Discussing What The Fast Mimicking Diet Is With Victoria Hahn | El Paso, TX (2021)



In today’s podcast, Dr. Alex Jimenez talks with Victoria Hahn about what the fast mimicking diet is and how is it beneficial to the individual and their overall health and wellness.


What Is A Fast Mimicking Diet?


[00:00:00] Dr. Alex Jimenez DC*:  We are live, El Paso. This is Dr. Alex Jimenez coming back with you. This is a special day, an extraordinary day. We are offering some information to you guys as my patients. Today’s a unique moment in time. As you can see, my podcast room is empty, as you’re going to be able to notice in this particular area. You can see the podcast presentation, and I’m doing this alone, and as we were doing, we’re following the rules of engagement of today. Now, today is a moment in time where we’re finding ourselves kind of a little bit on the sandy ground where the flow and the situation of our present state are that we’re all watching CNN. We’re establishing things. But one of the concepts that we’ve been looking at in the last couple of weeks before this all happened was a disorder that we are all experiencing right now; many of us are trying to figure out what we can do because we’re all feeling a little thick. We’re feeling a little fat. We’re feeling a little bit displaced from our usual patterns. So one of the aspects that we want to be able to do is to discuss what we can do with our physiology, things that we can do at home, something that we can adapt, and things that we can alter into our metabolic process. Now, as I’ve gone in the past, I’ve talked and discussed heavily metabolic syndrome. Metabolic syndrome is one disorder that affects us all. We have given us options and the options that we have done in terms of working with the sugar issues, the weight issues, the belly fat issues, and the underlying issues of the triglycerides that we’ve been discussing along with cholesterol issues. We have looked at diets that have different varying components. One popular diet is the fasting-mimicking diet. I had a fantastic experience when I went to Hollywood, Florida, about two years ago, where we did the Functional Medicine Institute program. We went out there and saw the program presenting the fasting-mimicking diet and teaching all of the new things that the diet can do in the physiological state. But one of the things is when people hear fasting, it’s confusing. So I’m going to bring in an impressive individual, Victoria Hahn, who works with Al-Nutra. She is the medical science liaison for the fasting-mimicking diet with Al-Nutra. She’s going to give us some information about things that we can do and about the diet because it’s a special diet and because we live on the border and we have a lot of, I guess, metabolic syndrome. Just by definition, there are issues with high blood pressure, glucose triglycerides, HDL issues. We want to take a look at the things that we can do. One of the most extraordinary things we’ve learned about metabolic syndrome is that it has an immediate response to the diet. But not everyone can do a particular type of diet, whether it’s intermittent fasting, a ketogenic diet, a different kind of water fasting. We’re going to go ahead and go over those things. So I’m going to present to you Victoria Hahn, who is the person who will bring this home to us, and she’s going to educate us on the process. So I’m going to bring her in right now, and we’re going to go ahead and talk to her, and you can see me in the sideline in the far distance. So as I kind of click that button. Victoria, tell us, are how are you doing? How’s everything going with you?


[00:04:24] Victoria Hahn:  Going well, staying safe, practicing physical distancing? You know, doing everything I can to ensure that I’m carrying myself safe and everyone else I interact with, including the hand-washing. So very important. We’re doing good. How are you?


[00:04:40] Dr. Alex Jimenez DC*: I’m doing very well. I wanted to present to my patients the fasting-mimicking diet. I have a box right around here, and I misplaced it while we’re talking about the products. But I’d like you to tell us a bit of what the fasting-mimicking diet is for the public to understand what the options are and what we’re talking about when we say this special, fasting-mimicking diet because it’s got a perfect, unique name to it. So tell us a bit of it. I know you got a presentation too, so I think you can share your screen, and you can start talking about it and let us understand a bit of what the fasting-mimicking diet is for the public.


[00:05:20] Victoria Hahn: Yeah, so fasting-mimicking diet. So before I get into the presentation, which let me pop this bad boy open, so fasting-mimicking diet is this concept that in essence, you know, maybe you don’t have to be fasting, so, you know, omitting food entirely to be fasting. And so that’s really what this diet brings. It brings the same type of physiologic and biological effect of fasting, but with food. And so it’s a novel and kind of bizarre kind of nutrition program because it takes you a little bit out of the box just thinking, how can you be fasting with food? And I’ll go over, in essence, how you can because there is a lot of science to explain how this works. And fortunately, unfortunately, it’s not as black and white as we like to make it. But that’s the beauty that you kind of find these physiologic loopholes to being able to kind of stimulate a similar process without having to go through that whole fasting process.


[00:06:26] Dr. Alex Jimenez DC*: In terms of this, this is the actual product here, and it looks like it’s pretty simple. It all fits in a box.


[00:06:34] Victoria Hahn: Yeah. It’s super straightforward. So, in essence, you get like a rather large box. And within that large box, and they’re all evenly listed out for you. So it says day one all the way to day five. The product is a five-day fasting-mimicking diet, so you get everything that you need. So there’s no, you know, having to go to the grocery store, which is kind of convenient during this time. But there’s no having to go out and buy and figure out how much of this I have to measure or weigh? What about this other ingredient? Or did I get enough of these plant-based products of that? It’s already laid out for you, and that’s really to not only aid in the use of it because again, the diet that may be fasting, but also in the consistency of it, we want to make sure that that’s what it’s doing. So we got to kind of treat it in this very almost clinical fashion.


[00:07:30] Dr. Alex Jimenez DC*: I’d like to add that in the design of presenting this full disclosure. I’ve done the fasting-mimicking dying three times each time. It’s been an experience for me, and the protocol does include three options or three times that you can do it as the most optimal as from if I’m correct, that three times are the times when we tested so. Tell us a bit of the product line, so I’ll let you kind of take it from here. Go ahead.


[00:08:02] Victoria Hahn: Yeah. So here, let me go straight into the presentation. We’ll start to kind of where some of these details. So the first question that, of course, typically is being asked is what your health care goals are? So before we even start to step in to prolong and what fasting-mimicking diets are and even how fasting is beneficial? You know, what are we all trying to achieve? And obviously, a lot of these are listed here. So bodyweight loss, body composition, even I would argue that body comp is way more important than body weight. Bodyweight only tells you so much, but the amount of fat and muscle mass you have is more important in the closet meter. I’ve had times where I’m going into my closet.


[00:08:50] Dr. Alex Jimenez DC*: I was wondering what that was.


