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Intermittent fasting: New Information

POSTED JUNE 29, 2018, 6:30 AM , UPDATED FEBRUARY 10, 2020, 12:00 PM

Summarized and edited July 10, 2020

Monique Tello, MD, MPH
Contributor

Many studies have been done on mice and rats that show a loss in weight, helpful to decrease blood pressure, and other unwanted factors related to poor health.  The human studies have also proven effective, but not that much different than many other diets.  People also may find it extremely difficult to “fast”.  Research has now shown that the time that you fast is a more reasonable and effective approach.

Origins of intermittent fasting

Fasting has been around for ages however it became popular in 2012.  There was a BBC broadcast journalist named Dr. Michael Mosley, who had a documentary called Eat Fast, Live Longer and a book called The Fast Diet.  Another book by journalist Kate Harrison The 5:2 Diet , chronicling her own experience, and then Dr. Jason Fung’s 2016 bestseller The Obesity Code, all brought this diet into the mainstream and popularity

“As a lifestyle-leaning research doctor, I needed to understand the science. The Obesity Code seemed the most evidence-based summary resource, and I loved it. Fung successfully combines plenty of research, his clinical experience, and sensible nutrition advice, and also addresses the socioeconomic forces conspiring to make us fat. He is very clear that we should eat more fruits and veggies, fiber, healthy protein, and fats, and avoid sugar, refined grains, processed foods, and for God’s sake, stop snacking. Check, check, check, I agree. The only part that was still questionable in my mind was the intermittent fasting part,” says Monique Tello, MD, MPH

Intermittent fasting does contribute to weight loss

“IF makes intuitive sense. The food we eat is broken down by enzymes in our gut and eventually ends up as molecules in our bloodstream. Carbohydrates, particularly sugars and refined grains (think white flours and rice), are quickly broken down into sugar, which our cells use for energy. If our cells don’t use it all, we store it in our fat cells as, well, fat. But sugar can only enter our cells with insulin, a hormone made in the pancreas. Insulin brings sugar into the fat cells and keeps it there.

Between meals, as long as we don’t snack, our insulin levels will go down and our fat cells can then release their stored sugar, to be used as energy. We lose weight if we let our insulin levels go down. The entire idea of IF is to allow the insulin levels to go down far enough and for long enough that we burn off our fat,” says Monique Tello, MD, MPH

Intermittent fasting may be difficult… but maybe not!

“Initial human studies that compared fasting every other day to eating less every day showed that both worked about equally for weight loss, though people struggled with the fasting days. So, I had written off IF as no better or worse than simply eating less, only far more uncomfortable. My advice was to just stick with the sensible, plant-basedMediterranean-style diet,” says Tello.

New research is finding that obviously not all fasting approaches are created equal and some are more acceptable to people, just as effective, and relatively easy to maintain. Utilizing a plant based diet also helped to sustain the diet, due to the fiberous nature of plant based foods.  These foods tend to keep you more full and help the fast interval to be not so severe.

“We have evolved to be in sync with the day/night cycle, i.e., a circadian rhythm. Our metabolism has adapted to daytime food, nighttime sleep. Nighttime eating is well associated with a higher risk of obesity, as well as diabetes,” says Tello.

“Based on this, researchers from the University of Alabama conducted a study with a small group of obese men with prediabetes. They compared a form of intermittent fasting called “early time-restricted feeding,” where all meals were fit into an early eight-hour period of the day (7 am to 3 pm),or spread out over 12 hours (between 7 am and 7 pm). Both groups maintained their weight (did not gain or lose) but after five weeks, the eight-hours group had dramatically lower insulin levels and significantly improved insulin sensitivity, as well as significantly lower blood pressure. The best part? The eight-hours group also had significantly decreased appetite. They weren’t starving,” writes Tello.

By employing the adjustment for timing of the meal, consuming food earlier in the day, and extending the overnight fast, significantly benefited metabolism even in people who didn’t lose a single pound.

Why does changing the time of your meals help?

“But why does simply changing the timing of our meals to allow for fasting make a difference in our body?”, asks Tello.  She explains that an in-depth review of the science of IF recently published in New England Journal of Medicine sheds some light. Fasting is evolutionarily embedded within our physiology, triggering several essential cellular functions. Flipping the switch from a fed to fasting state does more than help us burn calories and lose weight. The researchers combed through dozens of animal and human studies to explain how simple fasting improves metabolism, lowering blood sugar; lessens inflammation, which improves a range of health issues from arthritic pain to asthma; and even helps clear out toxins and damaged cells, which lowers risk for cancer and enhances brain function. The article is deep, but worth a read!

So, is intermittent fasting as good as it sounds?

Tello was very curious about this, so she asked the opinion of metabolic expert Dr. Deborah Wexler, Director of the Massachusetts General Hospital Diabetes Center and associate professor at Harvard Medical School. Here is what she told me. “There is evidence to suggest that the circadian rhythm fasting approach, where meals are restricted to an eight to 10-hour period of the daytime, is effective,” she confirmed, though generally she recommends that people “use an eating approach that works for them and is sustainable to them.”

In conclusion, they have proven and there is scientific evidence showing that “circadian rhythm fasting”, when utilized with a nutritious and healthy diet and lifestyle, can definitly be an effective way to lose weight.  This has been shown to be extremely beneficial to those at risk for/or prone to diabetes. The diet has also proven to be beneficial to those with eating disorders, or on diabetes.  Precaution for pregnant or breastfeeding women as they should not attempt this type of diet, unless under the close supervision of a physician who can monitor there condition.

4 ways to use this information for better health

 According to Monique Tello, MD, MPH

  1. Avoid sugars and refined grains. Instead, eat fruits, vegetables, beans, lentils, whole grains, lean proteins, and healthy fats (a sensible, plant-based, Mediterranean-style diet).

  2. Let your body burn fat between meals. Don’t snack. Be active throughout your day. Build muscle tone.

  3. Consider a simple form of intermittent fasting. Limit the hours of the day when you eat, and for best effect, make it earlier in the day (between 7 am to 3 pm, or even 10 am to 6 pm, but definitely not in the evening before bed).

  4. Avoid snacking or eating at nighttime, all the time.

Sources

Effects of intermittent fasting on health, aging, and disease. de Cabo R, Mattonson MP. New England Journal of Medicine, December 2019.

Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults: A Randomized Clinical Trial. JAMA Internal Medicine, May 2017.

Alternate-day fasting in nonobese subjects: effects on body weight, body composition, and energy metabolism. American Journal of Clinical Nutrition, January 2005.

The Obesity Code, by Jason Fung, MD (Greystone Books, 2016).

Intermittent fasting interventions for treatment of overweight and obesity in adults: a systematic review and meta-analysis. JBI Database of Systematic Reviews and Implementation Reports, February 2018.


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