Diet Thread

[CKinnard]

Then why do the Adventist pesco-vegetarians have the lower mortality rate, despite seafood being higher in sulfur content than both eggs and meat?

the pescos eat fish more than once a month, which doesn't include other forms of seafood with high sulfur levels, like crab, lobster, scallops.
many if not most fish have similar sulfur content to the skeletal muscle of other animals.

the AHS 2 study showing pescos have the survival advantage was only 7 years old. statistical power will increase as time passes.

not all confounding variables have been accounted for by AHS2 . i.e. it is possible many SDA members only adopt a stricter plant based diet once they start to experience health problems.

[Nobody]

From a co-author of the processed meat and cancer report to the WHO.

What is the single most important piece of nutrition advice you wish everyone knew?

Do not trust all information posted online about nutrition and health. Go to the most reputable sources. For knowledge about nutrition and cancer this would include the Physicians Committee, the American Cancer Society, the American Institute of Cancer Research, and the World Health Organization, among others. Epidemiological or experimental studies on diet and cancer are published every day. The press likes them, and they make for great stories, so they appear in the media very quickly. Not all meet the most rigorous scientific standards. And even if they do, the variability across the population is so large that epidemiologists never rely on one single study to make definitive conclusions. We rely on systematic reviews conducted by experts using rigorous methods.

There is the misconception that “everything gives cancer, so why worry about one dietary item or another, they will all cause cancer anyway!” This is not true. To date, there are only a handful of dietary items that have been consistently and solidly linked to cancer. Red meat is one of them, so we should take this seriously. Meat does not need to be the main staple of our diet, and it is not the only source of protein for kids and adults to be strong and healthy. We should give a more prominent role to plant-based foods, which when part of a balanced diet can provide all the essential nutrients we need to grow and stay healthy and strong, and also provide us with many disease- and cancer-fighting nutrients.

In the Western diet, we have grown used to the idea of having meat as the main food item on our plate and everything else on the side. Many people still think that without meat they cannot be healthy. We need to reverse our thinking and make plant-based foods the center of our plate.

(bold mine)

http://www.pcrm.org/nbBlog/q-and-a-auth ... cer-report

[mikesbytes]

Its like I've said before, it seems that people have the idea that if 100gms of something is good for you, then 1kg of the same thing is 10 times as good for you.

Generically speaking the biggest problem is a lack of knowledge and/or a lack of personal care. Its not that difficult to eat some green vegetables with every meal and not over do the calories

[Nobody]

What I learnt most from the video above is the causative association between hormone intake and certain types of cancers (called affluent cancers in the video).

[big booty]

And then there's the prolonged fasting effect that she needs to explain. I recently completed a 40 day fast in which I was surviving on ketone bodies. I had no hunger pangs, no starvation state of emergency in which my brain used every means to get me to eat to meet a set point. I've been eating for a couple of weeks since ending the fast, and am very comfortably sated on 800-1200 Calories a day, which includes around 300-600 Calories of activity related thermogenesis. So I am losing weight still...but now at a rate of 1kg a week as opposed to 2kg a week when fasting.

[/quote]


Did you go to Costa Rica and see Loren Lockman on your way to the USA? What were your trying to achieve during your 40 day fast? How much weight were you losing per day? 200-300 grams? 8-12kg total?

[CKinnard]

No I did the fast at True North Health where I am doing an internship. It's the most experienced medically supervised water fasting facility in the world. Loren seems reasonably informed in his utube videos, but he apparently has had many clients who had significant adverse responses, and he handled them very poorly. He is not medically trained, and does not monitor blood tests. After I read his application form to do a fast, I lost a lot of respect for him.

I mentioned my weight loss in the text you quoted. It is higher initially and decreases with time.
I was professionally curious to see what a fast does to the body and brain, and some of the chronic fatigue syndrome effects I still contend with. WF is now known to reverse chronic diabetes type 2, hypertension, the pain and inflammatory effects of many autoimmune diseases especially inflammatory arthritides, and some cancers. Though it is not a cure all.

However, a super clean diet WFPB Salt oil sugar free are required to sustain the effects. I've met enough repeat clients who have had complete remission from these conditions. Many talk about the struggle of letting go of old dietary habits, but over several visits gradually realize the diet is do-able and worth the adaptation to be rid of pain, lighter bodyweight, and more active.