What are Food Sensing Pathways?


[00:08:53] Victoria Hahn: Some things don’t fit the way that they used to, and that’s always a little alarming. And I don’t have a scale at home, and so that’s the way that I can determine whether or not I’ve been overindulging. So all of these things are secret pertinent. Most of us have specific weight parameter goals or metabolic balance goals or feel better about the angles. And so arguably, you know, I know I’ve said that few of these right here like I’m struggling to lose body fat even when I’m working out and trying to figure out how I want to eat. Even as a dietitian, some of these things are a little hard to figure out. You have to be constant trial and error, because unfortunately for some of these issues, we still haven’t necessarily figured out how to resolve them, which is why our daily obesity is such a vast issue that especially the United States and any of the Westernized societies we’re facing today. And so, you know, with any of those goals, we’re going to be talking about how can we feel better about them? And so that leads us to kind of a novel, a strategy which is fasting. Now, of course, you know, before we get into fasting, we want to define what it is. So what is fasting? Now, arguably, whenever I ask this question? Most people remark like, Oh, that’s muscle mass loss or, Oh, that’s, you know, me starving, or Oh, that’s me feeling hungry, or I can’t eat food, or isn’t that juice fasting? And to some extent, most of those would coincide with the standard definition of fasting, which would be to abstain from food or drink. And maybe that’s for religious observation, for example, Ramadan fasting or Yom Kippur. But you know, that’s just one way to think of fasting. You could think about it from the perspective of what’s happening within your body when you start to fast. So I like to think of fasting from this standard definition as the trigger for an outcome. And so, the result is what fasting is. And what that outcome is, is it’s the, you know, the lack of the triggering or the turning on, if you will, of what we call these food sensing pathways. It seems a little ambiguous. But truth be told, we’ve seen this in many different mouse models, as well as clinical trials. There are these pathways that our bodies have that responsibility. You shouldn’t take, and that makes sense, you know, if you eat food, something has to happen, right? Yes. All these pathways, these food sensing pathways. And so, in the absence of nutrients or rather the right amount of protein, calories, carbohydrates, you can, to some extent, circumvent their activation. And so that’s what fasting is. It’s this biological process.


[00:11:53] Dr. Alex Jimenez DC*: I like that word of food sensing pathways. How did that happen? How did that come about? I just tend to touch on that food-sensing pathways. It just seems to me like a very understandable way of allowing people to understand that that the body is sensing, almost feeling out, that the foods you know, so deep go deep there.


[00:12:18] Victoria Hahn: Yeah. No problem. So I honest to goodness, this is my favorite part about fasting, and it is the molecular biology surrounding it, its physiology. It’s honestly wonderful. But I’m a little bit of a nerd in that regard. But really, what this is and how we came about it. One of the individuals who kind of piecemeal all of these individual components was Dr. Longo, and I’ll get into some of what he’s contributed to this whole area of fasting and longevity research. But really, what these retention pathways are is they are these mechanisms that are triggered by certain levels of carbohydrates or sugars, or we call it glucose. Still, that’s just a carbohydrate of proteins or amino acids and certain degrees of energy. So calories, all of these things can contribute to this overall biological process that we think of as being fed. Because when you think about it, like when you eat food or what happens, obviously we know that something happens where we don’t feel like sluggish, and we get some energy, and now we can go and do things we start doing. And we know that that also helps out with weight gain. What is that cellular process with a biological process that would be these food sensing pathways to think about it?


[00:13:47] Dr. Alex Jimenez DC*: Simply incredible. Keep on going. What are the misconceptions?


What Are The Misconceptions of Fasting?


[00:13:52] Victoria Hahn: Yeah. And so in terms of just some misconceptions, you know, I highlight this one because you get to see quite a few of these juice shops that kind of pop up and talk about juice fasting. And it’s arguable because most of those juices are relatively high in calories and even carbohydrates. And so when you think about biological fasting, it’s not that because there’s just too much nutrition in these shakes, which is significant to some extent. You know, you want to get the vitamins, minerals, and such, but not from the standpoint of actual fasting is it’s not one-to-one. So maybe it’s fasting from the perspective of not eating solid food. So in that sense, it’s fasting. Fasting is so much more than just kind of the composition of your food. It is the actual amounts that you are getting of each different type of nutrient. And so it’s a little, you know, misconceiving. And there’s a lot of these things cropping up because fasting is such a novel topic, and it’s really popular. I mean, it’s just so popular. It’s gotten really popular in the last couple of years, which, you know, just kind of go a little forward in terms of how it got there. And I can show you some data as far as how popular it is in the US. So part of the reason that’s gained a lot of traction is because although fasting has been around for millennia, we had to evolve and adapt to these periods of basic food and not food. And so naturally, our bodies know what to do when it has that type of environment. But what we’ve seen in clinical trials is that it’s been shown to support metabolic health. It’s also been shown to support this fascinating concept called cellular cleanup. We like to use the phrase autophagy. It’s just a fancy word to say the cells. So each of your cells they have their microenvironment, and they have their kind of garbage disposal recycling center, which we could call autophagy. So it’s a fascinating process triggered by fasting, which can help lead to cellular renewal. So if your cells can kind of take out these, you know, less functional components and repurpose them for other types of activities, then as a whole, the cell can become more efficient. So that’s this concept of cellular renewal and ultimately what we see all these pieces contribute. Leading to is this promotion of longevity and healthspan. So this is how in essence, fasting can be so beneficial. So to get into, you know, how it’s so popular, it’s no surprise that it’s become one of the number one dietary patterns in the United States in twenty nineteen. So this is in twenty-eighteen. In twenty nineteen, it just took second place to this concept called clean eating. And you know, that’s not a bad thing. Clean eating is one of the better things that we can be doing for ourselves. But the exciting thing to note about fasting is that especially when you compare it to any of these diet patterns, so for example, vegetarian, vegan diet, low carb diet, gluten-free diet, Mediterranean diet, all of these are compositional changes, meaning, you know, with low carb, you have to be very mindful of the number of carbohydrates that you’re getting, sometimes even the types of carbs. So aiming for low glycemic index carbs, the ones that don’t cause your blood sugar to spike too rapidly. So you have to be mindful about what you’re eating, whereas, with intermittent fasting or just fasting as a whole, you don’t need to consider that component. I mean, I know nutrition for prolonged. We argue that you do. But fasting as a whole, it’s when and how you’re eating, is the consideration. You don’t have to modify what you’re eating. And so that might be part of why it’s been so well received as opposed to just the community as a whole. Wouldn’t you like to be able to continue to do what you’re doing with just a slight alteration? Yes, because it is easier and it completely shifts your diet.


