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What RDs Need to Know About Intermittent Fasting By Dr. Jo® Lichten
What RDs Need to Know About Intermittent Fasting
By Dr. Jo® Lichten
2
Jo Lichten, PhD, RDN • Affiliations/Bio: Dr. Jo has
presented more than 1000 programs to companies and conventions on energy management, staying healthy and fit on the road, and stress solutions. Jo is a consultant with Johnson & Johnson Human Performance Institute. She's the author of five books including her latest, Reboot.
• Disclosures: None
Learning Objectives
After completing this continuing education course, nutrition professionals should be able to:
1. Define common terms including fasting, intermittent fasting, alternate day fasting, modified fasting, and time-restricted feeding.
2. Describe how religions (specifically Islamic Ramadan and Church of Latter-day Saints) incorporate fasting.
3. Summarize animal and human studies on fasting in terms of weight loss, glucose/insulin, lipids, and inflammatory markers.
4. Explain how intermittent fasting regimens are hypothesized to influence metabolic regulation and influence cancer, reproductive health, mental health, and musculoskeletal health.
5. Debate the ethics of encouraging others to voluntarily withhold food and drink.
3
I Love to Eat
4
@GoDrJo
History of Fasting
5
1977 - 1978
6
Intermittent Fasting is NOT
Starvation 7
Intermittent Fasting (IF)
8
Complete or partial restriction in energy intake 1-3 days/week
Complete or partial restriction in energy intake for a defined period during the day (to extend the overnight fast).
Alternate Day Fasting
Modified ADF
Time Restricted
Fasting
Religious/ Spiritual Fasting
The Claims
• Reduce obesity
• Maintain muscle mass
• Prevent or slow progression of diseases
– Diabetes
– Heart disease
– Cancer
• Preserve learning and memory
• Extend longevity
9
Animal Studies - CR & IF
Calorie restriction (CR) in animals has been shown to :
• Increase life span
• Reduce metabolic risk factors for chronic disease (diabetes, heart disease, cancer)
Intermittent fasting (IF) was as effective as CR:
• i fasting glucose, insulin
• i total cholesterol, TG
• i cell proliferation
10
Varady et al, Am J Clin Nutr,2007 Longo and Mattson, Cell Metabol, 2014 Horne et al, Am J Clin Nutr, 2015
Late Paleolithic Era (50,000-100,000 BC)
“Our genome was most likely selected in the late Paleolithic era by criteria that favored survival in an environment characterized by fluctuations between periods of feast and famine.
The theory of thrifty genes states that these fluctuations are required for optimal metabolic function.”
11 Halberg et al, J Appl Physiol, 2005
Church of Jesus Christ of Latter-Day Saints (LDS or Mormons)
• Routine periodic fasting
– 1 day/month (do not eat or drink for 2 meals)
• High life expectancy at age 30
– Followed 34,192 LDS in CA
– Men=+7.28 years, women=+4.42 years than white CA
• Other explanations:
– Proscription of smoking and alcohol
– Healthier choices regarding diet, exercise, body weight
12 Fraser and Shavlik, Arch Intern Med, 2001
Healthy Stress
• Vigorous exercise stresses muscles and CV system
• The body responds by growing stronger
13
