Intermittent fasting is not a fad diet. There, I have written it. Intermittent fasting (IF) is eating in a restricted time period. If guided by a clinical nutritionist, it can achieve good metabolic outcomes. The conversion to a fad diet started when insufficient and inadequate "studies" started appearing regarding its amazing outcomes primarily viz a viz weight loss. Celebrities started endorsing the "diet" and it became a hit. Then came its effect on diabetes; again, ill-constructed studies made claims of "reversal" of diabetes and it became a demand from patients/clients.
Healthcare started looking into this seriously. Since 2016, there have been some good clinical studies including random control trials, and meta-analysis in human subjects on IF. Before we conclude this conversation, let me explain the metabolic parameters that are central for diabetes treatment.
Goals for management of diabetes are:
- Achieving and maintaining good glycaemic control
- Managing and reducing symptoms of diabetes
- Managing comorbid conditions like obesity, BP, and cholesterol levels
- Prevention of neurological, cardiovascular, and kidney functions
- Prevention of infections
To achieve these goals, it is necessary to follow a good overall lifestyle which includes a healthy diet, good physical activity, medication (if required), and timely testing.
IF is a program which can be followed in different ways.
- 5:2 fasting wherein 5 days are normal meals and 2 days are dedicated to eating only 25% -30% of calorific intake.
- 8:16 fasting where 8 hours are the eating window and 16 hours are fasting.
- 10:14 is 10 hours eating window and 14 hrs of fasting
All these methods have been investigated and the outcome mapped across various studies show certain benefits for diabetes control:
Good to moderate weight loss can be achieved with IF. 5% to 10% weight loss over a period of time is known to help control blood sugar control. When followed scientifically combining healthy eating and resistance training, you can ensure fat loss while preserving muscle. Lesser fat stores in liver and pancreas help with better glucose levels.
Improved insulin sensitivity:
IF works through what is known as metabolic reset. Fasting causes a depletion in carbohydrate stores, leading to the body using free fatty acids for energy. Ketones are the end products of this metabolic pathway. This process is associated with improved insulin sensitivity, decreased inflammatory responses, and hence, better blood sugar controls.
Lower insulin levels:
Insulin resistance is often associated with high circulating insulin. It is a common response in type II diabetes and pre diabetes. Prolonged high insulin is closely linked to increase in obesity, especially abdominal obesity, type II diabetes and cardiovascular diseases. The science behind IF is fasting for a fixed period of time that ensures lowering of insulin levels in the absence of carbs, leading to fat loss.
Improvement in hunger hormone:
Moderate improvement in hunger hormones is seen in IF. Ghrelin, the hunger hormone, increases during fasting and is associated with abdominal fat loss, and improved insulin sensitivity. On eating there is a drop in the hormone
Improvement in gut health:
Studies in animals and humans have shown an improvement in gut bacteria because of fasting. An increase in beneficial bacteria have been seen in the fasting state. It is believed that IF may permanently improve the beneficial bacteria colony in the gut.
Looking at these benefits, we could say that IF is great for diabetes. However research so far shows that every individual may not be a candidate for IF. The exact length of fasting is different for individuals and sometimes fasting has also led to stress.
To conclude the conversation, is IF the answer to controlling diabetes? May be. Your doctor is the best guide for your treatment protocols. Does IF lead to remission? Again you doctor has to see your overall health parameters before deciding if are you a candidate for remission. So the answer, my friend, is still blowing in the wind.
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About Rupali DattaRupali Datta is a Clinical Nutritionist and has worked in leading corporate hospitals. She has created and lead teams of professionals to deliver clinical solutions for patients across all medical specialties including critical care. She is a member of the Indian Dietetic Association and Indian Association of Parenteral and Enteral Nutrition.