Investigating Intermittent Fasting
/In a world of information overload, we are constantly inundated with nutrition advice coming from all directions, most of which is conflicting, confusing, and contradicting. As a registered dietitian, it’s up to me to weed through the hype, dig up the research, and uncover the truth. In fact, I often joke that my title, RD, has a dual meaning: “registered dietitian” and, “registered detective”.
Today’s nutrition investigation is on Intermittent Fasting. Gaining popularity thanks to celebrities likes Hugh Jackman, Jimmy Kimmel, Jennifer Lopez, and the Queen Bey, it’s time to set the story straight: Is Intermittent Fasting (IF) a safe and effective health intervention, or just another fleeting fad? Read on to discover the hard and fast truth behind IF.
Types of Fasting
Fasting regimes come in all shapes and sizes...
Alternate Day Fasting (ADF) - Alternates between eating days, where food is consumed as usual, and fasting days, where no calorie-containing foods or beverages are consumed,
Modified Fasting (MF): Limits caloric intake to 25% of daily requirements (~500 calories/day) for 2 nonconsecutive days a week, and ad libitum eating the remaining 5 days of the week (ad libitum = “as you please”)
Time Restricted Fasting (TRF): No limits on daily calorie intake, but rather time limitations are placed on meals. Typically, ad libitum eating occurs during an 8 hour window, and fasting occurs during the surrounding 16 hours of the day.
The Theories Behind IF
The concept of intermittent fasting was sparked by an assortment of theories. Some propose that long bouts of fasting more closely resemble the eating patterns of our fellow mammalian species as well as the typical meal frequency of our human ancestors during hunting and gathering eras. Others argue that time-restricted feeding helps synchronize our eating patterns with our biological circadian rhythm, so that oscillations in behavior, physiology, sleep, and metabolism are all synchronized in harmony. Longevity researchers suggest extreme calorie restriction and IF serve as mild acute stressors, or “fire drills”, conditioning the body to grow stronger and more resilient in anticipation for future stressors. These advantageous adaptations are hypothesized to boost disease resistance and promote longevity. Another theory is that IF creates ketosis, a state in which the body has fully exhausted its carbohydrate sources, and is forced to use fat as fuel. Some research suggests that ketosis improves cognitive function, increases insulin sensitivity, inhibits cancerous cell growth, and reduces inflammatory markers linked to chronic disease.
While proponents of IF tout its ability to support weight loss, reduce the risk of cardiovascular disease, type 2 diabetes, Alzheimer's, and cancer, and potentially prolong life, it’s important to take an objective look at the research before you go starving yourself.
The Evidence
Though limited, there are in fact scientific studies that support the above theories. The critical question becomes, how strong is the evidence? The answer: pretty weak. Here’s why…
Animal studies - The majority of research on IF is based on animal studies, specifically rodents like mice and rats. While animal studies can provide important scientific insight, unfortunately, the science does not always translate to humans; mainly due to the drastic fundamental differences in anatomy, biology, physiology in humans versus rodents. Extrapolating scientific findings from animal research to humans is the epitome of making an apples to orange comparison.
Human studies - There a handful of IF human studies, however, this research has several shortcomings. Of the limited human research that does exist, the results are inconsistent: some studies link IF to weight loss but show no effect on the risk of chronic disease, and vice versa. Small sample sizes, short study durations, and poorly constructed methodology significantly weaken the results derived from human research. Because the existing human studies are so short in duration, it’s nearly impossible to determine whether the potential benefits of IF are temporary or lifelong, and conversely, whether there are any long-term risks associated with IF.
Future Studies - In order to draw a definitive conclusion about IF, additional human research is required, using larger sample sizes, better research practices, and a longer duration of data collection. The research methodology also needs to be designed in a manner that specifically isolates “fasting” as the experimental variable, and accounts for all confounding variables. It’s still unclear whether the weight loss observed using IF in preliminary studies is specifically due to time restricted feeding, or if it’s an indirect result of the caloric restriction that naturally accompanies IF. Finally, more research is needed to tease apart the three types of IF in order to determine the optimal frequency and timing of meals, as well as identify the safest and most effective regime.