Adaptive Responses of Exercise
• Insulin sensitivity
• i TG, cholesterol, BP, HR
• HR variability
• i Pro-inflammatory cytokines
• # of mitochondria in skeletal muscle, liver, and brain cells
• Brain-derived neurotropic factor (BDNF) which plays critical roles in learning and memory
14 Mattson, Dose Response, 2014
Intermittent Challenges That Improve Health
15
Energy Restriction
Fasting
Mild Cellular Stress
Adaptive Responses
REDUCED Oxidative
Stress, Inflammation, DNA Damage
IMPROVED Cellular Energy
Metabolism
Resistance to Disease
Mattson, Dose Resp, 2014
Exercise
Tissue-Specific Effects of IF and CR
16 Brown et al, Brit J Diabetes Vasc Dis, 2013
(nitric oxide) (triglycerides)
Alternate Day Fasting
17
2013
2017
Ad libitum Fast: 0 kals
ADF (2005)
• 16 non-obese (8 men, 8 women)
– BMI ranged from 20-30
• ADF for 22 days
– Weight i 2.5%
– Even though advised that 2X would be needed on non-fasting days
18 Heilbronn et al, Am J Clin Nutr, 2005
ADF (2013)
• 30 healthy volunteers w/o recent history fasting
• Randomized cross-over trial
• ONE DAY FAST - Water only
• Compared to usual day of eating:
– i weight and TG
– increased HGH, hemoglobin, RBC, hematocrit, total cholesterol, HDL
19 Horne et al, Nutr Metab Cardiovasc Dis, 2013
Modified AD Fasting
20
Ad libitum “Fast”:
25% kals
Modified ADF (2007)
• 10 overweight asthma patients (9 females)
• 8-week trial
• Weight i 8%
– Asthma symptoms improved within 2 weeks
21 Johnson et al, Free Radic Biol Med, 2007
Modified ADF (2015)
• 59 obese weight-stable subjects (25-65 yrs)
• 8-week trial
• Weight i 4.2%
• i fat mass, visceral fat, and lean mass
22 Hoddy et al, Nutr J, 2015
Modified ADF with “Cheat Day”
• 15 adult overweight or obese women
• 8-week trial
• Weight i 7.1%, waist circumference i 5.7%
23 Eshghinia and Mohammadzadeh, J Diabetes Metab Disord, 2013
2 weeks observed
6 weeks ADF:
- 3 days (25-30%)
- 3 days (1700-1800)
- 1 day ad libitum
Modified ADF vs Control
• 32 normal/overweight subjects • 12-week randomized trial
• Weight i 6.5% vs control • Fat free mass did not change
24 Varady et al, Nutr J, 2013
Control OR Ad libitum “Fast”:
25% kals
Modified ADF with High-Fat Diet
• 32 obese subjects
• Two phase, randomized
• i Body weight
– HF = 4.8%
– LF = 4.2%
– Coming from fat, not fat-free mass
25 Klempel et al, Metabolism, 2013
2-week baseline maintenance
8-week ADF High Fat (45%), 13% saturated
8-week ADF Low Fat (23%)
Modified 5:2 Fasting
26 Brown et al, Brit J Diabetes Vasc Dis, 2013
Modified Fast (1998)
• 54 individuals with T2DM, 20+% over ideal weight
• 20-week behavioral weight control program
• Randomized to one of THREE groups
• Both VLCD groups lost more weight than SBT
27 Williams et al, Diabetes Care, 1998
Standardized Behavior Therapy
(SBT)
(1500-1800 kcals)
VLCD
Week 2: 5 consecutive days
Then, intermittent VLCD for 1 day/week for 15 weeks
…otherwise SBT
VLCD
Week 2: 5 consecutive days
Then, intermittent VLCD for 5 days/week very 5 weeks
…otherwise SBT
Summary: ADL & Modified ADF
• All of the studies reported weight loss
• Where noted, weight loss appears to be coming from body fat, not lean mass
BUT is the weight loss any different than simple calorie reduction?
