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People are intrigued by intermittent fasting

Miles Hassell, MD

Speaking about Type 2 diabetes reversal, including the strategy of intermittent fasting, at a recent GreatMed.org Town Hall meeting at St Vincent Hospital.

Critical thinking about Type 2 Diabetes and popular diets

When evaluating recommendations for any dietary approach, take a careful look at the evidence – in particular, at the number of people in the study, the methods used, the length of the study, and specific disease outcomes, including death.  Any diet encouraging us to eat more whole foods, increase vegetable consumption, and eat less refined carbohydrates is likely to point us in the right direction. Intermittent fasting is one of the many tools that can be helpful when waist loss is one of the goals, but any strategy is a good strategy that:

  • improves the diet quality,
  • reduces waistline through lower diet quantity, and
  • increases muscle mass and activity.

Intermittent fasting

If a person needs to lose weight (or waist) as part of their Type 2 diabetes reversal plan, reducing calorie intake is usually required. This can be done by either simply eating less overall, or following an intermittent fasting/intermittent energy restriction strategy [1,2].  With intermittent fasting, patients either sharply reduce calories for a couple of days per week, or compress their eating into fewer hours per day.  While all of these strategies work, some patients prefer one approach over the other. Whichever is chosen, the results that should be monitored include   weight loss, a lower HbA1c (a marker for type 2 diabetes) and improved well-being. The results can be impressive!  For example, a randomized controlled trial of patients  with type 2 diabetes, the active treatment group were assigned a program of 5 fasting days (840kCal daily) followed by 10 days of their regular diet, with the cycle repeated for 3 months.[3] After 3 months of this regimen, 50% of the intermittent fasting group and 2.8% of the control group eliminated their need for diabetic pharmaceuticals! [3] The fasting group saw their average HbA1c go from a high risk value of 7.65, to 5.66, which is normal. The control group HbA1c was unchanged.[3] Quality of life ratings of the intermittent fasting group increased by 4.57 points compared with the baseline scores, but decreased in the control group.[3]

If you need to lose weight and waist:

  • Work with your doctor, especially with regard to your diabetes and blood pressure medications
  • Eat less overall
  • Start every meal and snack with fresh fruits and vegetables
  • Become your own personal chef (avoid food that has been prepared outside your kitchen)
  • Always be imagining how to add more fruits and vegetables to every meal you prepare
  • Avoid foods made with flour and sweetened beverages
  • Have a daily exercise program that makes you short of breath
  • See Good Food Great Medicine, 4th edition, pages 78-79 & 90-109
  • Read our Waist Loss handout

Will intermittent fasting work for you?

Scrolling through headlines about intermittent fasting, you may likely find a definition of intermittent fasting that fits your current eating pattern.  Do you think spacing out meals might help you lose weight?  Or do small, frequent meals and snacks fit better with your lifestyle?  As Dr. Hassell stated in a recent Town Hall, if you know you need to lose weight (working together with your doctor), eat 20% less than what you’re eating right now…however, eat more fruits and vegetables. Can you start every meal or snack with a couple stalks of celery or a whole apple?  Does building in eating windows and fasting windows help you lose weight?  Work with your doctor to find an approach that is sustainable long-term.  A whole-food Mediterranean-style diet you make yourself, no matter how you fast in and around it, is still an evidence-based pattern to follow to shrink your waistline and your cardiometabolic risk.[4] Good Food Great Medicine, 4th edition, talks more about intermittent fasting on page 108.

[1]Carter S., et al. Effect of Intermittent Compared with Continuous Energy Restricted Diet on Glycemic Control in Patients With Type 2 Diabetes: A Randomized Noninferiority Trial. JAMA Netw Open 2018; 1(3). doi:10.1001/jamanetworkopen.2018.0756

[2]Jospe, M., et al. Intermittent fasting, Paleolithic, or Mediterranean Diets in the Real World: Exploratory Secondary Analyses of a Weight-loss Trial that Included Choice of Diet and Exercise. The American Journal of Clinical Nutrition 2020; 111(3): 503–514. https://doi.org/10.1093/ajcn/nqz330

[3]Yang, X., et al. Effect of an Intermittent Calorie-restricted Diet on Type 2 Diabetes Remission: A Randomized Controlled Trial. The Journal of Clinical Endocrinology & Metabolism 2022. https://doi.org/10.1210/clinem/dgac661

[4]Detopoulou, P., et al. Relation of Minimally Processed Foods and Ultra-Processed Foods with the Mediterranean Diet Score, Time-Related Meal Patterns and Waist Circumference: Results from a Cross-Sectional Study in University Students. Int. J. Environ. Res. Public Health 2023, 20, 2806. https://doi.org/10.3390/ijerph20042806

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Miles Hassell, MD