Weight loss was a secondary consideration, as there are more efficient ways to lose weight and retain lean tissue. i.e. one doesn't water fast to lose weight primarily.

[big booty]

I think Loren is well intentioned but a little out there. Ive watched some utube clips on Alan Goldhamer as well. Not sure Id want to go 40 days? Geez CK you must be eating a lot of crap to need that sort of detox. Ive been water fasting since October last year. Two days per week. Valter Luongo recommends 4 days per month, I broke it up into two bites of 2 days. Ive recently gone to one day per week as I don't want to lose any more weight but want to keep the benefits of fasting. It does become ridiculously easy doing them after a while. Nothing like getting your liver to actually perform the "other" function it doesn't get to do very often in our western society eating habits. Used to take me 60 hours to get to a ketotic state initially. Now Im there after 24 hours. If you can think of a better way to lose weight Id like to know what it is? Did you monitor lean tissue loss over the 40 days? What was it? Personally I don't think Ive lost a lot of lean tissue but I have no hard proof of that. If I have it hasn't affected my riding performance so far.

[Nobody]

From Plant Based thread:

Here you go Nobody. The first set of numbers are the current results and the second set are from last year. Had a look at the results and I don't have any hsCRP results unless its called something else? Or is this a test that you specifically have to ask for? I just asked for the "standard" blood tests. Granted Ive lost weight as well but my major dietary change was to swap out bread/toast for breakfast (don't really have much bread at all now) and replace it with high fat/low sugar yogurt and I upped my cheese intake, mostly in veggie salads as well as nuts (almonds and walnuts). That HDL result for me is a big deal, My HDL has been low for the last 15 years.

cholesterol 4.8, 5.3
Triglycerides 1.1, 3.0
HDL-c 1.2, 0.8
LDL-c 3.1, 3.1
BG 4.6, 4.8
chol/HDL 4.0, 6.6
BP 120/70, 132/84

BMI 22.4
WtH 0.488

Don't really want to lose any more weight as I reckon I look about right.

The inflammation blood marker hsCRP has been shown to be the most effectively single indicator of CAD from the study I PMed you, which is also below. It appears not many get hsCRP tested, since you need to ask for it. Or if they do, they don't post the results. So far only CK and I have posted ours. Mine is 0.6 (range 0 - 5.0) which puts me in the second lowest range for risk. I think CK's was usually 0.7.

http://circ.ahajournals.org/content/109/16/1955.full
http://www.ncbi.nlm.nih.gov/pmc/article ... /table/T2/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3038964/

As for the blood results you have, they can be fairly meaningless since you can have CAD/CVD with lower values than that. According to the Framingham study, a total cholesterol of less than 3.9 is advisable. Even then you can generally only be confident of not being surprised by a heart attack if you are eating plant based. My blood test comments have guidelines which say LDL-C ideally should be < 2.5 and for those at risk it should be < 2.0. Getting under 2.0 can be difficult if you have a high set point like me, since mine is still 2.2. As an example, a colleague's wife had to have 2 stents put in with lower cholesterol values than him and he had a CT Coronary Artery Calcification (CAC) scan score of 0. They eat the same, so genetic plays a big part. That is where hsCRP can be useful as a screening tool for picking up susceptibility to CAD. A CAC scan is even more useful, but involves radiation exposure from the machine, even without a radioactive contrast injected. So IMO only worth it for those who have repeated higher hsCRP scores (> 3.0).

Your WHtR of 0.488 illustrates how poor BMI is as a measurement. BMI looks good at 22.4, but WHtR is still at the higher end of the normal range of 0.4 to 0.5. I haven't measured mine for a few months now, but I think it was 0.431 last time I checked. I'll probably start measuring weight and waist again when it gets warmer, since my variance is low.

http://www.ashwell.uk.com/images/2011%2 ... Charts.pdf
http://press.endocrine.org/doi/abs/10.1210/jc.2009-1584
http://www.ncbi.nlm.nih.gov/pubmed/22106927

Your systolic BP is at the borderline of ideal to pre-high according to the Blood Pressure UK chart below. Probably considered good for the average person from a GP's perspective, but a bit high for a cyclist who is watching their diet. Mine used to be 122/81 before the diet change. Both times the GP has measured mine in 2014 and 2015, he got 115/65 which he said was excellent (I assume for my age of 48yo) since the middle of ideal in the chart says 105/70. The nurses use an automatic BP machine at the hospital where I go to get my blood drained every 3 months (hemochromatosis) measure between 110 to 120 for systolic. Keep in mind that hydration has a lot to do with BP, among other things like stress etc. So really only accurate as a trend indicator when measured repeatedly over the long term.