28
CR vs IF
29
CR vs 5:2 IF (2011)
• 6-month randomized study of two options for 25% calorie restriction
• 107 overweight or obese premenopausal women
• Equally effective for weight loss
30
Harvie et al, Int J Obes (Lond), 2011
Everyday = 25% kcal reduction
5 days/week = estimated calorie needs
2 days/week = VLCD of 25% kcal needs
OR
Summary: Comparing IF to CR
8 comparison studies (complete or partial restriction, 3-12 weeks)1
• Comparable weight loss when overall energy restriction remained similar
– IF = 4-8%, 11-16%
– CR = 5-8%, 10-20%
• Average weight loss was 0.2-0.8kg/week (0.44-1.76#/week)
• Those reporting – equal efficacy for fat mass, fat-free mass, and waist circumference
Meta-analysis of 10 (four ADF and 6 matched VLCD)2
• No significant difference in mean body weight loss or fat-free mass than ADF (after adjustment for BMI and duration)
31
1Davis et al, Eur J Clin Nutr, 2016 2Alhamdan et al, Obes Sci Pract, 2016
What the Researchers Say
• “IF thus represents a valid – albeit apparently not superior – option to continuous energy restriction for weight loss.” (Seimon, Mol Cell Endocrinol, 2015)
• “IF was as effective as continuous dieting. May be useful for those who find CR too difficult to maintain.” (Keogh et al, Clin Obes, 2014)
• “Meta-analysis suggest ADF is an efficacious dietary method, and may be superior to VLCD for some patients because of ease of compliance, greater fat-mass loss, and relative preservation of fat-free mass. (Alhamdan et al, Obes Sci Pract, 2016)
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Can They Maintain the Weight Loss?
33
CR vs IF (2014)
• Overweight and obese women
• Randomized parallel study
• Weight loss not significantly different at both times
34 Keogh et al, Clin Obes, 2014
OR 8 weeks CR
8 weeks IF
44 weeks Wt Maint
44 weeks Wt Maint
CR vs 5:2 IF (2013)
• 115 overweight women with history of breast cancer, age 20-69 • Randomized for 3-months weight loss:
• PLUS 1-month weight maintenance of either:
• Both IF had greater reductions in body fat compared to CR
• During weight maintenance phase, BOTH IF diets maintained weight loss
35 Harvie, Br J Nutr, 2013
5:2 IF <CHO for 2 days
(-25% kcals)
CR (-25% kcals)
5:2 IF
PRO+FAT for 2 days (-15% kcals)
6:1 IF <CHO for 1 day/wk
6:1 IF
PRO+FAT for 1 day/wk
CR vs IF (2016)
• 40 overweight or obese adults • 2 phases • 6 days/week – 6 meals/day, >30% protein
with 25% calorie restriction (1200-1500 kcal) • 1 day/week (310-410 kcal)
• Phase 1 - same i body weight – Also, same for men and women – RMR unchanged (per kg)
• Phase 2 (n=24) - IF less weight regain (6%), total body fat (12%), and abdominal body fat (17%) compared to AHA heart healthy diet (HH)
36
Zuo et al, Front Physiol, 2016 Arciero et al, Nutrients, 2016
12-week HP IF
Weight Loss Diet
44-week Maintenance HP IF 1-2/M
44-week Maintenance
AHA HH
Can They Stick to the Fast?
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Adherence
• May not be well-tolerated by 10% (or possibly more) of the obese population1
• Adherence to ADF was fairly high (86%), but studies were short and participants were often closely monitored1
• Do you plan to continue after 6 month trial of either 25% CR or 5:2 (also 25% calorie reduction/week):
– 58% of IF and 85% of CR subjects planned to continue the diet allocated at randomization2
38
Varady et al, Am J Clin Nutr, 2009 Harvie et al, Int J Obes (Lond), 2011
Can Participants Fast on their Own?
• 16 obese adults (12 women) • 10-week trials which consisted of 3 phases:
• Weight i 5.8% (5.6kg) • % body fat i 45-42% • Weight loss constant during controlled food
intake and self-selected
39 Varady et al, Am J Clin Nutr, 2009
2 weeks control (weight maintenance)
4 weeks
CONTROLLED ADF (25% vs ad
libitum)
4 weeks
SELF-SELECTED ADF (25% vs ad libitum)
Simplicity of IF
40
IF: Focus on WHEN, not WHAT
41
WHAT
WHEN
Calorie Reduction
Intermittent Fasting
IF: Diet Only Every Other Day
42 Varady et al, Am J Clin Nutr, 2009
Moody? Hungry? Grumpy?
43
Mood, Energy, Depression?
