yeah. And just to kind of clarify, it's a little bit before that. It's truly dawn to dusk. And so typically when people look up sunrise, like on the east coast, you know, I'm like in the greater Philadelphia area, sunrise is kind of in the neighborhood of like a little after like 636, 45, but we cut it off like right before 6 o'clock. So it's like a really like the cuspid dawn and then you know, sunset is pretty true to it. I recently made the shift of early morning training, both cardiovascular exercise and strength training prior to going to the to work. And as long as I get to better reasonable time, which for me is before 10 pm, then getting up around 5 a.m. to get a 6 a.m. workout has a work really, really well. I love that approach. I'm not always successful with that approach, but I do enjoy it far more than having to go after work for several reasons, right? Whether it's traffic in the gym or it's just like having something in the back of my mind that I got to get one more thing in or missing time with my family and my daughter later in the evening. So that's where I was. Unfortunately, I've been dealing with a little bit of an injury lately. And so my training was compromised leading up to this, but I was still getting four strength training sessions and sometimes five strength training sessions in per week. Okay. Yeah. That's where I was. Got it. Okay. So then Ramadan starts and now how are you changing your regimen from a workout standpoint? Are you still doing mornings? Still. Yeah. And I want to mention that I've tried every possible timing over the last 20 years that you could play around with this. Probably more than that. And you know, I fasted and played football, high school football. We've done all that. We've had game days. And so, you know, I think pretty well prepared to see what works best for me. And so again, from a logistical standpoint, from a family standpoint, like I will finish eating and I'll go about 30 to 45 minutes afterwards. The key point though in terms of the adjustments that I've made is not necessarily for the timing. The adjustments I've made is to the actual training regimen. And so volume has been cut drastically, right? Another thing that I was doing, I was doing full body training sessions. That's kind of my preferred way to do it, quote unquote, more functional, right? But also, I think from a training density point, it's better for me. There's a cardiovascular component to that. I enjoy that. I like to move back and forth. My heart rate's really high. What that causes though is a great amount of systemic fatigue. I knew I could not afford that during Ramadan because when you have that profound systemic fatigue, you'll get really, really thirsty and exhausted and again, I mentioned sleep deprivation rates. So that's not going to be something that's going to work out well. And so the biggest modification is to go a shift from a full body training regimen for resistance training to an upper lower split. That also cutting back on the volume, both sets and reps and even the intensity. So those are the big changes that I've made, but I'm still training two upper body days and two lower body days. Yeah, I can imagine, man, not having water during your workout. That's pretty rough, for sure. Okay. So then what were your goals? Did you have to change your goals when it came to cutting, building muscles, strength, et cetera? Yeah. That was a great question. I think you have to start with realistic expectations, considering if you're following it to the tee and also depends on what time of the year it is, right? So we're in the spring time now. And so the faster anywhere from 14 to 15 hours long, like toward the end of the month, but if you're doing it in the summer, like that 17, 18 hour fast rate, the water is the biggest thing. So having expectations of trying to put on muscle mass when you're in a sleep deprived and probably a calorie deprived state, that's not going to work well. Can it happen? Sure. Will it happen? Probably not. Same thing with fat loss and just any type of aesthetic goal. So typically we would recommend, and I think what works well is to go to something that requires maintenance. And so we made, I personally made a good amount of progress in the last couple of months from a physique standpoint and also strength, right? We talked about fat loss before for me, that's been worked out well. And so my goal this month is one not to get injured, two, it's just to work on my mobility and stay healthy and then maintain as much muscle mass and maintain as much strength as I have gained over the last five, six months. Gotcha. Yeah. How are you looking at your nutrition? So I think before when we talked, you know, you were talking about hitting maybe 2600 calories and you'd go anywhere from maintenance to a little bit below if we were cutting, how are you viewing that now, especially when you're eating twice a day that I'm guessing? Probably the goal after dusk. The first? Yeah, the first week. My goal was, and after the first week, it hasn't worked out as well. My goal was to get about a thousand calories in the morning, a thousand calories when I break my fast, which would be around 715, and then get a high calorie and nutrition protein drink, like one of those fair life core power lead things, which is 42 grams, right before bed. Now sometimes I don't even make it to like 930, and so that makes it really harder. And so over the last week, because I'm so tired, I'm trying to go