[00:18:13] Dr. Alex Jimenez DC*: You know, simplicity has always been a component of trying to come together and making it easy for people. If it’s too hard, you know you can do fasting, but soon as you make that mistake of going elsewhere and they don’t know the rules of engagement. It just goes crazy. This is so cool because it’s all packaged in one kind of dynamic. So as I see that, tell us a bit of the overall. When you say 36 percent, I noticed that you said 36 percent follow a specific eating pattern. What was that number versus the 16 percent? I noticed there intermittent fasting was the top end for patients.  


[00:18:53] Victoria Hahn: Yeah. So, in essence, they were trying to say, and this was from a more extensive study. But anyhow, what they were trying to say is that people are following dietary patterns. It may not be, I suppose, too specific regarding certain reasons that weren’t well elucidated as to why they’re following these nutritional patterns. But it is to say that people are starting to follow specific ways of eating. So, in essence, that’s this categorization of all of these different diets, and these are the ones they were following. They wanted to see how many people in the United States are doing fasting. How many are doing paleo, gluten-free down to the Dash diet and dietary approaches to stop hypertension and the ketogenic or other high-fat diets they want to catalog. In essence, what the US is doing in regards to their nutrition. So that’s really where this number was coming from.


[00:19:57] Dr. Alex Jimenez DC*: That makes perfect sense.


Different Types of Fasting


[00:20:00] Victoria Hahn: And to continue here so we can go over different types of fasting because, you know, even in the previous slide was showing you intermittent fasting that doesn’t say. It’s even how they were categorizing the transgenic. So it doesn’t say a lot. There are many iterations of these comprehensive topics, but to hone in on the fasting and, you know, different types of fasting. So I like to think of fasting as the umbrella term, and you can find that by the duration of time. So, in essence, fasting can be longer. So we call that prolonged or periodic fasting, typically two or more days, or it can be shorter, and we call this intermittent fasting, and that’s typically two or fewer days. I will argue that in the literature, when you’re reading about intermittent fasting, you know, unfortunately, those kinds of lumped together all types of fasting, and it has to do with the fact it’s a buzzword. And, you know, it’s kind of what gets the clicks and such. But unfortunately, with that being said, there’s a lot of misinformation because unless you’re reading into what type of intermittent fasting pattern or fasting pattern they’re talking about, it’s just all kind of amalgamated together. And it’s really confusing. Were they talking about time-restricted eating, or were they talking about the five-two diet? It’s kind of up in the air unless you know you’re doing your due diligence. So it’s unfortunate. But for the sake of, you know, how we define fasting, this is our main definitional structure. So to get into different types of intermittent fasting patterns, I’m sure everyone is super familiar with time-restricted eating. Yes. Like the 16:8? Yeah. Do you practice that at all?


[00:21:48] Dr. Alex Jimenez DC*: As a matter of fact, I do. One of the things that I’ve always mentioned is that certain body types require specific patterns. And I’ve looked at people’s schedules, and it’s almost like the advanced test version of the process with the ketogenic diet. You know, it takes a particular hardcore individual to do it. So, you know, intermittent fasting allows people to kind of start controlling that. We start by just simple things like circadian, eating during the daylight, OK, and don’t eat at night versus bringing it down to eight hours. And, you know, having 16 hours of just good non-mechanism of eating. So I have done that. And the better they became, the intermittent fasting individuals and the patients I have, I would go to the next level of going six hours. Now some patients can, I mean, my extreme athletes and the individuals who are just high performers, they can push it down to three, but it takes a level of mental fortitude to be consistent in that. So I have seen that ability in certain types of people or even different lifestyles. People who work at home can do a more ketogenic diet. But you know, in my particular practice, I physically work on people. Or if your job is physical, it’s kind of hard to maintain that if you’re expending calories throughout the day. So it depends on the individual. So we need something understandable that makes sense to the public and lets them understand that they can attain those high levels of physiological and metabolic advancements, such as apoptosis, the autophagy that occurs, and the re-using of the body with a simple mechanism. So I love this, and this is the kind of stuff I enjoy. So to answer your question. Yes, I have done it in the past.


[00:23:37] Victoria Hahn: Nice. Yeah, and arguably, I’ve been seeing within just the consumer channels, television eating has got to be like one of the number one forms of intermittent fasting right now. And it’s because of that ease to some extent, because it’s like a daily window of fasting where you don’t have to be doing it for like a couple of days at a time or four days at a time. You are just doing it for like a day, and it’s only a few hours within that day. And arguably, one of the most well-researched ones would have to be the 16:8 or the 12:12. So more information is coming out on this type of fasting pattern. It’s all just in the works. One type of intermittent fasting pattern. There’s also the 5:2 diet. This one was quite popular, like 20 or 10 years ago. So five days of average calorie intake, two days of fasting. Typically, those days are not one right after another, but it can depend on the individual. And then there’s alternate-day fasting. Quite extreme, although some people like to practice this. This is basically where your fasting for one day, and then the next day you’re not fasting and doing a regular calorie intake, then the next day you are fasting, and then you’re not fasting. We keep doing that day after day. So that can be quite a long-term commitment. So to shift our focus to the opposite end of the spectrum to the more extended versions of fasting, there are a few examples of this. There’s water fasting, which is very straightforward. Typically, this is done under the supervision of a medical provider, and you’re sequestered somewhere.


[00:25:09] Dr. Alex Jimenez DC*: Like we are right now. Like, we’re all sequestered right now.


[00:25:14] Victoria Hahn: Yeah, seriously. And it’s because, for some people, this can be pretty risky, and I’ll get into some of those risks. And just as a whole, it can be pretty tricky because typically, this is fasting for days at a time. And then there’s the fasting-mimicking diet. So just going back to the main focal point, the FMD is a version of a prolonged fast. It’s not a short-term fast. It’s technically a longer fast because you’re fasting for days at a time instead of just a couple of days or a few hours. And this one doesn’t typically have to be in the hospital. Thankfully, the majority of people do this at home safely.


[00:25:49] Dr. Alex Jimenez DC*: It’s incredible.


What is Fasting?