• <15% reported negative side effects, such as feeling cold, irritable, low energy, or hungry1
• <15% reported dizziness and general weakness, with no change after 8 weeks of diet2
• Depression decreased2
• Alleviated depression with some improvement in QOL3
44
1Patterson et al, J Acad Nutr Diet, 2015 2Hoddy et al, Nutr J, 2015 3Teng et al, Physiol Behav, 2011
Hungry?
16 non-obese (8 men, 8 women), fasted every other day for 22 days1 • Hunger increased on first day of fasting and remained elevated
10 overweight asthma subjects (3 women), 8-week ADF (25% kcal)2 • Significantly higher level of hunger on CR days compared to the ad
libitum days throughout the study
ADF, CR, vs Control3 • No changes in appetite ratings (hunger, satisfaction, and fullness),
dietary restraint, emotional eating, uncontrolled eating or self-efficacy in the ADF or the CR as compared with control
45
1Heilbronn et al, Am J Clin Nutr, 2005 2Johnson et al, Free Radic Biol Med, 2007 3Alhamdan et al, Obes Sci Pract, 2016
Overeat on Feeding Day?
59 on 8-week ADF (25% kcal)1
• Restrictive eating increased, binge eating decreased
1 day trial2 – 10 adults (3 women) on each, randomized order:
• isoenergetic intake, partial 75 % ER, total 100 % ER. – Food intake recorded for 2 subsequent days (ad libitum) – Both ER interventions = 3-d energy intake deficits of ~30%
8 weeks of modified ADF3 – On feeding days only ate 95% of calculated energy needs
46
1Hoddy et al, Nutr J, 2015 2Antoni et al, Br J Nutr, 2016 3Klempel et al, J Nutr, 2010
Overeat on Feeding Day?
3 day trial with 18 lean men and women2
• During ER: Energy intake was 7% higher on day 2, but not signif diff on day 3
• Hormonal appetite markers did not respond in a manner indicative of hyperphagia (ghrelin, GLP-1)
47
1Klempel et al, J Nutr, 2010 2Clayton et al, Am J Clin Nutr, 2016
OR Day 1 100%
Day 1 25%
Day 2 B: 100%
L&D: ad libitum
Day 2 B: 25%
L&D: ad libitum
Day 3 B: ad libitum
Day 3 B: ad libitum
Time Restricted Feeding
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Eat ad libitum within specific time windows 1. To extend night fast
2. For religious/spiritual fasting
2016
Diet-Induced Obesity (DIO) Mice
49
Develop:
• Obesity
• Insulin resistance
• Dyslipidemia
Gain weight when:
• High-fat or high-sucrose diet
• Fed during day
• Inactive
Chaix and Zarrinpar, Adipocyte, 2015
Time Restricted Feeding in Mice
• Restricting feeding times to night only:
– i Body weight
– i Total cholesterol, TG
– i Glucose, insulin
– Insulin sensitivity
50 Rothschild et al, Nutr Rev, 2014
TRF Attenuates Poor Diet in Mice
When fed:
• Normal chow (NC) – ~80% calories consumed at
night
• When fed high fat (HF) – Spread out intake ~50/50
– When restrict intake to night, these mice are almost indistinguishable to those fed NC
51 Chaix and Zarrinpar, Adipocyte, 2015
Diurnal Cycle in Humans
52 Patterson et al, J Acad Nutr Diet, 2015
Circadian Misalignment
• While maintaining an isocaloric diet:
– i Glucose tolerance
– Insulin
– Blood pressure
– i Leptin (satiety hormone)
• Shift work (15-20% population)
• Night owls
53
Zarrinpar et al, Trends Endocrinol Metab, 2016 Scheer et al, Proc Nat Acad Sci, 2009
Dr. Jo’s Sleep Webinar Series
• Part 1: Sleep: Cycles, Rhythms, Health, and Weight.
• Part 2: Out of Sync Sleep: Chronotype, Jet Lag, Seasonality Disorders, and Shiftwork.