http://www.bloodpressureuk.org/BloodPre ... ssurechart

[CKinnard]

I think Loren is well intentioned but a little out there. Ive watched some utube clips on Alan Goldhamer as well. Not sure Id want to go 40 days? Geez CK you must be eating a lot of crap to need that sort of detox. Ive been water fasting since October last year. Two days per week. Valter Luongo recommends 4 days per month, I broke it up into two bites of 2 days. Ive recently gone to one day per week as I don't want to lose any more weight but want to keep the benefits of fasting. It does become ridiculously easy doing them after a while. Nothing like getting your liver to actually perform the "other" function it doesn't get to do very often in our western society eating habits. Used to take me 60 hours to get to a ketotic state initially. Now Im there after 24 hours. If you can think of a better way to lose weight Id like to know what it is? Did you monitor lean tissue loss over the 40 days? What was it? Personally I don't think Ive lost a lot of lean tissue but I have no hard proof of that. If I have it hasn't affected my riding performance so far.

Valter Longo is highly respected by the True North people, and vice versa. He is going to do human trials using True North as the facility soon. It's important to keep in mind his studies to date have been mostly on animals. Several other fasting groups are also going to do trials at True North. There's a lot going on here and in the pipeline regarding PBWF SOS diet and water fasting. The next few years are going to see a rapid increase in evidence for these 'therapies'. There is now a full time post doc research director at the center who is coordinating many of the planned projects. Nevertheless, I don't blindly buy into the whole philosophy of this place, but won't go into it. On the whole the founders are pioneers who took on enormous financial and professional risk, and have been burned multiple times....but slowly very high quality people are getting on board. The medical forces against a center like this are unbelievable. This place would not have been possible in Australia. Alec Burton only survived because he kept a very low profile.

Yes, I ate and drank a lot of the wrong stuff last year, in which I put on 17kg and worked too much.
I didn't monitor lean tissue loss. The only way to do it reliably is via dexascan or underwater weighing.
I've recommended the facility get an underwater weighing system and several staff agree.
According to the data they have here, it's estimated I lost 1kg of lean tissue.
It may be more. I weighed around the same at the beginning of last year as I do now, but my waist was narrower.
On that basis I think one should not do water fasting to lose weight.
A sustained Calorie deficit of a prescribed % of bodyfat per week, is smarter and what the science recommends.
The deficit can be achieved by alternate day fasting, intermittent fasting, or a consistent daily Calorie deficit.

[big booty]

Interesting, thanks for that insight. I would describe what I do as intermittent fasting. I find it easy, do it one day per week, maintain a constant weight and my blood results are heading in the right direction. Im happy. Im not convinced a constant calorie deficit would actually work in the long run. Your body isn't that stupid and will find a way to "cheat" to make up for the constant shortfall. Hence why a lot of people complain about being cold all the time when on constant deficit diets. The "thermostat" has been turned down to conserve energy and guess what, people stop losing weight, get discouraged and give up. Not sustainable. where as intermittent fasting I think is sustainable.

[CKinnard]

Im not convinced a constant calorie deficit would actually work in the long run. Your body isn't that stupid and will find a way to "cheat" to make up for the constant shortfall. Hence why a lot of people complain about being cold all the time when on constant deficit diets. The "thermostat" has been turned down to conserve energy and guess what, people stop losing weight, get discouraged and give up. Not sustainable. where as intermittent fasting I think is sustainable.

A water fast is a constant calorie deficit. Are you saying all water fasters are going to gain all their weight back afterwards? This just isn't true.
Either way, how comfortable someone is on a sustained deficit has a lot to do with their psychological state and how well they can recruit ketosis.
I know more people who have lost weight comfortably on a sustained deficit than I don't.
Since finishing the fast, I have been on a sustained deficit of 1000 Calories, and am still losing weight obviously.
It's not an issue for me, at all. And in that time I've been riding a mountain bike in the hills and going to the YMCA to pump iron.
If I could live here for the rest of my life, I would not be tempted to overeat. The cravings start when stress starts, and the endocrine and metabolic systems are stress tested. If diets don't work, it is more likely because people fail to manage their stressors after losing weight, in addition to desiring foods that give them a dopamine hit.