a little bit earlier even. So, you know, from 730, I'm not waiting till 10 o'clock anymore. So it's just now it's been two meals. And yeah, they're anywhere from the morning is typically a thousand to 1100, because I don't have much of an appetite in the morning. And so the evening is a larger calorie meal, so around anywhere from 1100 to 1300. And yeah, as a result, I am a little bit in a deficit, but you know, very close to where I was, which would be not far, not much of a deficit, right? I haven't remeasured my body fat and weight since the last two weeks, but I just, prior to going in, my maintenance calories daily were right around 27, 27, 50. So if I'm around 2400, I'm in a slight deficit at this point. Okay. And how much more important is it to pay attention to protein now? So yeah, not compromising on that. So my number one in macronutrient that I'm looking, and I'm pretty good with getting around 80 to 100 in the morning. And I have to use a lot more protein shakes to do that, just because sitting down and eating clean, you know, we've had Joe Ferris come on a recent, sitting down and eating clean a thousand calories is very challenging to do. But likely with some oatmeal, dare I say, and the chocolate protein thing, like, you know, you can create that and add some calories there to throw some, some healthy fats in there. It's been really easy. And in the evening, I'll, I'll break fast with a high protein shake and then go into maybe some type of, you know, either it's eggs or probably in the evening, I don't do it without eggs, but I'll do like really lean meats, which will give me a lot of protein. So I've been very good with still hitting the 200 gram a day for protein count. And initially, because I wanted to spread that out, right, we recently talked about the study about 100 gram, but unfortunately, like right now, I don't have the luxury of trying to break that up into four or five servings, so, or, um, sittings. So we're just doing it in two, two and a half, maybe, something like that. What, tell me the effects that you've noticed, um, having those larger meals in the morning, you know, also at night, how's it affected your sleep, how's it affected your energy during the day? Have you noticed anything? Yeah. So eating a big breakfast, my workouts are, I am, I feel like I've been getting stronger, believe it or not. Wow. You know, again, Dylan lower body injury for my upper body lifts, I am moving a lot more weight, despite being in a quote unquote fastest, not on top of SF head state, because I'm working out an hour later, but I'm not drinking water, but, you know, again, we don't really need it because my workouts are 45 minutes tops, 50 minutes long with the, with the prep, as Joe says. So I have been, I've still been getting stronger, um, and, you know, really, uh, what actually I'm not wondering after some of the research that I'm going to share with you later on, that that increase in performance is a direct correlation and causation, as the evidence was just from having adequate amount of carbohydrates to fuel my performance. So that has been really awesome, and I'm wondering if I'm going to continue with that. So we'll talk a little bit about that later. The sleep part can be challenging. It's a little hard to parse out whether the higher, um, stomach distension in the evenings is compromising my sleep. It does tend to do that if I eat too close to bed, which is another reason I gave up the later shake, and I was like, all right, you know, I don't want to get up in the bed. I don't want to afford to even get up to go to the bathroom once. If I'm sleeping any, if I'm going to be in bed for seven hours tops, I don't want to get up to go to the bathroom. So I'm okay not drinking. Um, oh, one thing I forget to mention, I think this is important. I think adding an electrolyte drink to your regimen is important. So elementary really would love it if you guys would sponsor us, um, because I just had to, I had to buy myself a 36 pack, tried the watermelon flavor, by the way. Oh, so it's good. Yeah, it's great. No, I love it. Oh, watermelon flavor. Okay. Which reminds me, I have a million of the chocolate ones that I need to ship over to something like that. I hate it. I hate it. So yeah, the chocolate is not good like on its own. You have to find a way to like, you know, like hot chocolate or something with it. I mean, I can stomach it, but yeah, I feel you. I think the fruit stuff, I mean, what about the lemon habanero or what was the other one? There's another one. Chili, chili. It's okay. But if you drink alcohol, you can make margaritas out of it. So it's like lemon habanero is an interesting flavor to me. I'm surprised that they came up with it, but there must be a demand for it. Yeah, I think the way they try to market it probably is more of like a, you can use it to drink while just stay hydrated when you're like drinking alcohol and stuff. Fair. But yeah. All right. So let's actually, I really want to talk about the mental aspect of this, right? So we know all those things that you just talked about, the workout, the sleep. Like for both of us, we're super attuned to making that work and optimizing it based off our schedules, based off our lives and, you know, whatever may be going on at that time. How do you feel your mental state, you know, has been throughout what's been two weeks now around them? Or getting, right? Okay. How, yeah, how do you feel like your mental state is and how do you pretty much