[00:25:51] Victoria Hahn: Yeah. So they get into some of the ultimate effects of intermittent fasting and just other fasting patterns. I like this table because it tries to simplify and put a caloric restriction here. Because when you start to look at the research for fasting, it seems like it is coming out of this umbrella of dietary restriction for restriction. So it deserves a space based on this chart. However, it is vastly different than fasting. So in terms of caloric restriction, we see that obviously, this leads to weight loss sometimes, mainly because it’s chronic and depends on how much caloric restriction you’re implementing. Some people can lose lean body mass, so you have to be mindful and careful about implementing this pattern. We haven’t necessarily observed the cellular rejuvenation effects that are going back to that renewal. That recycling it’s not well documented was caloric restriction. And of course, you do get food, and to some extent, it is, of course, safe. But shifting our focus to the different types of fasting patterns, you know, intermittent fasting again, we get to see the weight loss. It’s been variable in regards to lean mass body protection. Some studies had shown that when body mass was impaired, but this may just be an artifact. It’s not very well elucidated. This likely depends on the kind of mass that you’re doing the five-two, eight-ten, TRE time-restricted eating. You know, it’s a little up in the air, but this one has been variable, not necessarily an impact on the cellular rejuvenation. Again, very inconsistently reported, if at all. Sometimes you get food on the stats, and then you don’t depend on the type of fast you’re doing, and typically it’s quite a safe diet to do. But again, it depends on the iteration. The following kind of fasting is periodic or prolonged fasting, which talks about water fasting and specificity. So obviously, we see weight loss with this pretty dramatically so as well. Lean body mass can be sacrificed with this type of fasting pattern. So again, you want to make sure that you’re being medically supervised if you’re doing a water fast four days at a time. It’s a careful balance, especially wherever you are before you start into that. So don’t try that one at home, please. But this is the only one that we get to see cellular rejuvenation. So it appears that the sustained stress of fasting is really what’s dictating this type of recycling and renewable capacity is fasting for a while. Obviously, with this type of fast, you don’t get food and safety. Like I was mentioning, it’s very variable. Don’t try that one at home.


[00:28:41] Dr. Alex Jimenez DC*: Yeah, that fasting needs to be supervised.


[00:28:44] Victoria Hahn: A fasting-mimicking diet is a form of a prolonged fast. And you know, you do get to see the weight loss very similarly to periodic fasting. Fortunately, and I’ll show you some of this data. Lean body mass protection is interesting and may be a testament to the fact that there are nutrients in the diets and see this preservation effect still with the cellular rejuvenation impact. So thankfully, it is stressful enough. Fasting four days at a time again is the mantra to triggering that you do get food, and we regularly track its safety. So it has been proven to be safe.


[00:29:24] Dr. Alex Jimenez DC*: Guys, if I may, one of the things that I do is we make sure that we use biometric assessment exams. Body mass index is BMI, BMR, BIA are ways that we can assess muscle density or how much protein is in the body, how much muscle is about versus bone density. We got to be very careful that we do this in a very safe way. So, in essence, as she alluded to it, she was very exact. We have to make sure that we don’t lose muscle mass, and that’s the beauty of this diet plan because it has been shown to preserve muscle mass while you go through this process, but it also helps with cellular rejuvenation. It’s almost like you’re cleaning out your body. So hate to use those examples, but we can go into the physiology of it. But this is a very attractive mechanism, and it’s almost like a Tarzan effect. We go just to the point, and she’s going to allude to that to the fact where the body starts shifting. And that’s when the diet and so we go through these cycles. So to prevent muscle or muscle mass loss, it has to be timed at a certain point. So the beautiful thing is that Dr. Doctor is unique. What country is he from?


[00:30:46] Victoria Hahn: Italy.


[00:30:47] Dr. Alex Jimenez DC*: Yeah, he’s got a unique accent, and he is amazing. He’s at the University of Southern California. So it’s incredible that they have these. There are always people who go to California, the intelligent people do, and they come up with these great technologies that today we’re seeing the effects. And I’m not going to sway too far, but we know the genomics effects or the genes are responding. And that’s why you were talking about the food sensing system. Our whole body is designed with DNA that reacts to everything, whether a drug or food. So as it responds, this diet is in sync, dancing with it and so to speak. Forgive me if I’m wrong; I’ll let you continue. I’m very excited about the rejuvenation processes and also the lean muscle mass protection process.


[00:31:34] Victoria Hahn: Yeah. And those are honestly the most exciting pieces of fasting is that if done in the right way, exactly as you’re saying, are done in the right way. You can get benefits out of it without sacrifice. And that part of there’s a whole concept called or misses. And in essence, it’s this idea that you know, to one degree, the same thing could be wrong, but to another degree, it could be beneficial. For me, fasting, it’s a stress response, and it’s similar to any other stress response, especially in today’s environment; we don’t want to be stressed out. We want to make sure that we’re being healthy about that. But a little bit of stress can be good. And so it’s getting its fine-tuning that it’s figuring out what degree and to what duration. That’s the beauty of this concept that a lot of work, a lot of time within 20 years, actually went into trying to figure out how this whole mechanism works.

Hormesis and FMD


[00:32:39] Dr. Alex Jimenez DC*: If I may touch on that word again, hormesis. So from what I’m gathering, it’s the extent and the timing of the duration. Is that what it is to do? So like it’s like from what I gather, it is to the what the word that you said to the extent of it or the amount of go-ahead was?


[00:32:58] Victoria Hahn: Yeah, it is to say it was hormesis. It’s, in essence, like in its most straightforward concept. And you know, there are many different ways to look at it. But in essence, it’s this idea that the degree of something can be positive or negative or have a different effect at different levels. Makes perfect sense. For example, even with periodic fasting, with water fasting to a very high degree, obviously that can be very detrimental, damaging metabolic just because it’s starving. If you’re fasting for too long, so you don’t want to do that, you need to figure out the degree of fasting you need to get because we know there are benefits to a certain extent, but then afterward probably isn’t. And so that’s part of this whole concept of fasting-mimicking diet and understand why it’s the five days and such.


[00:33:57] Dr. Alex Jimenez DC*: So it makes perfect sense. Thank you.


