How Long Should Patients Commit To Intermittent Fasting
The length of a fasting regimen will depend on multiple factors including patient and physician goals .
A distinct advantage to fasting that can promote long-term adherence is its adaptability. Fasting can accompany any diet and fits into a variety of schedules. It is unique from other diets in its low-maintenance, no-cost character: specific foods are not required to prepare, meal replacements do not mandate purchase, and no additional time is required to adhere to a fasting regimen.
While religious practices have incorporated fasting for millennia, clinical trials on fasting protocols range from 8 to 52 weeks. Case series report de-prescription from insulin within weeks to months, and show fasting regimens to be well-tolerated over several months.
The Backstory On Intermittent Fasting
IF as a weight loss approach has been around in various forms for ages but was highly popularized in 2012 by BBC broadcast journalist Dr. Michael Mosleys TV documentary Eat Fast, Live Longer and book The Fast Diet, followed by journalist Kate Harrisons book The 5:2 Diet based on her own experience, and subsequently by Dr. Jason Fungs 2016 bestseller The Obesity Code. IF generated a steady positive buzz as anecdotes of its effectiveness proliferated.
In the Obesity Code, 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 Gods sake, stop snacking.
Monitor Blood Sugar Levels
Regularly monitoring your blood sugar levels is necessary if you have diabetes. However, it becomes much more critical if you decide to start intermittent fasting. It’s common for your blood glucose to fluctuate during fasting periods and after. If you have type 1 or 2 diabetes, youre at a higher risk of hypoglycemia and hyperglycemia during these fluctuations.
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How To Get Started
Getting started is simple.
In fact, chances are youve already done many intermittent fasts before. Many people instinctively eat this way, skipping morning or evening meals.
The easiest way to get started is to choose one of the intermittent fasting methods above and give it a go.
However, you dont need to necessarily follow a structured plan.
An alternative is to fast whenever it suits you. Skipping meals from time to time when you dont feel hungry or dont have time to cook can work for some people.
At the end of the day, it doesnt matter which type of fast you choose. The most important thing is to find a method that works best for you and your lifestyle.
Summary
The easy way to get started is to choose one of the methods above and give it a go. Stop immediately if you experience any adverse effects.
Prescribing Intermittent Fasting In Practice: Recommendations
While alternate day fasting and periodic fasting have demonstrated efficacy in improving metabolic risk factors, it may be difficult to convince patients to give up or severely restrict calories for an entire 24h period. In America, we often eat 3 meals per day in addition to frequent snacking. Furthermore, in American culture most social engagements involve food. Asking patients to eliminate these experiences from their day to day lives may become burdensome, and thus hinder patient compliance. Finally, patients switching to an intermittent fasting regimen may initially experience symptoms such as hunger and irritability, although these symptoms often dissipate within the first 30days . Therefore, it would be more appropriate to gradually introduce intermittent fasting in the form of time restricted feeding. For example, clinicians may first recommend that patients restrict their intake to a daily 12h period, typically an overnight fast . As patients become more comfortable with this pattern of eating, the feeding window can be restricted further . This allows the patient some daily flexibility in choosing when to consume calories, thus increasing the likelihood of compliance. Lastly, patients who have become adapted to time restricted feeding may choose to switch to alternate day or periodic fasting with the supervision and guidance of a registered dietician. See Fig. for a detailed example of an intermittent fasting prescription.
Fig. 5
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Intermittent Fasting And Insulin Sensitivity
Insulin plays a significant role in glucose homeostasis due to its influence in promoting the storage and utilization of glucose. However, the effects of insulin are not limited to glucose homeostasis. Insulin also plays a role in the stimulation of DNA synthesis, RNA synthesis, cell growth and differentiation, amino acid influx, protein synthesis, inhibition of protein degradation, and most importantly, the stimulation of lipogenesis and inhibition of lipolysis .
It is the development of insulin resistance, which is defined as the necessity of higher circulating insulin levels in order to produce a glucose lowering response, that is thought to be responsible for the development of type 2 diabetes . In order to promote regulation of glucose homeostasis, insulin works primarily on receptors in skeletal muscle, liver, and white adipose tissue . In short, there are several proposed mechanisms regarding the development of insulin resistance. One of the more prominent theories describes the association of increased adiposity and the subsequent chronic inflammation that leads to the development of insulin resistance in tissues .