People really have the wrong idea about dieting, which has been given a bad image by health professionals who say diets don't work.
Diets do work. It's how the majority of people lose weight. It's just that many dieters delude themselves they can go back to their old dopamine stoking ways after losing weight triggered usually by some psychological stressor.
Scientists who say diets don't work are making the presumption that a dieter's desire to return to their previous bad eating habits is not maladaptive or pathological. Rather they are saying the person's physiology while eating a healthy diet after dieting is pathological. It's very sloppy thinking. Personally, I don't think many diet researchers understand all of the inputs into appetite and cravings.

[big booty]

No not at all, I think we are just crossed up with our definitions. I think my definitions are different to what yours are, that's all. Lets assume you need 2000 cal per day for weight maintenance. If I were to run a deficit of 285 cal per day compared to what I needed I would call that a constant deficit diet. At the end of the week I would have had 12000 cal instead of 14000. What I call an intermittent fasting diet would be one where I ate 2000 cal for six days and a water fast on day seven. Im still sitting at 12000 for the week but have achieved it in a very different manner. Alternate day fasting I eat 2000 then reduce to 1428 the next day then 2000 etc. At the end of the week Im 12000 cal.

Fully agree that fasting has received "bad press". When I tell people what I do they give me very strange looks. Surely that cant be good for you?? Arent you starving yourself, your muscles will waste away etc. I actually find it very easy to fast now but it probably took me about 6 months before it got ridiculously easy. About a month before I stopped getting headaches and feeling "off". I can go for walks, bike ride etc on my water fast day. Im not stupid enough to say I'll be setting PBs on those days but I can ride my bike with ease at a reduced rate.

Fully agree with what you are saying about most dieters. They treat the diet as a destination. They lose the weight they wanted to lose, revert back to their old eating habits and yo-yo up and down. Im treating my fasting as a journey rather than a destination.

I cant say I really understand the psychology of dieting (or at least those people that want to lose weight but just cant). For many of them their eating habits mask many other psychological disorders. Their weight is just a manifestation of other problems. The mechanics of losing weight to me is very easy. If people don't know how to eat properly you just tell people what they need to do, yet so many are unsuccessful, saying they just cant do it. Its a complicated issue for many.

[big booty]

OK I just read your post again. I can see where the confusion about a constant calorie deficit came from now. Yes a 40 day (or any length of time really) water fast, is a constant calorie deficit diet. I got no problem with that and I think it works a treat. Such a diet flips you into a ketotic state really quite quickly. About 24-48 hours and your usually running on ketone bodies. Like I said I used to do 2 days per week until recently, now its one day per week. I think there are benefits to be had which go beyond weight loss.

What I don't think works well and dooms most people that have a weight issue is when they try to limit their calories on a daily basis. Say they need 2000 cal and they try and eat 1500 cal every day. Personally I think it just sets them up for failure. They never flip over to running on ketone bodies and rather then tapping into their fat reserves their bodies find ways to "cheat". Their activity levels slow down, their homeostatic body temperature drops etc. They feel like shite and you just cant sustain that sort of effort for any length of time. They eventually crack and the weight comes back with a vengeance. If they did intermittent water fasting instead I think they would be successful. But try convincing people that this is OK to do and they wont believe you.

You say youre currently on 1000 cal a day still. Im assuming you still need to lose some weight? Personally Id swap what your doing to eating your daily requirements and doing one or two days per week water fasting instead. Id be really interested to know if you were in a ketotic state doing what your doing. I doubt it but I could be wrong.

[CKinnard]

They never flip over to running on ketone bodies and rather then tapping into their fat reserves their bodies find ways to "cheat". Their activity levels slow down, their homeostatic body temperature drops etc. They feel like shite and you just cant sustain that sort of effort for any length of time. They eventually crack and the weight comes back with a vengeance. If they did intermittent water fasting instead I think they would be successful. But try convincing people that this is OK to do and they wont believe you.

You say youre currently on 1000 cal a day still. Im assuming you still need to lose some weight? Personally Id swap what your doing to eating your daily requirements and doing one or two days per week water fasting instead. Id be really interested to know if you were in a ketotic state doing what your doing. I doubt it but I could be wrong.

My experience is that it is very possible to flip to ketosis on a 300+ Calorie daily deficit.
Though the person's endocrine state and microbiome have to be considered, as these can influence which food group the person is more likely to feel comfortable with.