[00:34:00] Victoria Hahn: Yeah, no problem. So they get into some of those benefits. And I think to recapitulate, so a weight loss is a benefit of prolonged fasting, metabolic health, supporting that cellular cleaning, that ability to recycle, and keeping the sense of well-being. We surveyed in 2019, and that was a fascinating finding, which I’ll show you some of that. So those notes are all of these things are some of the benefits of basically doing fasting, whether it be water-only fasting or any other type of prolonged fasting. But it does come with a subset of risks. First things first, it’s tough to adhere to, and I would argue that you know, even for myself and any of the patients that I’ve ever had to try to get them to do small behavior changes. So, for example, you know, hey, try to incorporate one vegetable per week that can be pretty difficult for some people to do, and you know, it was a behavior change. At the end of the day, it’s a behavior change. You have to modify something you’re doing, especially when you’re continuing to do something; it’s hard to adjust when you get stuck in a routine. And not to kind of integrate too much of what’s happening in society right now, but you know, we’re kind of starting to see that. In contrast, even how people adjust to today’s society, it disrupts our routine and doesn’t feel very nice, right? So that’s part of this notion of behavior change. And so if I were to tell somebody, Hey, I want you to watercress for four or five days at a time, that’s me taking out everything. I’m just entirely abruptly altering their lifestyle, and that could be nearly impossible for some people. So it’s no surprise that water fasting is just challenging to do. But at the same time, as we were going over that, it could also be at the risk of lean body mass. So let’s get to the point of wanting to do it. You have someone to supervise you. You know, there’s still an inherent risk of descending on how long you’re doing the water fasting. There’s always a potential to lose lean body mass, and obviously, it’s malnutrition that is what water fasting is as a whole. The lack of nutrients when you’re only consuming water, at least macro and micronutrients. Water is another type of nutrient, but it’s this deprivation of them. And so it can be very dangerous from that perspective, especially given wherever you’re starting was going into that would be insufficient. So we further exacerbated. And then, interestingly, there is this gallstone risk. Dr. Longo does talk a lot about this one, and there are some studies to show that specific periods of fasting, there’s almost like a period where it’s not so risky, and then it gets to a point where it becomes more difficult. So there are many things that we have to consider with water fasting if one is to try to even do it on their own. And then thinking that it may not be appropriate for everybody and more than just these reasons listed. And so, you know, that’s part of the reason why Dr. Longo had developed this fasting-mimicking diet. Part of the reason was just the, and this is a picture of him right here. This is Valter Longo, Dr. Longo. And yes, he is at USC, and he’s the director of the Longevity Institute there. And in essence, you know, initially, a lot of his research was on stress response and longevity and antioxidative capabilities, as well as water fasting. And it’s one thing to water fast yeast or mice. It’s an entirely different ballgame to water fast people. You know, if it doesn’t work out as efficiently for apparent reasons. So that’s part of why he had to figure out a way to study this fascinating process still that he could combine and bridge together. He was able to see that we screwed sensing pathways there so intimately tied to this aging process. And if you were to elevate them to high, we can see that they accelerate aging in essence. So the idea is maybe we can try to modify or modulate or adjust this type of aging process by adjusting these food sensing pathways and so that this part of this pinnacle research that he was trying to figure out. But when you get to study this with people, you know, they don’t want water fast. And so that forced him to figure out an alternative to water fasting. And that’s the birthing of the fasting-mimicking diet that is just it’s out of absolute necessity in terms of wanting to study it. And as a researcher, you know if you spent so much time on something, you want to see it through, especially if you think it’s going to be beneficial, so you have to adapt and adjust. And that’s what he did.


[00:39:18] Dr. Alex Jimenez DC*: You know, it’s one of those things when we’re looking, as I alluded to initially, we’re sitting at home where we’re trying to figure out with the dynamics of the present-day what we can do for ourselves and how we can kind of benefit from this period of time of pause. We’re all in a queue. So this is an excellent way of looking at changing our metabolism and making it work. Going back to that first moment when I first understood this or was made aware of the fasting-mimicking diet, I was surrounded by the top functional medicine doctors in the country. There’s a bunch of guys that put this thing together and functional medicine. Still, the onslaught of all the specialists worldwide came to figure out and understand this new science that had been dropped down at the Functional Medicine Institute seminars. We were all very aware of what it was, and you could see that the thriving doctors worldwide from all over the globe were trying to figure out how we can incorporate this for patients? So I feel blessed to have you here again. So to mention that again and to continue with your story, I just want my patients to know that this is a blessing to have you guys here for the people of El Paso.