program your day to make sure that you're in a good state that you feel like you've won the day that you still feel like you're productive and not necessarily compromising too much on your goals? Yeah. So that's why I think doing that early morning workout on the fan of it. And again, I know that some people have the luxury of becoming nocturnist during this time. And that's what I did in the time where I was training for just a big bike trip down the east coast that I did. I had shifted it down because I was in the summer break between med school. And so I just stayed up all night and I slept in the day. I don't have the luxury of doing that now. But if my performance is good and I get that early check off the box, that allows me to feel like I got an early morning win and it's better. You know, you get the post workout clarity because you have moderate intensity workout. Yeah. You perform a little bit better too because I'm also keeping mine and we're not drinking as much caffeine anymore, right? So the day gets a bit challenging. Another thing is, you know, now with the absence of water, absence of caffeine throughout the entire day and absence of food six, seven hours later, the afternoon or evening workout where, you know, you've been faster for nearly 12 hours, it would be far more challenging because again, I'm also sleep deprived. So I think, you know, there's no substitute for playing around with that and seeing what works best for you. Sometimes people will, as long as, you know, all these other things are checked and maybe if sleep quality hasn't been disrupted too much or they don't have stressful jobs and maybe they don't have a family, sometimes people will get a spike. And another time that's worked really well for me is to immediately work out prior to breaking fast and then post workout, you can have a nice meal. So that's been a good approach too. But as I've gotten further in my training and become an attending, that approach has become harder and harder because we have stressful jobs, right? And so, and so I think the sleep has been harder to control for once you have a family and you have other responsibilities and, you know, things of that nature. And so that's where the morning workout has been really, really helpful and getting, getting that early one. And I think, as I mentioned earlier, like, you just have to be realistic. Like, this is not the time to set PRs and stuff. Could it happen? Yeah. You know, so you just have to have a realistic goal, realistic expectations and just understand that, okay, like, these conditions are not optimized for you to perform. Yeah. And I'm happy to talk about that because we have enough athletes like career, career, career Irving, right? Yeah. I don't know if you saw. And, like, he's fasting, right? And there's professional soccer players, basketball players is a collegial player too. So people have been doing this forever and because of that, fortunately, we have good evidence of where people have been studied during the month of Ramadan and performances study, and all that kind of stuff. So. Yeah. Yeah. Are you more mindful throughout the day about, you know, the number of steps you're getting or you're trying to limit the amount of activity or you're parking closer to the grocery store? No. No. Am I trying to preserve energy? No. In fact, and that's really interesting you bring that up because, and I'm happy to dive deeper into it because, yeah, go for it. You know, they've looked into this, right? They talk about, they talk about the fasting and, you know, whether that's good for like fat loss and stuff. So, okay, maybe this is good segue, right? And so, you know, one of the things that people will talk about is like, oh, you should do fast at cardio because that's going to be better for fat loss. And there is sound logic to it from a theoretical standpoint. And what the theory is that you are on an empty stomach, you don't have high glucose reserves in your blood at the time. And so, therefore, you're going to have increased fat oxidation. And I promise you I'm going to answer a question in a minute, a couple of minutes. But the idea is that you have less glucose and therefore, like the, the hepatic stores are going to be lower or the stores are going to be higher, blood glucose is going to be lower. And you're going to have more fat oxidation. And so, you're going to burn fat for fuel. Like, remember, there's a disconnect between burning fat for fuel and fat loss, right? The DCing fat mass. And there was a recent study on this and we'll look at, it was an Edenberg paper in 2019, which I was reading a couple of days ago where they were looking at this and, you know, they had four different groups and they looked at a 24 hour energy balance with skipping breakfast before exercise, you know, eating or exercising in a fed state and it was modern intensity cardio. And then also feeding them after and not feeding them after their so forged separate groups. And what they essentially found was that, you know, overall, people who did exercise in a fastest state did have a 24 hour negative energy balance. Now that does support the idea that you are going to burn fat for fuel and that makes sense. The problem with that becomes though, a lot of times, people don't end up doing that. And the reason is because one of the main things that that's been proposed and proven is that people are great compensators. So if you end up exercising, right, a lot of times people end up