Water fasting is not well understood by most. It is a very severe experience to put the body through, and ime should not be attempted without blood tests and medical hx interrupted by a physician experienced with fasting.

Many people fail on a stable Calorie deficit because they don't comprehend how mind and emotional state impacts appetite. They think they just have to focus on food, when they need to also work on psychoemotional issues.

OK, I have a big meeting with a google panel in Palo Alto in the morning.

[big booty]

Good luck with your google meeting. So are you in a ketotoic state? Easy enough to measure with one of the many glucose/ketone meters on the market. Im in a ketotic state after 24 hours of water fasting. Not sure I could do or would want to do what you did, but 1-3 days isn't a problem. well at least for me it isn't. Id say the vast majority of people would fail a stable (daily) calorie deficit diet, its just plain hard work. I don't think I could do it for any extended time. Intermittent water fasting (one or two days per week) on the other hand I personally find very easy to do.

[CKinnard]

Good luck with your google meeting. So are you in a ketotoic state? Easy enough to measure with one of the many glucose/ketone meters on the market. Im in a ketotic state after 24 hours of water fasting. Not sure I could do or would want to do what you did, but 1-3 days isn't a problem. well at least for me it isn't. Id say the vast majority of people would fail a stable (daily) calorie deficit diet, its just plain hard work. I don't think I could do it for any extended time. Intermittent water fasting (one or two days per week) on the other hand I personally find very easy to do.

Most people who eat clean can move into ketosis after 2-3 days water fasting, once you get through your glycogen stores.
How uncomfortable it is can depend on insulin resistance, other endocrine disturbances, and toxins that begin to be released from fat reserves. Further, my blood glucose stayed above 4 the whole duration of the fast.

Recent evidence shows endogenous glucose production is significantly enhanced by intestinal gluconeogenesis which can contribute up to 66% of normal blood glucose levels.

http://diabetes.diabetesjournals.org/content/60/12/3121
http://www.sciencedirect.com/science/ar ... 2714001910
http://themedicalbiochemistrypage.org/g ... substrates

[big booty]

My definition of moving into ketosis is when I record a level of 0.5mmol/L or higher of ketone bodies. I get there after 24 hours of my once a week water fast (fast is 36 hours). Used to take me 48 hours (when I did 60 hour fasts). Now what does that mean? Are my glycogen levels never fully topped up? Or is my system flipping over prior to complete depletion? Don't know. Never had a problem with my glucose levels, they are always in the low 4s during a fast. If I avoid grain based foods then its usually high 4s or to low 5s even when eating. Eat grain based products and its usually high 5s.

[CKinnard]

My definition of moving into ketosis is when I record a level of 0.5mmol/L or higher of ketone bodies. I get there after 24 hours of my once a week water fast (fast is 36 hours). Used to take me 48 hours (when I did 60 hour fasts). Now what does that mean? Are my glycogen levels never fully topped up? Or is my system flipping over prior to complete depletion? Don't know. Never had a problem with my glucose levels, they are always in the low 4s during a fast. If I avoid grain based foods then its usually high 4s or to low 5s even when eating. Eat grain based products and its usually high 5s.

Been a too big 10 days for me.
To what extent you are in ketosis is dependent on ketone bodies AND blood glucose levels.
As you are probably aware, it is not an either or thing. It is a progressive change from reliance on blood glucose to a greater reliance on ketones in the absence of glucose.

You could postulate for a long time on why ketone bodies are rising quicker earlier in a fast.
If you are eating a diet higher in fats and lower in carbs, you should kick over to fat oxidation earlier.
If you have less lean tissue, you will have less muscle glycogen storage capacity.
If you are doing less cardio exercise, you will favor fat oxidation.
If you are more sedentary, you will favor fat oxidation.

Remember, fat is the favored energy substrate at lower VO2max%'s.
If you lie around sedentarily all day, day after day, as in water fasting, you will not notice the discomfort usually associated with change from carb burning to ketone burning.

[big booty]

Agree with most of what you are saying. Not sure about this statement though "If you are more sedentary, you will favor fat oxidation." I would have thought that most obese people would favour glucose as their preferred energy substrate rather than fat?