[00:40:47] Victoria Hahn: Yeah, no problem. You know, I’m excited to be here. I’m excited to be able to share some of this information. So yeah, we’re just kind of keep on going. So in terms of the fasting-mimicking diet, you know, it’s just such an interesting and novel product as a whole. And so, it ticks off some of these essential elements of a breakthrough product. So it is all plant-based. That’s something interesting to note because even when some people go through it, you know, you’re thinking like, “Oh, no. I can’t do just plants like, I always eat meat. I love my meat.” And you will be surprised you can do that for five days. Absolutely. And that’s, you know, I’ll go over the kind of emotional effects that happen with FMD and prolong. But it’s interesting that, yeah, everybody, you actually could be eating just a plant-based diet, and this is just one way to do so. And again, it’s only five days. So it’s not a full-time commitment. But part of what built this was NIH and the university-based research and development. Again, 20 years of research went into this concept and just a lot of grant funding, honest to goodness, and foundational research. So preclinical, we had to test it out on different animal models first. And then, we started going into clinical trials to show its safety in humans. In essence, and of course, this technology has been patented and is very innovative. And so that lends well to why we wanted to go forward with that patents. And a lot of the research, if you were ever to want to look into it, is published in some of these top-tier medical journals. So maybe you’re not familiar with some of these, but these are the journals we use and as clinicians to find evidence-based information. So it does speak volumes that any of these publishers were like, Hey, this does sound good. Like, let’s publish this, let’s get it out there. It’s huge to have this happen. So it adds to the validity of this concept, which is nice. Of course, it is. And so then to kind of get into like the biological effects of FMD. And this is a real, simplified version of what happens, but for the most part, it kind of meets all of these little parameters. This does happen. It’s just sometimes we like to simplify. So on day one, I like to call this the equalizer, and it’s because everybody gets the same day one. It’s around 100 calories for that day, and it’s there to equalize and wash you out from whatever you were doing before breaking into the proline. So basically, this is, you know, that transition day. So some people, by the end of it, you’ll start to ramp up this fasting state by day two. This is the fasting state. Now you’re fasting the caloric ranges, they do drop down by two to five, and they have a weight-dependent factor. So you’ll get a little bit of a different core from now, depending on your weight. But in essence, the calories are anywhere from 700 to 800 calories. And so, by day two, we would like to view this as that fat-burning day because you have to have your body adapted to fasting now. It has to utilize different substrates to fuel itself, so it will start to burn fat. By day three, you really would have ramped a process called ketosis. Most people can reach the state on day three, but it’s contingent on the individual. Everybody has a different metabolic rate. Everybody has a different body composition, so not everybody will reach it on this day. But we do observe that many do. And that’s really like an accelerated state of fat burning, in essence. And you can perpetuate ketosis by way of fasting or by a ketogenic diet. They are a little different. So they don’t get there the same way. But the outcome is relatively similar, at least in kind of ramping up this fat-burning process. But day three is also where the cellular body is starting to kick start that recycling mechanism, which can start on day two. But this is really where it’s taking that full fledge running the course, by day four, more of the cellular recycling again, sustaining that fat burning that ketogenic stage. And by now, more of the cellular renewal. So enough of that recycling has occurred. Now it’s optimizing and by day five again is a sustained effect of the fat burning process, recycling, and renewal. And so that lends is well into day six, which is where you kind of kick yourself out of the fast. And it’s important to note this because, interestingly enough, what I get to hear from some users is that even if before they started the program, they’re thinking, “Oh, this is going to be a little too hard. Why not? I’m going to do it. You know, my health care providers are telling me that I should do this for myself.” So they go through it. And then, by day five, they’ll call us up, and they’ll say, “Hey, you know, I feel excellent right now. Can I do another fast after this? Like, can I do two in a row? How do I extend this? Try to do some water fasting afterward for a couple of more days? You know, what do I do?” And obviously, the answer is, no, we don’t want you to be water fasting or doing back-to-back FMDs. That’s not the point, but it is rewarding to hear that because it’s echoing of people are starting to feel quite nice. And the point of why we want to kick people out of the fast after day five is because part of the fast is this cleanup. It’s this fat-burning phase. But to capitalize on all of that cleanup and all this kind of new foundation that’s been laid out, you do have to re-feed. So you have to start reintroducing nutrients. You do have to repeat yourself afterward. And that’s this balancing act between fasting and feasting bowls is important. So going back to those food-sensing pathways, it’s one thing to kind of trying to downplay them or turn them off. But we don’t want them off forever. We do need to turn them back on. It’s just this modulation of its kind of this playing around. Is it turning it on, turning it off, is it flexible? That’s what’s part of providing some of these benefits. So it’s not just always turning it off; that would not be a good thing at all. And so fasting is its concept; although it’s simple, it’s complex because there are so many different things that we have to consider with it. And that’s going back to that idea of, you know, it depends on how much you’re getting, and you’re going to get a different effect. So obviously, we don’t have fasting forever to be a damaging effect, but fasting for that amount of time.


The Process of FMD


[00:48:04] Dr. Alex Jimenez DC*: Victoria, I got a question for you. In terms of looking at that particular graph model? I noticed that I’d done this a few times now, and the dynamics are like your drawing there. I’ll go right back to it because that diagram, it’s kind of like it shows an up and a down, talk to me a bit of the emotion that people experience in general in terms of each type of day as they go through this because one of the great things about this diet is that it’s structured. I have a philosophy that has the most excellent order always rules. There’s perfect order in the structure of the design of this. And one of the things that I see is at that moment, your mind starts going, and your body starts changing and the dynamics that are occurring. One of the great things to hold on to is a structured mechanism that you can follow, and you just continue with the path. But talk to me a bit about the emotions and what people experience on the days that go by because that’s unique. And by the way, I will say that my first time doing it, I experienced the unknown. I didn’t know how I was going to respond. The second time I was ready, I was almost like I was prepared to go for it. And then the third time I was even, it was a surprise that I was experiencing different emotions, though similar but an extra level of emotional experience and mindset that changed throughout the days. Tell me a bit of what you’ve noticed with the patients throughout the United States that take this diet.


[00:49:35] Victoria Hahn: Yeah, so in terms of actual survey data, unfortunately, we don’t have many feelings during prolonged. We do have one afterward, which is quite interesting. But to get into more of an anecdote, I typically get to hear what we’ve discussed as a group. But all of the team members of that have, you know, something that’s pretty common. Again, everybody experiences a little differently, and that’s not really like a straightforward response. And I understand it is kind of its fear, though, but it’s yeah, it’s true. You know, some people go through this, and they’re like, “Oh, this was such a breeze, you know, like, I didn’t even feel like I was fasting.” And then others are like, “Wow, you know, I’ve just never fasted before. And now, I fasted.” So they’re like, they’re kind of amazed by that experience. But arguably on day one, when most people don’t have any actual remarks on this day, some people will remark that “Oh, well, you know, it’s a little bit less of what I usually eat,” but it has so many calories in it. And also the way that we’ve structured out the actual day one, you get around almost like for technical meals that day. You get two of these large, like high healthy fat bars and then not be satisfied. And then also we have like two soups and a variety of snacks. So you get a lot of food in. And if you divide it upright, you’ll notice that you know it does sustain you quite well. But by day two, three. Arguably, these are the days that most people may remark like, “I feel kind of sluggish. I don’t feel like myself.” They’re questioning why they’re feeling off if you will, and it’s not specific. It’s not like, “Oh, you know, I have this type of pain, or I have this type of feeling.” It’s just kind of like, I feel a little, not myself today. And usually, we like to kind of like in that to this transition. So are you going from sort of carb-burning to this fat-burning state? So that’s like that adaptation. We’re not too sure if that’s what’s happening, but it can be argued that some people, at least if you’ve never gone through a fast before, you may end up feeling kind of some of these like, “Oh, I feel a little off these two-three,” but usually by day four or five, and especially on day five. These are the days that typically people think kind of the most revitalized if you will. So they have energy on these days. They rebound, so they don’t feel that same kind of like, “Oh, I feel awful.” They’re like, “Wow, I have so much energy right now,” and I get a lot of phone calls or people; they feel like they shouldn’t have that much energy. They’re a little worried, like, “Oh, you know, I woke up early today and got a lot done. Is this normal?” And it’s funny because, to some extent, that’s part of that adaptation and how we’re kind of picturing it.