Is Fasting Good For Diabetes
Research has shown that intermittent fasting may be beneficial. It may lower blood glucose levels , blood insulin, and HgbA1c, but there are side effects and potential risks. And, although the research is promising for intermittent fasting and diabetes, additional research should be done in more populations and for longer periods of time.
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What Changes Happen In Your Body When You Fast
Your body is burning the glucose first 8 to 12 hours of fasting. Then, you start burning the fatty acids. Your muscles are full of triglycerides and glycogen . So for example, when you eat on regular basis glucose goes to your muscles and if this glucose is not used by your muscles due to lack of physical activity or excessive calories glucose turns into triglycerides which is a form of fat.
Our body starts using triglycerides in a fasting state once you deplete the glucose and glycogen stores. Then, triglycerides that turn into fatty acids, and the fatty acids turn into ketone bodies.
So, you start burning ketones.
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The Benefits Of Intermittent Fasting
While intermittent fasting may present risks for some, it could also provide benefits over and above other approaches. A 2017 study in the World Journal of Diabetes found that just two weeks of intermittent fasting led to significant weight loss as well as improvements in glucose levels. Its possible that intermittent fasting could lead to reduced insulin resistance, says Kerry Mansell, co-author of that study and a professor in the College of Pharmacy and Nutrition at the University of Saskatchewan in Canada.
Research supports this hypothesis. Some work on people with diabetes has found that intermittent fasting may increase insulin sensitivity and also reduce insulin levels in the blood. This is a big deal. Essentially, fasting is doing what we prescribe diabetes medications to do, which is to improve insulin sensitivity, Horne says. At least one small trial found that adopting an intermittent fasting diet allowed diabetes patients to stop taking their insulin drugs altogether. That studys findings still need to be replicated in a larger group. However, these sorts of results are encouraging. Insulin resistance is associated with higher levels of inflammation and other risk factors for cardiovascular disease. Even when people arent losing weight on a fasting regimen, some research has found that insulin sensitivity improves markedly, Horne says. This is something you typically dont see with other caloric-restriction diets.
Cons Of Intermittent Fasting
Intermittent fasting is one way to regulate your calorie intake and work toward improving your metabolic health.
Though the eating pattern can certainly be part of a healthy diet, it will likely take some adjusting to in the beginning. Plus, simply put, intermittent fasting is not right for everyone.
Here are a few downsides you could encounter when first trying intermittent fasting.
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Type 2 Diabetes And The : 2 Fast Diet
The fact that intermittent fasting shows evidence of improving insulin sensitivity may be an attractive option for people with a BMI over 25, borderline diabetes or with type 2 diabetes but not on blood sugar-lowering medications.
The diet may be good for people who can handle single days of significantly restricted calorie intake in preference to modest calorie restriction every day.
On fasting days, the body will be forced to use stored energy from the body, fat and stored sugar , which can help with weight loss and may improve blood glucose and cholesterol levels.
If you are on insulin, or hypo causing medication, such as sulphonylureas or glinides, an intermittent fasting could significantly increase the risk of hypos. Your doctor should advise you on whether the diet is appropriate.
Does Intermittent Fasting Work
Both intermittent fasting and time-restricted feeding have demonstrated efficacy in reducing weight, central adiposity, and HbA1c in clinical trials ranging from 8 to 52 weeks. There is also evidence that intermittent fasting and time-restricted feeding improve insulin sensitivity as well as biomarkers relating to cardiovascular disease such as blood pressure and resting heart rate.
A therapeutic fasting regimen in patients with type 2 diabetes is also a known strategy for de-prescription and inducing disease remission.
Ongoing research is exploring the relationship between periods of fasting and improved immune function, increased longevity, treatment for chronic neurological disorders, enhanced cognitive performance, and more.
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Trying A Different Approach To Intermittent Fasting
Fast-forward to this year. After being more sedentary than ever during the quarantine, I needed something to switch up my routine. I decided to try intermittent fasting one more time.
However, this time I looked at a different model: the Warrior Diet. There isnât much research specifically backing up this approach to intermittent fasting, but I thought that with some modifications, it might work for me.
Empowered by my previous experience and knowledge of how I responded to different foods and eating at various times of the day, I decided to modify the plan for myself right from the start.
Rather than eating a large meal at night, I had my largest meal as a midafternoon meal . Rather than fight against my own usual body rhythm, I decided to work with it so the plan would be more sustainable for me.