compensating and eating more and adjusting more calories because you exercise. And so they're like, yeah, I'm exercising and I'm burning more calories. I'm a negative state, but you eat more and therefore you don't do that. And so another thing happens, the other side of it, right? So it's going to come down to energy balance at the end of the day is sometimes people will exercise and then they're not exercise activity decreases over time. And that's another reason they might not end up losing weight or losing fat and stuff. So I am just as mindful because it gets very easy as they're lethargic and dehydrated and decaffeinated to not get the steps in to not move around to sit more. And so as a podcast, I'm standing up, right? So I have to be more mindful of doing that because you don't want to fall into that trap because your again, your body feels tired too. I think for me, it's not the lack of nutrition. It's the lack of sleep is the biggest driver of like not wanting to move. Like I just want to take a nap. But knowing that fact is that when people eat less, they move less. And that's why they won't be in a deficit, you know, you just have to be more mindful. Not only that, sorry, getting carried away, there was a study not too long ago. And I remember reading, I forget the details of it, but they looked at cognitive performance in individuals during though, I think they were during the mother Ramadan. And what they found was individuals who tended to move more had better cognitive performance while they were in a fast state, individuals who did. So that is obviously helpful when we know the benefits of exercise and cognition that's been well documented. And so even again, with the absence of water and caffeine, that's another hack, so to speak. Yeah, I love that. You know, I've done up to 72 hour fast, my own, and I can definitely say the cognition is the biggest thing I've probably noticed. And then it's interesting, right? I'll be, let's talk about faster cardiovascular versus, you know, fast state weight lifting. If you want to go into some of that, I think it's a good transition. And then I can talk about my experience to a little bit on that. Yeah. Yeah. So I think the best recent study that I've come across is this eating bird paper, just because they looked at it. And, you know, I already kind of gave the punchline a way for this, which it did prove that. And again, this is not the only study there's a couple of papers in there. And I think this is probably the best study for people to start with. And they can look at some of the references. But we do have good evidence suggesting that, you know, fasting because of increased fat oxidation is going to help. The problem is, most of these studies are going to be short term studies. So I think this might have been a four week study that they're looking at. I think they have studies I'm familiar with. Another one doesn't come to mind right now. It was an eight week study that showed a very similar result, which is a crossover study. And so, something to keep in mind is that might be beneficial, but one thing that we've talked about with prior guests, we've talked about consistency, the biggest thing when it comes to fat loss, fat mass loss, and weight loss over time. We've talked about this before, right? Losing weight isn't usually the problem in this country, in this world. It's maintaining those losses over time. And so is it going to be sustainable? Because after any amount of time, people can offset and make the energy balance neutral or positive for some of the things that I mentioned earlier by decreasing your need, excuse me, yeah, by decreasing your need, right? Non-exercising activity thermogenesis or by increasing the compensatory eating strategies. So whatever it might be on a later day. So it has to be sustainable strategy long term. And then the other piece of it is some people just feel better training in a faster state. And now we can dive into the psychology of that, right? The performance are you feeling better because you feel like you're doing something that a person, are you actually feeling better? So that's a different kind of words we won't open that. But I think ultimately comes into the practicality of it that is this sustainable at all. And then last thing that I'll leave you with is you also have to identify which master you're serving. What I mean by that is if we're talking about weight loss and fat loss, sure you may have increased fat oxidation and they may help you burn more fat for fuel. However, what's clear in the evidence is that performance is going to be suboptimal. And if you're training with any type of meaningful intensity, so moderate to high intensity workouts. And I mean, there are several studies that I can talk about where they look at strength gains and time and time again, it shows that when you ingest carbohydrates prior to training, you have better performance. And so one could argue that if your performance is optimal and you're working hard on the gym, you're building more muscle, you're creating a greater metabolic sink, right? And we know the muscle, as we talked about organ longevity, helps you even burn more fat because you have a greater basal metabolic rate. And so as you can see, it gets very complex. And so, you know, we just have to identify like what seems to work and that a lot of times people just have to try the different approaches to see what works best for them. Yeah, for sure. That's the one trap I fell into