Millennials are pretty clever (Confession: I’m a millennial). We’ve managed to coin or create a term for almost every activity imaginable. The concept of eating when hungry, yet avoiding frequent snacking is known as “time-restricted eating.” The periodic practice of abstaining from food, whether it be 12, 16, 24 hours or beyond is known as “intermittent fasting.” Further still, intermittent fasting protocols vary from whether an individual completely abstains from all caloric intake (yet consumes water), versus restricting caloric intake to 20-25% of estimated energy needs for some time as in the 5:2 diet or various alternate day fasting protocols.
Regardless of the protocol, similarities in the proposed mechanism exist. The premise is improving insulin sensitivity to allow the body to access stored fat. Decreasing fat, especially abdominal or visceral fat, improves many metabolic functions, and can lead to the improvement of many disease states.
We’ve seen countless success stories, including my own. Yet, many people continue to remain skeptical and downright critical of fasting participants. Debating with individuals who are regularly engaging in skeptical responses without an attempt of obtaining information is no more productive than pushing a brick wall and expecting it to move. Yet, for those individuals TRULY interested in reading the evidence, below are my top 5 articles to date, which you can refer open-minded individuals to learn more!
This list is not all-inclusive, and undoubtedly, new articles are published regularly. Therefore, literature searches at regular intervals are always recommended if you desire to remain current. The articles presented below are not to be construed as medical advice and are for informational purposes only.
Additionally, when reviewing an article, many people (including physicians) only read the abstract. A second pitfall is reading only the conclusion. The conclusion is what the AUTHOR wants you to believe, it is not necessarily what the DATA or results section support. Conclusions are often overstated. Many factors may reach STATISTICAL significance, but not CLINICAL significance. The most important parts of any paper are the methods and results sections. Pay attention to these sections and make your own conclusion. Then, if your finding agrees with the author, perfect! If not, that is fine as well.
As always, the information of this page is not medical advice.
Title: Flipping the Metabolic Switch: Understanding and Applying Health Benefits of Fasting
Authors: Stephen D. Anton, Keelin Moehl, William T. Donahoo, Krisztina Marosi, Stephanie Lee, Arch G. Mainous III, Christiaan Leeuwenburgh, and Mark P. Mattson
Journal: Obesity (Silver Spring). 2018 Feb;26(2):254-268. doi: 10.1002/oby.22065. Epub 2017 Oct 31.
This article is a PHENOMENAL overview of the proposed mechanisms behind fasting, how one enters a fasted state, and the potential health benefits (1). If you want to understand the proposed mechanisms, the interactions between ketosis, and other concepts of fasting, this is a must read review. A personal favorite of mine is the description of how fasting actually induces changes which are protective of muscle mass. Therefore, the classic “starvation” argument need not apply. This article provides an overview to dispute the false concept that fasting and starving are one and the same.
While it will take a few sittings to complete the article, it is well worth it. The article discusses a historical perspective, followed by detailing the interactions of intermittent fasting on several organ systems and ending with an overview of health implications. If you seek a deeper understanding of intermittent fasting, this is a great place to begin.
Title: Therapeutic use of intermittent fasting for people with type 2 diabetes as an alternative to insulin
Authors: Suleiman Furmli, Rami Elmasry, Megan Ramos, and Jason Fung
Journal: BMJ Case Rep. 2018 published online in October 2018.
Yes, this is NOT a randomized control trial. Yes, the sample size is only three. Yes, it is a case study, yet this article is straightforward and demonstrates the point that intermittent fasting can have clinical utility. The report highlights the reversal of insulin use in patients with longstanding Type 2 diabetes. This, in itself, is fascinating and begins to challenge the dogma that insulin requiring Type 2 diabetes cannot be reversed.
All three patients no longer required insulin therapy after varying lengths of intermittent fasting protocols combined with a low-carbohydrate diet (2). Another essential item to note is that periods of fasting beyond 48 hours did not occur. While many people elect to partake in extended fasting for various reasons, I highlight this point to emphasize that prolonged fasting is NOT required to achieve health benefits, especially when combined with a whole, real foods lifestyle.
Authors: James J DiNicolantonio and Mark McCarty
Journal: Open Heart
Alert. This is a science-heavy publication; however, it seemed only fitting to list this after Dr. Furmli et al. given this provides a potential mechanism to explain the above results. This paper outlines some of the proposed mechanisms in which intermittent fasting induces autophagy, particularly in the pancreas.
The pancreas contains cells responsible for the production of insulin. Dysfunction of the pancreatic, insulin-producing cells is one of the mechanisms leading to diabetes, therefore, restoring their function, in combination with improving other metabolic derangements, should logically result in disease reversal. Another interesting aspect is it demonstrates the potential to integrate pharmaceutical agents and intermittent fasting, particularly metformin and acarbose (3). While the paper lists several agents, which have the potential to act together with intermittent fasting, these two stands out the most due to their affordability. Could physicians potential prescribe low-cost medications TOGETHER with intermittent fasting to promote disease reversal? This paper raises the potential.