The other part that made it more workable for me was that during the rest of the day I could munch on small amounts of raw fruits and vegetables.
I returned to my previous strategy of testing my blood sugar six times a day and, with this method, I never experienced a hypoglycemic event.
I began to lose small amounts of weight, about a half-pound to a pound per week. After 3 months on this plan, my A1C also decreased. Seeing the lower A1C felt like a big win!
Since it feels natural and matches my own body rhythm, Iâm not feeling deprived at all, and Iâve also noticed an increase in energy.
Intermittent Fasting For Diabetes Explained
Are you hungry or insulin resistant? This is a question that I pose with type 2 diabetes. When your cells are resistant to insulin, you will feel hungry more often, which leads to incresaed food intake. The reason for this is because sugar isnt getting into your cells because insulin isnt doing its job effectively.
Intermittent fasting can improve insulin sensitivity as a result of weight loss and some of the other benefits associated with it.
Another important factor in improving insulin sensitivy is eating whole foods, staying away from processed carbs, while increasing your fiber intake. One way to accomplish this is by adding more green leafy vegetables to your diet, such as one of my favorites kale. And a tried and true way of controlling your blood sugar is keeping an eye on the carbohydrates you eat.
One of the biggest concerns with intermittent fasting and type 2 diabetes is the possibility of hypoglycemia and your medicines. Ive said this many times in the past and its worth repeating. Any diet can work in the short term, but it can only work in the long-term if its sustainable. A part of your lifestyle.
While the sample size in some of these studies that I looked at were relatively small 3 patients in one study, 41 in another I did come across some promising data. But over the long-term, I did observe where patients gained more weight and werent able to make intermittent fasting a part of their lifestyle. So its important to keep this in mind.
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Circadian Rhythm Fasting: Why Youve Been Fasting All Wrong
Intermittent fasting. Its all the rage these days. But are you doing, right?
I know, I know, there is a plethora of information telling you it must be a done a certain way where you end up eating later in the day sometimes before bed. The trend is to skip eating upon waking and extend that well into the afternoon.
But is that the correct way to fast? More importantly, if youre honest with yourself, does that really for work you?
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What Is Intermittent Fasting And What It Is Not
Intermittent fasting is fasting a long time, typically is 16 to 20 hours a day. Some people prefer fasting for a shorter time such as 8 to 12 hours but thats not necessarily the same as 16 hours of fasting when it comes to health benefits. Intermittent fasting 16 to 20 hours a day can help reverse insulin resistance and put diabetes in remission.
Todays topics are
What is intermittent fasting and what it is not?
What happens in your body when you fast intermittently
Why should you fast intermittently?
How to deal with side effects such as irritability or mood problems
Working out while fasting
What Happens To Your Body During Fasting
The changes that occur in the body during fasting depend on the length of the continuous fast. Usually your body enters into a fasting state eight or so hours after the last meal. Your body will initially use stored sources of glucose and then later in the fast it will break down body fat to use as the next source of energy. Using your bodys fat stores as an energy source can, in the long run, lead to weight loss. Losing weight, particularly if you are overweight, can also lead to better control of blood glucose, blood pressure and cholesterol levels. However, fasting should not be used as a way of losing weight in the long term.
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How To Deal With The Side Effects Or Symptoms During Intermittent Fasting
When you fast for 16 hours, you are going to be irritable. You are going to feel weak. You are going to have a little bit of mental fog. The good news is that the symptoms will go away within the first 2 to 4 weeks of intermittent fasting practice. Similar symptoms are reaction antibody happens when you start exercising after a sedentary lifestyle. You start going out to the workouts and you to the gym and the next thing you feel like all of your muscles are failing. However, if you keep going to the gym, your body will learn to recover from the stress response and you will have stronger muscles and more endurance/fitness.
The process is not any different than going through alcohol withdrawal or a smoker stopping smoking. At first, you are not going to feel good because your body is not used to fast for a long time.
But once you go through the symptoms of intermittent fasting, youre going to be a new person in a few weeks. So, you have to be patient for the side effects to go away. In the meantime youre going to be irritable, you also have to control yourself since its your body youre going through this, not your spouse or your family. You dont have to put other people the same stress that youre going through.
It is not a bad idea for you to explain to people around what you are going through and how it is a temporary symptomatic process.