during that school is that I would not eat prior to working out because, you know, there's a whole talk in your growth hormone and the spike and then even post, you know, one hour to two hours after the workout, growth hormone spikes. And then, and then getting the protein in, right? And that was kind of my mindset to it. That was not making any gains until I really flipped it around, started eating, pre and post workout, seeing that performance go up, seeing the strength gains go up and just overall feeling much better. And then again, coming down to energy balance, right? I think, like you said, so many people are caught up in the timing of things. And I mean, we're definitely not at that competitive level like Joe is where sure that stuff might matter. But, you know, we're definitely learning about it and trying to optimize for certain things. So I think it's interesting, you know, as we try to experiment with our lives, trying to share it here on this podcast, hopefully, you know, people can take away some good things. What about, if you, I mean, is this, is Ramadan the only time you're fasting or are you fasting outside of this at all? You know, I, so I was big in intermittent fasting, like I said, probably circa 2011 and when it became big, and I have to shout this out because my bias because of Ramadan was like, oh my god, like science is really learning the value of intermittent fasting and all that kind of stuff. And now we've gotten to be wiser and have recognized that perhaps the effects are purely from a negative energy balance standpoint, from a metabolic health standpoint, because I think, smarter people than us have said, you have to find practice some type of cognitive restriction, whether it's dietary, time restriction, or what's the last one that I'm thinking? No, it's dietary restriction, so it's specific macronutrient time restriction or something else. I can't think of it. But anyway, some type of restriction, right? And so the intermittent fasting or time-rested eating, whatever you want to call it, allows you to more easily, because it's it's binary. It's on or off, eating or not eating. And so it's much simpler to do that. But lately, I think once the literature's gotten to be a bit clearer, I have not done any, I think it would last two years aside from just a month of Ramadan. But I don't know, I've also never done anything longer than a 36 hour fast. So I'm curious what that would be like. Not curious enough to try it yet, but we'll see. All right, ice bath before that. Well, ice baths make you hungrier. So no ice baths. That's what Lane Norton has said. That ice baths have an effect to increase like chloric intake. Like they just make you hungrier. I'd have to look at exactly what their chemistry is behind that and stuff. But it's funny. Yeah, is it not just kind of increasing the thermogenesis? No, regardless. Yeah, that's what I'm assuming. But you know, I want to, because I was talking about performances, and I really do think it's important, because I think about, we talked to Dr. Sean Arne about this way back in the day, right in the archives, people can look at that. And if you just search performance and fasting, it's so important for people to consider this. I mean, I'm going to quickly just reference three studies because I was reading this morning and it kind of carried away a little bit. But there was this 2019 crossover trial that they looked at resistance treatment, who consume breakfast, 1.5 grams per car, per kilogram of body weight, or only water two hours before performing workout, which they tested strength training. So four sets of back squats at bench press performed to failure, using 90% of 10 RM. But they found the breakfast group had the total number of repetitions performed increase the total number of reps performed by 10 for the squat and two for the bench press. But you know, one thing that they noted that these people, everybody who was in it, they were all regular breakfast consumers. So, you know, they ate breakfast at least three or more days per week. And so that might suggest that there's a no-cebo effect as well. That the participants might have convinced themselves that if they're skipping breakfast, that their performance would suffer and did that, right, cause it. And so this goes back to that notion that I was saying, okay, like, you know, some people think that, you know, the fed state or fast state might have a certain effect on their performance. And no-cebo effect is very, very powerful, just like the placebo effect is very, very powerful. And it actually potentially changes your physiology. Your heart rate can be higher, right? Your muscles can be like moving in a different speed. Another 2020 crossover trial. And this is where it gets really interesting. Again, same idea, 1.5 grams of carbs per kilogram of body weight. And this is a, they had three arms. So they had that, they had an identical semi-solid viscous breakfast that contained very little energy. Okay, only 29 calories, which was the placebo group, and then had a water-only group. Two hours prior to exercise, this is what they're ingesting. What they found here was that the total number of basketball repetitions performed was similar between the two groups, breakfast and placebo, placebo, which is, remember, only 29 calories. And the conditions were, so they were superior, whereas water-only group did not have an improvement performance. And what they attributed this to, because it was a semi-solid