• Visit the “Webinars” page on www.CE.TodaysDietitian.com to register for this recorded webinar series!
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Early Eaters vs Late Eaters
• 420 individuals grouped according to the timing of their main meal (lunch/Spain)
• Until reached their weight goal (~5 months):
– 1 hr group session weekly + recommended portions for diet based on principles of Mediterranean diet + moderate physical activity + cognitive-behavior
• Early eaters lost significantly more weight than late eaters
– No difference in caloric intake, energy expenditure
55
Garaulet et al, Int J Obes, 2013
Breakfast Eaters
• Overweight and obese women
• Both followed 1400 calorie diets
• BREAKFAST Group: – Better fasting glucose, insulin sensitivity, and
improved lipid profile than DINNER group
56 Jakubowicz et al, Obesity (Silver Spring), 2013
B = 700
L = 500
D = 200
B = 200
L = 500
D = 700
Breakfast
Dinner
Night-time Energy Restriction
• 27 healthy young men, normal BMI
• Cross-over design (2 weeks each):
• Significant weight difference
57 LeCheminant et al, Br J Nutr, 2013
Control No eating after 7PM
Gained 0.6 kg Lost 0.4 kg
3 Meals vs 1 Meal
• 15 healthy, normal weight adults 40-50 years
• Randomized cross-over (8 weeks each)
• Consumed all their calories for weight maintenance
– 3 meals vs 1 meal (5-9PM)
• No difference in weight, body fat BUT
• 1 meal:
– fasting glucose levels, impaired morning GTT associated with delayed insulin response
– Significant in hunger and desire to eat
– Significantly BP, total cholesterol, LDL, HDL
58
Carlson et al, Metabolism, 2007 Stote et al, Am J Clin Nutr, 2007
Muscle Loss?
59
TRF with Exercise
• Young previously-untrained males • 8 weeks resistance training
– 3 X week, 4 sets of 8-12 reps
• TRF = had to eat within 4-hour period – Though no limitations, reduced energy intake by ~650
kcals/day of TRF
• Did not adversely affect lean mass retention or muscular improvements
60 Tinsley et al, Eur J Sport Sci, 2016
Resistance Training +
Normal Diet (no limit on eating times)
Resistance Training +
Consumed 100% in 4-hour period
TRF with Exercise
• 34 resistant-trained males were randomly assigned to similar macro % (pro = 21-22%, fat = 24%):
• After 8 weeks: – Decrease in fat mass in TRF compared to ND – Fat-free mass, muscle area of arm and thigh, and maximal
strength were maintained in both – Testosterone and IGF-1 decreased significantly in TRF (no
changes in ND)
61 Moro et al, J Transl Med, 2016.
Normal Diet
(no limit on eating times)
Consumed 100% in 3 meals:
1PM, 4PM, 8PM
OR
Maintenance of Muscle Mass?