[00:52:42] Dr. Alex Jimenez DC*: Victoria, I’ll tell you, when you mentioned that one of the beautiful things is that we have a social network when I have done this with a group of people. I found it very cathartic to communicate, take pictures of us while we were with the packages, and share, so I didn’t feel alone. I felt like I was in a community doing this together. So yes, when I recommend people do this as husband and wife or families that are large, they can try it together because it brings you together because you’re doing something for yourselves at the same time. So I got to tell you from my own experience that I felt the need to communicate, and it served me well to have that ability to communicate through social media. So, yeah, it’s an awesome thing.


[00:53:32] Victoria Hahn: Yeah, and I definitely would agree that, if anybody is thinking about doing the fast, you know, definitely work together with others. It’s funny because of the types of questions that arise; you’ll find that maybe you have the same questions, perhaps you have questions, and you develop these inside jokes. I know for myself and a few others in the office. Whenever I’m doing the fast, there’s like a little packet of olives. But anyhow, it’s funny because you get like this little packet of them, and there’s a little olive oil on the package. And once you’re done eating them all, like we are just kind of like taking all the liquid out and celebrating.


[00:54:18] Dr. Alex Jimenez DC*: Yes, those olives are delicious.


[00:54:21] Victoria Hahn: Yes, it’s funny. You can build a sense of camaraderie with this show that you’re with others when you’re doing it in terms of, you know, socializing with them? So other things that we see with the fasting-mimicking diet, which is specific to FMD, we ran a clinical trial, so there were researchers in 2017. They ran a clinical trial, and seventy-one individuals had completed this trial. And in essence, they wanted to see the effects of one round of fasting-mimicking diet on the five-day FMD, done once a month for three consecutive months. And so after what they had remarked that individuals, they lost on average five-point-seven pounds of BMI; body mass index that dropped by zero point nine points. And so that ratio of body weight to height trunk fat went down. So, compositionally wise, what kind of weight did people lose? It appeared to be this trunk fat, and lean body mass was thankfully preserved. We did not observe any lean body mass loss. So a lot of these healthy weight loss type benefits with the fast. And again, this was the five different be done once a month for three consecutive. And so other benefits that we see, of course, this promotion of cellular cleanup, reduction of body weight and body fat. And then, interestingly, this maintenance in the level of IGF one, which I didn’t go over too much, and I won’t spend too much time on this bad boy because it gets rather relatively complex. But IGF one, it’s called insulin-like growth factor one, and it’s been implicated in this aging process and disease. And that part of one of the food sensing pathways. So this one is essential and one of the things that Dr. Longo had just done a lot of research with, trying to figure out what’s triggering it and how we can modify it, at least with fasting. So these are all outcomes that we see with the FMD.


[00:56:30] Dr. Alex Jimenez DC*: It is a bad boy. It is the one that we focus on when we talk about metabolic syndrome, and it goes intense and does make a difference on that bad boy called insulin. So it’s a good one. So I definitely will allude to that in a future podcast because it’s crucial that even though it looks kind of menacing and it’s a deep word, I love that the research was done with that as the basis.


The Mechanisms of FMD


[00:56:55] Victoria Hahn: Yeah, and you can spend a long time on this one. Its whole mechanism is a beautiful thing. But yeah, it just it’s interesting to see that again, like this kind of short-term intervention. We see some of these outcomes. So to go over some of these outcomes and like one, two, three, four formats. So one of them, of course, is rejuvenation, wellness, and health optimization. This program was designed to promote healthspan. Which health span is this concept of healthier years lives. So it’s one thing to live longer. That’s fine. But what if you know those years where you are in feeble health during that time? That wouldn’t be too fun, right? Maybe then you would reevaluate that concept of live fast, die young. So it’s so much less about that. It’s more about healthier lives. So, you know, making sure that there’s quality with that quantity is so important.


[00:57:52] Dr. Alex Jimenez DC*: Victoria, that’s a huge point there because touching on that one delicately, the issue is when I talk to my patients, I tell them, I want you to live 100 years. That’s what I say. I say that to them. We got to do it because when we look at the turn of the century, people didn’t live far beyond the 50s. Today, we live much longer. In the mid-60s, it was 65. Today we’re reaching even up to 100. Many of us have parents in their 90s and close to the hundreds, and one of the biggest concerns that people have is I don’t want to live that long. I don’t want to feel ugly or bad. And that’s precisely what you’re alluding to, the quality of life you’re feeling in that process. So yeah, it makes sense.


[00:58:30] Victoria Hahn: Yeah, absolutely. You know, and it’s a kind of it’s not a novel concept, but I feel like it’s gaining some traction more recently. But anyhow that I go a little further and just on these research results, there was a kind of weight management effect, so fast way to lose weight, specifically coming from the circumferential region so that shrunk fat, abdominal fat without any of that lean body mass loss. And again, this was only with five days. So, you know, think of short-term interventions of five days, don’t want to run for three consecutive days, and go back to what you said earlier. That’s where we get this concept of the once a month for three consecutive months. It’s based on a clinical trial. Ultimately, in terms of how many times you may want to do the fasting-mimicking diet, that’s a discussion for you and your health care provider. And also just, you know what your health care goals are as a whole. So it may not be appropriate for everybody to do them once a month for three consecutive, but for some, you know, it may. And to note, these effects did persist even when individuals went right back to their regular diet. So we had some follow-up evaluation after those three consecutive cycles. There was like, in essence, around like three or four months after those last three cycles. And during that time, the researchers have told those individuals, Go back to their usual standard diet. There was no post protocol.


[01:00:00] Victoria Hahn: They didn’t follow a healthy diet, Mediterranean exercise more? There wasn’t any of that instruction, and we still did see this persisting in these weight loss effects, which was quite interesting. And, of course, in addition to some of the other markers that we had measured, we saw that this had helped maintain healthy levels of not only IGF one. So going back to the insulin growth factor one, super important but also systolic blood pressure. And then to get into some of those well-being aspects, I was mentioning earlier. So this was based on that survey that we had conducted in 2019. And what we have kind of summarized from this survey was that these participants reported just a multitude of these well-being aspects. So an improvement in their energy levels and would be after the fasting-mimicking diet. They also felt more empowered to make healthier changes in their life, and they felt like they had a positive impact on their lifestyle after the FMD. So it’s interesting to note that there is this kind of emotional or wellness aspect or impact to completing. In essence, prolonged, just five days can set the tone for so many other things to come. And although we didn’t measure this in the clinical trial, we took it upon ourselves to evaluate this on the neutral side, and we did get to see a lot of these fascinating empowerment outcomes afterward. And so then to kind of summarize, and this is, you know, in essence, my last slide before I have this Q&A. So to summarize the benefits of the FMD and this is again, you know, after the once a month for three consecutive four-five days on twenty-five off two more times in a row, we did see the maintenance of healthy levels of IGF one, systolic blood pressure. We all saw that lean body mass was maintained at a healthy level, and of course, we saw this reduction in weight and abdominal fat.