viscous stuff, is that, hey, just to the subjective feeling of not having hunger, right, improve your performance. A third study, more recent study, in 2022, again, similar idea. Here, they had breakfast, you know, people consume same 1.5 grams per kilogram of body weight. Two hours prior to resist exercise. But the only difference between the breakfast was the actual viscosity. So take it to the next level, right? And so the way they did that is they thickened by Xantham gum, which I make my protein fluid. That's a brilliant idea, a little hack for people, to give some more substance. And they wanted to, you know, elicit the differences between subjective hunger between conditions. And here, the total number of backscout reps was greater in the thickened breakfast condition. So 57 versus 51 reps. Again, hunger was lower. And, you know, maybe suggest the performance was a little bit better. So in combination, I think like these three studies, and tons other one, that people can easily find a PubMed, suggest that, hey, just even the subjective experience of feeling hungry versus not hungry, can really add, you know, have a positive effect on your performance. But, you know, we know there's physiological other reasons as well, we talked a little bit about, you know, having glucose in your blood, how that uses his fuel and, you know, what that might mean as well. But that's, I feel like talked about a lot. But the state of feeling hungry versus not hungry, that's something that actually hadn't thought a lot about in terms of how that affects performance. I had a friend in med school who could not have optimal performance, unless he ate before weightlifting. Like he just couldn't, it would just, like you said, something in his brain would just go and he wouldn't be able to. So he had to have a heavy meal before weightlifting. But this is interesting, man. I think, you know, both of us had, we used to be chronic fasters six, seven years ago. We both changed our minds on it. I will still be a regular faster here and there. You know, I used to do, I still probably do about 24 hours once a week. I've decreased that a little bit, but I'll go up to a 72. But the main thing I want to tell people is, don't, you have to know your reason for fasting, right? If you're fasting for fat loss and for health and nutrition, and you think that's healthy, you have to master the basics first. So master the calorie counting first. Master what it is like to be at your maintenance calories. Because I just see too many people go on opposite ends of the spectrum. They're fasting one day, the next day, they're hyperchloric. And so they're kind of just swinging back and forth. So primarily for me, when I fast, it's really from a discipline meditation standpoint. It's more from a cognition standpoint and testing myself and saying, hey, I know I'm going to get hungry. How do I go back to the primitive days, essentially, if there's no food around? And so I usually use it as a mental toughness test for me, rather than more of a nutrition standpoint. And that seems to work well. I think when you are fasting, for me, what helps is getting as many steps in. I'll go for a quick run, go for a quick 3,000 step walk, and those hunger pains start to go away. I'll also make sure to try to get more of those weight lifting sessions in, just to preserve as much strength, muscle mass during that time. Who knows how much of a real difference it's going to make. I've really looked at the research. I know Peter Athea talks about doing that. But yeah, just some tips there for people who think about facet cardio and just fasting in general. By the way, did you see that headline that came out a couple days ago about the increased heart risk from eight hour time research to eating? I might have come across my social media feed, but I did not click on it. What do you want to do? Yeah, no, I mean, I barely looked at it. It wasn't even peer reviewed. I think it was just like peer observation from people saying, like, hey, if you're a faster, you have increased cardio, cardiovascular risk. And everyone, all the lot of influencers right now are like, hey, don't bother with this. It's not even a real study. There's not even peer reviewed. There's nothing in here about it. I didn't even bother really looking at it. But just letting people know in case they're freaking out, it's just interesting about the timing of it. Isn't that anybody who sleeps eight hours? Because my daughter is a risk. I didn't even really look at it, so. I really like that you said that. I think ultimately, it's really important to understand your reasons for doing really anything, but especially this, because and then also experimentation, there's no no better way to figure out what seems to work best for you. You know, whether it's in Ramadan or it's not, you know, whether it's any other time of the year and why you're doing that. And ultimately, you have to test it. You have to objectively monitor it and track it and then figure out. Ideally, you know, you also figure out the reasons for your training. Like, if you're doing it for performance, I think the evidence is pretty clear. But listen, you might be the exception to the rule that that could be true. You know, one thing we didn't touch on is, and I won't spend it. Because we're going to, I'm going to link Lane Norton's head of post on this because this is one of the ideas I want to talk about this is because some some schmuck went on and I think, you know, he, as