• 64 obese individuals • 12-week study. Randomized to FOUR groups:
• i Weight, fat mass & waist circumference in combo, ADF and exercise groups (from most to least)
• Lean mass retained in combo only
62 Bhutani et al, Obesity, 2013
Control ADF
(ad libitum + 25% kcals)
Exercise Combo:
ADF + Exercise
1 3 2
Religious Time Restricted
Feeding
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Religious or Spiritual Fasting
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• Ramadan1
– From dawn to sunset (~12 hrs) during holy month of Ramadan
– Different from year to year – Usually 1 large meal after sunset and 1 lighter meal before
dawn
• Latter-day Saints2 – Church members are encouraged to fast (no food or drink)
for two consecutive meals during one Sunday/month – Taught as early as age 8
1Trepanowski and Bloomer, Nutr J, 2010 2Fraser and Shavlik, Arch Intern Med, 2001
Other Religious or Health Fasting
• Greek Orthodox Christians1 – “Fast” for total of 180-200 days – More vegetarian than fasting
• Biblical-based Daniel Fast1 – Prohibits animal products, refined CHO, caffeine, alcohol,
sweeteners, additives/preservatives – Often 21 days
• Dr. Mark Hyman’s Detox2 – 10 days: no dairy, sugar, caffeine, wheat, alcohol
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1Trepanowski and Bloomer, Nutr J, 2010 2http://www.10daydetoxcookbook.com/bonus/10DDStarterKit.pdf
Ramadan
Meta-analysis of 35 studies1
• Significant weight loss – i1.5kg for men, i 0.92kg for women
• Most weight loss didn’t last more than 2 weeks after Ramadan
Meta analysis of 30 articles2
• Females – weight unchanged
• Males – weight loss
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1Sadeghirad et al, Public Health Nutr, 2014 2Kul et al, J Relig Health, 2013
Intermountain Heart Collaborative Study
• Database registry of 32,000+ men & women, 18+
• Utah
• 30 years (1994-2024)
• Observational
• Purpose: – Collect and analyze clinical and laboratory data and tissue
samples from patients who are diagnosed with any type of heart disease
– Collect the same information and samples from healthy controls in participating Intermountain Healthcare facilities
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Intermountain Heart Collaborative Study (2008)
Routine periodic fasting (1 day/M) was associated with lower risk of coronary artery disease (>10% coronary stenosis on angiography) • Adjusted for traditional risk factors, including
smoking • Notable because LDS proscription of alcohol…and
many studies suggest higher CAD risk compared to moderate levels
68
Horne et al, Am J Cardiol, 2008
Intermountain Heart Collaborative Study (2012)
Diabetes was present in: – 10.3% of patients who fasted routinely – 22.0% of those who do not fast
• CAD was found in: – 63.2% of fasting – 75.0% of non-fasting patients
• Glucose: – Fasters = 108 ± 36 mg/dl – Non-fasters = 115 ± 46 mg/dl (signif)
• BMI: – Fasters (27.9) – Non-faster BMI (29.0)
69 Horne et al, Am J Cardiol, 2012
Biomarkers for Chronic Disease
70
Mechanisms of Action
71 Patterson et al, J Acad Nutr Diet, 2015
Mobilization of Fatty Acids
72 Mattson et al, Proc Natl Acad Sci U S A, 2014
Blood Lipids
• 4/8 i Triglycerides
• 2/10 i LDL
– Correlated with the reduction in body weight and visceral fat
• 3/10 HDL (mostly remained unchanged)
73 Patterson et al, J Acad Nutr Diet, 2015
Change in Gut Microbiome
74 Chaix and Zarrinpar, Adipocyte, 2015
Biomarkers of Dietary Restriction
75 Lettieri-Barbato et al, Aging (Albany NY), 2016
Meta-analysis of 43 studies: • 30 = CR • 4 = IF • 9 = low or VLCD
Fat Mass
• Both CR and IR appear to be equally effective for reducing:
– Body weight
– Fat mass
– Visceral fat
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Inflammatory Markers
ADF & Modified ADF
• CRP 4/5 NS
• IL-6 NS
• TNF- 2/3 NS
77
Patterson et al, J Acad Nutr Diet, 2015
Metabolism Markers
i Insulin, IGF-1 (insulin growth factors), HOMA index
ADF & Modified ADF1
• 5/9 i insulin
• 3/9 i fasting glucose.
IF vs CR2
• Comparable reductions in fasting insulin and insulin resistance
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1Patterson et al, J Acad Nutr Diet, 2015 2Barnosky et al, Transl Res, 2014
One Day Study
• Ten (three female) healthy, overweight/obese participants
• Three-way cross-over study for ONE DAY each: – Isoenergetic intake – Partial 75 % ER – Total 100 % ER
• Relative to the isoenergetic control: – Postprandial glucose responses were significantly
increased following total ER (+142%) and to a lesser extent after partial ER (+76 %)
– Delay in the glucose time to peak after total ER only
• How does metabolism adapts over time?