[01:02:17] Dr. Alex Jimenez DC*: That’s amazing. This is it right here?


[01:02:19] Victoria Hahn: Yeah, that is it, so any questions?


Consult With Your Health Care Provider


[01:02:22] Dr. Alex Jimenez DC*:  Well, yeah, the question that I’m getting here from some of my people on the feed is that they love the presentation. And actually, there are three nurses there that say that they’re doing it, and they’ve done it in the past, and they loved it too. So let me ask you this. There’s a person who says he’s 300 pounds, and he’s about five foot seven. Can he do it? He’s clinical from the dimension there. I think a clinically obese. And that issue there, he’s concerned that it may be something that he can look at and try. What could we say to him?


[01:03:00] Victoria Hahn: Yeah, so what we can say to him is in that sense, you know, this program is one of the intentions of it is weight loss. But given that we know that obviously with a significantly elevated BMI, you may want to discuss it with your health care provider to determine if prolonged would be right for you. And then, in addition, with that frequency would look like so. I think the next step would just be having that conversation, opening it up. And it’s a pretty easy, straightforward conversation to have because, ultimately, what prolonged is that it’s just a five-day fasting-mimicking diet. But arguably, you could probably also say it’s a five-day reduced-calorie program. And typically, the health care provider will have a few questions about that. But it’s pretty straightforward.


[01:03:55] Dr. Alex Jimenez DC*: Victoria, I would add that for an individual with that presentation, talk to your doctor first, find out metabolically how you stand if you have any underlying issues in today’s environment. Before we go on and do anything unique and then you have some underlying issues, kidneys, heart issues, always get their doctor to approve these processes because you want someone to evaluate that, and that makes sense. The other question I have here, Victoria, that I noticed here was that people are asking where they can get it? Where can they order it? And is this something that they can get online? Do they have to go to a doctor? What typically are most people doing?


[01:04:35] Victoria Hahn: So, I don’t know if you have a channel


[01:04:39] Dr. Alex Jimenez DC*: I do. Yeah, we have our channel.


[01:04:42] Victoria Hahn: Yeah. So in case you are a patient of Dr. Jimenez, then definitely discuss with him and determine if it’s a good fit for you. In essence, you might want to go through his channel, but we do also have a website. I would argue that most individuals are looking to incorporate fasting into their life, yeah, typically will just, you know, kind of purchase it on their own through the patient portal that we have online. But absolutely for some of the individuals you may have some questions about, is this right for me? Then it’s always going to be more appropriate for you to have that open discussion with your health care provider.




[01:05:24] Dr. Alex Jimenez DC*: We do a complete functional wellness assessment in our office. We go through deep, and we figure out where the physiology is. We do at least a wellness panel to determine what’s going on, and we evaluate the BMI BIAs consistently and every few weeks. It’s important to know if you’re going to be scientific about the process to have. If you specifically have underlying issues, you want to ensure that you have a watchful eye by your specialist, doctor, or family physician. So that makes terrific sense. Well, Victoria, I got to tell you, this has been a blessing on our behalf of El Paso, and I want to thank you at least. I want to thank the group over there at El Neutra and Prolonged for the design. The product is one that we need to have an environment where metabolic syndrome does affect so many, and we want to be able to do certain things to control our diets. When I first came to El Paso, the story was we were the fattest sweaty town in the United States. And sadly, that was it was known. But today, there are fitness centers everywhere. In 1990, when I came out here, there were no fitness centers. People are very health conscious. My patient base is hugely educated. The internet has as evolved. People are learning, and people understand the sciences of biomedicine, biometrics designs, and assessing the body for what it is. The question many times, because there’s so much information, is, Well, what do I start? How do I do this? This is an excellent diet. It’s a marvelous mechanism and a plan to follow with scientific backing, a fundamental approach that is, you know, second to none. I love the research. I consistently have their books. I have books to offer my patients if they ever want because I do have people that want to learn the breadth and width of the science behind the evolution of this particular diet. So I’m very much excited to bring this to the community. So I want to thank you, Victoria, and I want to thank your group and organization for allowing at least this presentation to go live on social portals to bring a different option for our patients. And I want to honestly thank you very much because it’s been a blessing to hear the areas. Let me see if I can get you in there somehow. But you’re there. I’ll put you in the middle there, and what we can do is in the future; if you guys have questions, call me and discuss these things. And is there anything else that you would want them to know? Victoria, in terms of this protocol?


[01:08:15] Victoria Hahn: So just a brief tidbit and not downplay anything, but to note. And I want to make sure this is clear that, of course, FMD is fascinating and novel. But just to mention, it has not been evaluated by the FDA to treat, diagnose, cure, prevent any condition. So it’s not meant for a therapeutic rationale. Instead, suppose you have these weight loss goals, healthy aging support goals, or metabolic balance goals. In that case, that’s something that can fit in, but just always be very mindful that it’s not intended for the treatment and has not been evaluated for those types of implementation.


[01:09:01] Dr. Alex Jimenez DC*: Well, said Victoria, I got that, and it makes perfect sense, and I appreciate you going out of your way to show us this process and to give us the parameters. Thank you very much.



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We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez, DC, or contact us at 915-850-0900.

We are here to help you and your family.


Dr. Alex Jimenez DC, MSACP, RN*, CCST, IFMCP*, CIFM*, ATN*


Licensed as a Doctor of Chiropractic (DC) in Texas & New Mexico*
Texas DC License # TX5807, New Mexico DC License # NM-DC2182

Licensed as a Registered Nurse (RN*) in Florida
Florida License RN License # RN9617241 (Control No. 3558029)
Compact Status: Multi-State License: Authorized to Practice in 40 States*

Presently Matriculated: ICHS: MSN* FNP (Family Nurse Practitioner Program)

Dr. Alex Jimenez DC, MSACP, RN* CIFM*, IFMCP*, ATN*, CCST
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