The Cross Examination
The case for Intermittent Fasting was analyzed from all angles. Here are the pro’s and con’s to consider..
The Con’s of IF
Skipping Meals - Fasting requires skipping meals, which can induce hypoglycemia, ketogenesis, brain fog, fatigue, mood swings, hunger, and a slowed metabolism.
Dysfunctional Eating - Extreme restriction during fasting promotes mindless and uncontrollable binge eating on feeding days, creating an unhealthy “all or nothing”, yo-yo approach to eating.
Quantity over Quality - With so much focus on meal timing, IF tends to lose sight of what’s most important: the quality of your food. The emphasis becomes more about when you eat rather than what you eat.
Calorie Restriction in Disguise - Fasting involves significant calorie restriction which is associated with slower metabolism, malnutrition, disordered eating, and unsustainable weight loss followed by a significant relapse of weight gain.
Impractical, & Practically Impossible - IF requires resisting human nature and ignoring our instinct to eat in response to hunger, to gain energy, to be social, and to thrive. Following an IF regime for a lifetime is not only unenjoyable and illogical, it’s completely unrealistic. A true health solution is one that yields lasting results in a practical, reasonable, and realistic manner.
A Flawed Definition of “Health” - IF’s claim to fame is its ability to support weight loss, reduce risk of chronic disease, and boost longevity. But since when is the definition of health merely the absence of disease, or a number on the scale, or the length of your life? True health isn’t about body weight, it’s about nourishing your body with an abundance of nutrients that empowers you to shine. It’s not just about the absence of disease, but about optimizing well-being. It’s not just about living a long life, but living a vibrant, rich, and fulfilling life. Undernutrition, deprivation, and starvation, will never be a formula that cultivates true health.
The Pro’s of IF
On a more positive note, there is a valuable lesson to learn from Intermittent Fasting, and that’s the relationship between food and time. Today, eating has become a ‘round-the-clock activity, snacking our way from one meal to the next. A better understanding of how your food choices, meal timing, and eating frequency interact can help guide you towards a healthier, more personalized eating pattern. Here’s how:
Food Stamina - Pay attention to the composition of your meals, and note which foods provide long staying power versus which foods provide quick bursts of energy followed by abrupt crashes.
Pace Yourself - Everyone is different. One person may function better on three square meals/day, while another may benefit from 4-6 smaller meals. Get to know the ideal meal structure that supports your personal digestive pace
Sneaky Hours - Keep track of not just when you eat, but why you are eating. You’ll be surprised to find that you tend to repeatedly snack out of boredom or emotion during certain times of the day (mostly mid to late afternoon, and in the evening). Anticipate these hours of the day by arming yourself with non-edible antidotes for boredom or stress, such as calling a friend, or going for a walk.
Eating Curfew - Most of our late night eating involves mindlessly munching on nutrient deplete nonsense, completely out of boredom or fatigue. Take a play out of the IF playbook and aim to cap all food intake at least 2 hours before bed.
Get into a groove - Once you identify your ideal meal timing and frequency, form a daily routine that follows this eating pattern. Then repeat, repeat, repeat. The structure and consistency not only make healthy living easier, but it’s also the key to lifelong maintenance.
The Final Verdict
When it comes to IF, the jury is still out. But rather than wait around for stronger and more conclusive evidence, take advantage of the strategies already proven to optimize health and well-being: Eat real food. Sleep. Hydrate. Move. Relax. And, be mindful. Not only is this formula logical, practical and enjoyable, it’s also effective and science-backed. Case closed!
http://www.andjrnl.org/article/S2212-2672(15)00205-1/fulltext
http://translational-medicine.biomedcentral.com/articles/10.1186/s12967-016-1044-0
http://www.fasebj.org/content/29/1_Supplement/117.4.short
http://www.cell.com/cell-metabolism/pdf/S1550-4131(15)00224-7.pdf