he blasts people, he always does. This person said that fasting was super for muscle building or eating training in a fed state was causing more muscle loss. Some version of that. And what I explained in terms of fat oxidation is kind of the logic that he used, but it doesn't make any sense. You know, Lane did a good job kind of explaining how muscle protein synthesis is maximized in your fed state and, you know, linked a couple of studies with that. And so that's, that's in a nutshell. And so again, that's, we're not going to spend too much time, right? If you're, if you have adequate amino acid reserves, you're going to build more protein. So like, we'll just leave it at that. That's not a shocking thing. But I am going to, I'm not spending too much time, but I'm going to link this one study because this is a question my friend had about training time is in Ramadan and how that affects it. Recent study, 2023 done, first author, Tricky, that looked at last semester, the timing in Ramadan and this effect on muscle. Again, similar of everything that we talked about, the two different groups, the fed state was in the morning, the fastest state was like eight hours later if they hadn't eaten anything. And same differences in terms of how much weight they lost, body fat they lost. But the performance in terms of increase, like objectively deadlift. And I think even the squat that it was, the 1RM for the deadlift and squat, increase in the fed group. So again, you know, fed state performance is going better, despite sleep quality being worse in both. And despite also both of them losing body weight and body fat. So interesting that you're, you're getting leaner, right? No change in lean body mass. So you're losing body fat, you're getting leaner, but you're getting stronger at the same time, considering all things that we talked about. And this has now my lived experience as you already asked me. So that's some pretty cool too. Do you know, do these research papers talk about an optimal time of eating before the workout? Or now, is there 30 minutes left? I mean, yeah. Yeah, no. So most of the time what they'll try to do is, depends on the type of meal that you're doing is, it'll be anywhere from one to two hours. So the papers that I mentioned, the three studies earlier, the trials looking at the 1.5 grams, particular grams, there were all two hours prior to that. That's typically the window in like all the studies that they'll look at, somewhere between two to three hours. But you know, people also depends on the type of exercise you're doing. If you're going to a cardiovascular intensive exercise and you're going to be running, you don't want a lot of heavy GI load. Right. And so that's where it matters. But typically in any of these laboratory studies and in the laboratory study of Dr. Arndt that we did, you know, you would not keep it under the one hour period. It just wouldn't. But it's going to be, as Joe said, eat for what you're going to do, not for what you've done, right? So it really matters. I like that. That's definitely one thing I'm going to take away from this episode is paying more attention to at least that fed state and prior to the workout. Cool, man. Do you have any like high level tips for people going through Ramadan when it comes to just the things you've learned? You know, obviously we know context matters. People are going to have specific goals. But what do you think are kind of the overarching principles that people really should take away? I think biggest thing is prioritize what is super important to you about this month. And, you know, if that, whatever that means, you know, and just understand that maybe this might not be the month like I said to hit PRs and be okay with taking a month. The other thing interesting one thing is people would be amazed how little volume is actually required to maintain strength. And, you know, and how, you know, you could cut it by 50% and still maintain muscle strength and be able to do that. Of course, it's going to very individual and visual. So don't freak out about that. This was important for me until I had to dive into literature because it's like, oh my god, my training is going to go down and all my gains, my gains. So that's big one. Your sleep is going to be compromised. So try to get that wherever you can. And again, it's going to be trial experimentation. If you are serious about your training and nutrition, figure out what protocol works best for you. Use the strategy, some strategies I mentioned in terms of electrolyte drinks because that's going to hold on to water. It's a lot of times people will just drink tons of water, drink as a coffee, it becomes a diuretic. And they're not holding up because they're not using the electrolytes with that. You can make your own electrolyte. But those would be the three, four things I'd say. True. I like it. Well, dude, I'm enlightened. I would consider this a holy discussion and appreciate you sharing your experience, man. Thank you. Awesome to. Thank you for listening to another episode of Medicine Reignified. As a reminder, our newsletter is officially rolled out. And if you'd like more actionable tips and tricks delivered right to your inbox, please be sure to visit the website and input your email. And you will have it delivered to your inbox every Sunday afternoon. Please also check out our social media platforms where you can find more content like this. 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