79 Antoni et al, Br J Nutr, 2016
Latest CER vs IER
• 63 overweight/obese participants with T2DM
• Randomized for 12 weeks
– CER (continuous energy restriction
– IER (5:2) (intermittent energy restriction)
• Similar improvements in glycemic control (HbA1c)
80 Carter et al, Diabetes Res Clin Pract, 2016
Ramadan Fasting
Meta-analysis of 30 cohort studies of young men and women1: • i LDL cholesterol • i Fasting blood glucose levels
Study of 20 healthy adult males2 • i glucose, insulin, adiponectin • Insulin sensitivity, i insulin resistance
Study of 27 PCOS women3 • Did not affect glucose hemostasis parameters, lipid profiles
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1Kul et al, J Relig Health, 2013 2Gnanou et al, J Diabetes Metab Disord, 2015 3Asemi et al, Arch Iran Med, 2015
Men vs Women
• Limited number of studies
• Overrepresentation of women
• No gender differences in weight loss1
– Similar i weight, body fat, abdominal body fat, visceral body fat…and lean body mass
• Possible difference in glucose/insulin (worse in women?) 2
82
1Martin et al, Endocrinology, 2007 2Varady et al, Obes Res Clin Pract, 2016
Men vs Women
• 8 men, 8 women non-obese
• 3 weeks of alternate day fasting
• Serum glucose clearance after a liquid meal (500 calories Ensure with 80g CHO, 18g PRO) – Worsened in women after alternate day fasting
– Glucose response was unchanged in men.
83 Heilbronn et al, Obes Res, 2005
Ad libitum Fast: 0 kals
Adipokines
• Adiponectin is a specific cytokine (cell signaling proteins) secreted by adipose tissue1,2 – Circulating levels are negatively correlated with body
composition
– Adiponectin (correlates with healthy metabolic profile)
• Leptin is thought to play a role in long-term regulation of caloric intake, fat deposition, and energy balance1,3 – Acts as a signal to the brain, reflecting energy stores in the
body
– i Leptin is associated with diminished visceral abdominal mass (higher in obese subjects)
84
1Eshghinia and Mohammadzadeh, J Diabetes Metab Disord, 2013 2Brown et al, Brit J Diabetes Vasc Dis, 2013 3Alzoghaibi et al, PLoS One, 2014
Adipokines
ADF & Modified ADF
• Adiponectin 2/5
• Leptin 2/5 i
85
Patterson et al, J Acad Nutr Diet, 2015
Insulin Growth Factor Binding Proteins
• Insulin-like growth factor-binding protein-1 and -2 specifically bind and modulate the actions of the IGFs
– Insulin is the primary determinant of IGFBP-1 levels in serum.
• Dietary restriction can increase IGFBPs
– mostly IGFBP-1 and -2 levels
86 Lettieri-Barbato et al, Aging (Albany NY), 2016
Summary
87
Summary
• The vast majority of fasting research has been in animals
• Preliminary evidence in humans demonstrate
– Similar weight loss to calorie restriction diets
– Relative preservation of fat-free mass
– Similar metabolic effects
• IF may be easier to adhere to for some people
• More studies are needed, especially with controls
88
Coming Soon
• 2-year SWIFT Study (Australia/New Zealand) of 250 overweight adults – Compares different types of support while following
diet and exercise of their choice (including IF)1
• 1-year HELENA Trial with 150 overweight or obese non-smoking adults 2 – Randomized: IF vs Control. – Measuring difference in expression levels of 82
candidate genes
• 1-year Intervention Trial - CR vs IF (5:2) with T2DM 3 89
1 Taylor et al, BMC Public Health, 2015 2 Johnson et al, Contemp Clin Trials, 2016 3 Carter et al, World J Diabetes, 2016
Many More Questions
• Would IF cause similar results in the general population?
• Does IF encourage extreme behavior, such as bingeing in some people?
• How does IF affect exercise habits, sleep quality, social life, relationships?
• Can eating just one meal a day compromise diet quality?
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