Authors: Krista A Varady*, Surabhi Bhutani, Monica C Klempel, Cynthia M Kroeger, John F Trepanowski, Jacob M Haus, Kristin K Hoddy and Yolian Calvo
Journal: Nutrition Journal
Like many people on a weight loss journey, I’ve participated in several online weight loss groups. In one particular group, MANY users had very negative opinions regarding intermittent fasting. While coworkers may make sly remarks, the Internet seems to bring out the inner and UGLY troll in seemingly “normal” individuals. Aside from the trolls, I ran into another concept, which is that people of healthy weight should not fast. Let’s think about the logic behind this for a moment…there isn’t any!! As with any lifestyle change, it would not make sense to abandon the lifestyle simply because you reach a “goal” weight (assuming the move was a healthy one).
This publication involves a randomized control trial involving overweight AND normal weight individuals to examine the effect of alternate-day fasting and the impact on weight loss and coronary artery disease parameters over 12 weeks. Weight loss and fat mass loss occurred while preserving free-fat mass. Additionally, markers of inflammation decreased, LDL, and triglycerides improved, and adiponectin (which improves insulin sensitivity) also increased (4). These results were also replicated in obese individuals as well in a separate study (5).
Whether you participate in alternate day fasting or shorter fasting periods, a lifestyle of intermittent fasting seems to promote favorable health benefits in both obese and non-obese individuals (4, 5). Studies of alternate day fasting also seem to suggest benefits are possible irrespective of dietary approach (6).
Title: mTOR and autophagy: A dynamic relationship governed by nutrients and energy
Authors: E.A. Dunlop*, A.R. Tee
Journal: Seminars in Cell & Developmental Biology
This article is not for the faint of heart. I would definitely NOT recommend starting here, but for those with a more profound interest in biology, autophagy, and understanding the process, this is a MUST read. At the very least, you should come away realizing the potential for intermittent fasting to improve other aspects of health beyond weight loss.
As I listen to podcasts, view chat forums, and receive Instagram and Facebook questions, a misconception seems to persist that autophagy is an all or none phenomenon. To be clear, autophagy is a complex series of events, which can occur in the presence of amino acid depletion, glucose depletion, oxidative stress, through targeting via pharmaceutical agents, and other ways, which are continuing to be discovered (7). Contrary to popular belief, the potential for the up-regulation of autophagy is potentially present in both low carb and plant-based nutritional lifestyles.
Another misconception involves autophagy as an on and off phenomenon (8). Baseline autophagy is occurring all the time to remove damaged cells (7). The proposed issue becomes insufficient up-regulation of autophagy due to a constant state of energy excess (which intermittent fasting can address), leading to the accumulation of damaged proteins and promoting disease. This article is a great place to start if you are interested in learning more of the complexities surrounding this process.
REFERENCES
- Anton SD, Moehl K, Donahoo WT, Marosi K, Lee SA, Mainous AG, 3rd, et al. Flipping the Metabolic Switch: Understanding and Applying the Health Benefits of Fasting. Obesity (Silver Spring). 2018;26(2):254-68.
- Furmili S. ER, Ramos M., Fung J. Therapeutic use of intermittent fasting for people with type 2 diabetes as an alternative to insulin. BMJ Case Rep. 2018.
- DiNicolantonio JJ MM. Autophagy-induced degradation of Notch1, achieved through intermittent fasting, may promote beta cell neogenesis: implications for reversal of type 2 diabetes. Open Heart 6.
- Varady KA, Bhutani S, Klempel MC, Kroeger CM, Trepanowski JF, Haus JM, et al. Alternate day fasting for weight loss in normal weight and overweight subjects: a randomized controlled trial. Nutr J. 2013;12(1):146.
- Eshghinia S, Mohammadzadeh F. The effects of modified alternate-day fasting diet on weight loss and CAD risk factors in overweight and obese women. J Diabetes Metab Disord. 2013;12(1):4.
- Klempel MC, Kroeger CM, Varady KA. Alternate day fasting (ADF) with a high-fat diet produces similar weight loss and cardio-protection as ADF with a low-fat diet. Metabolism. 2013;62(1):137-43.
- Galluzzi L, Pietrocola F, Bravo-San Pedro JM, Amaravadi RK, Baehrecke EH, Cecconi F, et al. Autophagy in malignant transformation and cancer progression. EMBO J. 2015;34(7):856-80.
- Dunlop EA T, AR. mTOR and autophagy: a dynamic relationship governed by nutrients and energy. Semin Cell Dev Biol.36:121-9.
DISCLAIMER: The advice on this page is not meant to replace or represent medical advice. This is nutritional advice, which is NOT the same as medical advice. Before any weight loss endeavor, the consultation of an experienced health care provider is a must. As a general rule, the following individuals should not participate in fasting:
- Diabetics-particularly those on insulin
- Lactating women
- Pregnant women
- Individuals with a history of eating disorders
- Children under the age of 18
This list is not
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