I'll add a little bit with regards to fat/glucose usage and transferring from glucose to ketones. I have no hard evidence but the logic makes sense to me. Your cells have the ability to utilise glucose or ketones as an energy source. If you incorporate fasting as a regular process then cells that are better adapted to running on ketones will be favoured and the weaker poorly performing cells that only do well on glucose will struggle. As part of autophagy those poorly performing cells will be killed off first. Over time with a continual fasting regime you become ketone adapted. You ability to access stored fats and to utilise ketones increases. You don't necessarily have to be on a low carb diet for this to happen although I suspect it would enhance the process.

[RhapsodyX]

What you are thinking of is along the lines of the "Fast Mimicking Diet". Short term fasting (days) simply isn't going to drive the adaptations in a useful fashion the way long-term starvation ketosis or nutritional ketosis does. Or, from a sports perspective, training in ketosis to drive the adaptations takes months before some of the benefits appear to be realised (ie. using ketones to fuel muscle mitochondria in an anaerobic capacity rather than just improving aerobic FFA oxidation).

Catalyst did a story on this recently as well, "Live Long Die Young".

All interesting stuff.

[big booty]

Initially I was doing 2 water fast days per week to lose weight. I reached my self imposed goal weight but wanted to maintain the benefits of fasting so have been doing 1 day per week. I have been doing this for about 10 months now. I noticed a big shift at about the 8 month mark. I now find it ridiculously easy to do. I do not put this down to the psychology of my mindset. I do not get headaches, I am not lethargic, I do not crave food. I flip into ketosis sooner (my definition of ketosis is 0.5mmol/L ketones) Personally I think there are benefits to be had and I think there has been an adaption that has taken place.

Yes interesting stuff. Chris Froome isn't the only one that trains in a ketotic state, lots of other riders have started doing it as well.

[VinceGU05]

No I did the fast at True North Health where I am doing an internship. It's the most experienced medically supervised water fasting facility in the world. Loren seems reasonably informed in his utube videos, but he apparently has had many clients who had significant adverse responses, and he handled them very poorly. He is not medically trained, and does not monitor blood tests. After I read his application form to do a fast, I lost a lot of respect for him.

I mentioned my weight loss in the text you quoted. It is higher initially and decreases with time.
I was professionally curious to see what a fast does to the body and brain, and some of the chronic fatigue syndrome effects I still contend with. WF is now known to reverse chronic diabetes type 2, hypertension, the pain and inflammatory effects of many autoimmune diseases especially inflammatory arthritides, and some cancers. Though it is not a cure all.

However, a super clean diet WFPB Salt oil sugar free are required to sustain the effects. I've met enough repeat clients who have had complete remission from these conditions. Many talk about the struggle of letting go of old dietary habits, but over several visits gradually realize the diet is do-able and worth the adaptation to be rid of pain, lighter bodyweight, and more active.

Weight loss was a secondary consideration, as there are more efficient ways to lose weight and retain lean tissue. i.e. one doesn't water fast to lose weight primarily.

anyone heard about the Tolman's and their practices. tyler tolman seems to have a fair operation in place and the dear wife is thinking of going for a 30 day detox at his bali resort ( i think she just wants a holiday from me! )

[CKinnard]

Haven't heard about him. But there's lots of non medical centers around offering fasting experiences.
From a quick squiz of his website it seems he offers juice fasting which is much easier on the body than water fasting, presuming one doesn't have chronic diseases. A rest such as he offers would be healthier than a holiday of mindless alcohol intake and thrill seeking.

[big booty]

Juice fasting? An oxymoron surely?

[CKinnard]

depends on your definition of fasting. some sources call it a willing abstinence from some or all food and liquid.
if you wanted to be a pedant, you could argue drinking water during a fast isn't 'real' fasting.

benefits of juice fasting, especially when a Calorie deficit is observed, are that the digestive, absorptive, and metabolic systems are rested, relative to the non fasting state.

Many at True North are prescribed this rather than a water fast, because their bodies cannot tolerate the severity of a water fast.
They still get many of the benefits, but at a slower rate.
i.e. if a person has significantly reduced renal clearance of uric acid, they will need to keep their fluid intake up to facilitate clearance. However, this will deplete electrolytes such as potassium faster. Eventually gout will express or low serum potassium. Either condition is unsustainable.

Most unschooled in the medical sciences have this naive belief that everybody's organs work perfectly until they get sick in old age. That isn't the case, at all. Most people walking around in the street have at least one seriously compromised physiological system. It could be your vision, hearing, balance, an endocrine subsystem, neural, immune, etc, etc.