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Intermittent fasting

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This article is about intentional fasting. For involuntary fasting, seeStarvation.For fasting before a clinical or surgical intervention, seePreoperative fasting.

Intermittent fastingis any of various meal timing schedules that cycle between voluntaryfasting(or reduced calorie intake) and non-fasting over a given period.[1][2]Methods of intermittent fasting includealternate-day fasting,[3]periodic fasting,such as the5:2 diet,and dailytime-restricted eating.[1][4]

Intermittent fasting has been studied to find whether it can reduce the risk of diet-related diseases, such asmetabolic syndrome.[1][5][6][7]A 2019 review concluded that intermittent fasting may help withobesity,insulin resistance,dyslipidemia,hypertension,andinflammation.[1]There is preliminary evidence that intermittent fasting is generally safe.[8]

Adverse effects of intermittent fasting have not been comprehensively studied, leading some academics to point out its risk as adietary fad.[9]The USNational Institute on Agingstates that there is insufficient evidence to recommend intermittent fasting, and encourages speaking to one's healthcare provider about the benefits and risks before making any significant changes to one's eating pattern.[10]

Fasting exists in various religious practices, includingBuddhism,Christianity,Hinduism,Islam,Jainism,andJudaism.[2][11][12]

History

[edit]

Fasting is an ancient tradition, having been practiced by many cultures and religions overcenturies.[9][13][14]

Therapeutic intermittent fasts for the treatment of obesity have been investigated since at least 1915, with a renewed interest in the medical community in the 1960s after Bloom and his colleagues published an "enthusiastic report".[15]Intermittent fasts, or "short-term starvation periods", ranged from 1 to 14 days in these early studies.[16]This enthusiasm penetrated lay magazines, which prompted researchers and clinicians to caution about the use of intermittent fasts without medical monitoring.[17]

Types

[edit]
Intermittent fasting calendar for 1 week, alternating feasting days (green), in which the person eats a normal diet, with fasting days (red), in which the person performs intermittent fasting

There are multiple methods of intermittent fasting.[1][2][4][18][19]

  • Time-restricted eatinginvolves eating only during a certain number of hours each day, often establishing a consistent daily pattern of caloric intake within an 8–12-hour time window. This schedule may align food intake withcircadian rhythms(establishing eating windows that begin after sunrise and end around sunset).[20][21]
    • One meal a day fasting is having just one meal a day, and not having anything for the rest of the day.
  • Alternate-day fastinginvolves alternating between a 24-hour "fast day" when the person eats less than 25% of usual energy needs, followed by a 24-hour non-fasting "feast day" period.[4][8][19]There are two subtypes:[9][22]
    • Complete alternate-day fasting is total intermittent energy restriction (IER vs. CER = continuous energy restriction), where no calories are consumed on fasting days.
    • Modified alternate-day fasting involves partial intermittent energy restriction which allows the consumption of up to 25% of daily calorie needs on fasting days instead of complete fasting. This is akin to alternating days with normal eating and days with avery-low-calorie diet.[23]
  • 5:2 dietis a type of periodic fasting (that does not follow a particular food pattern) which focuses entirely on calorie content.[1]In other words, two days of the week are devoted to consumption of approximately 500 to 600 calories, or about 25% of regular daily caloric intake, with normal calorie intake during the other five days of the week. It was first documented in a 2011 article co-authored byMichelle Harvie,Mark Mattson,and 14 additional scientists.[24][25]It was later published in the UK andAustraliabyMichael Mosleythrough the 2012BBCdocumentaryEat, Fast and Live Longer(where he learned about the 5:2 diet fromMark Mattson).[25][26]It also became common in Australia.[27][28][29]
  • Periodic fasting or whole-day fastinginvolves intermittent periods of water fasting longer than 24 hours.[1][22][30]

The science concerning intermittent fasting is preliminary and uncertain due to an absence of studies on its long-term effects.[1][10][31][32]Preliminary evidence indicates that intermittent fasting may be effective for weight loss, may decreaseinsulin resistanceand fasting insulin, and may improvecardiovascularandmetabolichealth, although the long term sustainability of these effects has not been studied.[1]

Research

[edit]

Body weight and metabolic disease risk

[edit]

There is limited evidence that intermittent fasting producesweight losscomparable to acalorie restricted diet.[5][6][33][34]Most studies on intermittent fasting in humans have observed weight loss, ranging from 2.5% to 9.9%.[35][36]

The reductions in body weight can be attributed to the loss of fat mass and some lean mass.[37][38]For time restricted eating the ratio of weight loss is 4:1 for fat mass to lean mass, respectively.[8][19]Alternate-day fasting does not affectlean body mass,[4][39]although one review found a small decrease.[40]

Alternate-day fasting improvescardiovascularand metabolicbiomarkerssimilarly to acalorie restriction dietin people who areoverweight,obese or havemetabolic syndrome.[5][7][30][41]As of 2021, it remains uncertain whether intermittent fasting could prevent cardiovascular disease.[42]

Intermittent fasting has not been studied in children, elderly, or underweight people, and may be harmful in these populations.[5][7][10][43]Intermittent fasting is not recommended for people who are not overweight, and the long-term sustainability of intermittent fasting is unknown as of 2018.[10][44]

A 2021 review found that moderate alternate-day fasting for two to six months was associated with reductions of body weight,body mass index,and cardiometabolicrisk factorsin overweight or obese adults.[45]

Other effects

[edit]

Cancer and other diseases

[edit]

Intermittent fasting is not recommended to treatcancerin France,[46][47]the United Kingdom,[48]or the United States,[49]although a few small-scale clinical studies suggest that it may reducechemotherapyside effects.[50][51]Periodic fasting may have a minor effect onchronic painandmood disorders.[52][53][54]

Exercise

[edit]

Athletic performance does not benefit from intermittent fasting.[55]Overnight fasting before exercise increaseslipolysis,but reduces performance in prolonged exercise (more than 60 min).[56][57]

Side effects

[edit]

There is preliminary evidence that intermittent fasting appears safe for people withoutdiabetesoreating disorders.[8]

Reviews of preliminary clinical studies found that short-term intermittent fasting may produce minor side effects, such as continuous feelings of hunger, irritability, dizziness, nausea, headaches, and impaired thinking, although these effects disappear within a month from beginning the fasting practice.[58][59]A 2018systematic reviewfound no major adverse effects.[5]Intermittent fasting is not recommended forpregnantorbreastfeeding women,growing children and adolescents, the elderly, or individuals with or vulnerable toeating disorders.[18]

Tolerance

[edit]

Tolerance of a diet is a determinant of the potential effectiveness and maintenance of benefits obtained, such asweight lossor biomarker improvement.[34]A 2019 review found that drop-out rates varied widely from 2% to 38% for intermittent fasting, and from 0% to 50% forcalorie restriction diet.[5]

Possible mechanisms

[edit]

Preliminary research indicates that fasting may induce a transition through four states:

  1. The fed state orabsorptive stateduringsatiety,when the primary fuel source isglucoseand body fat storage is active, lasting for about 4 hours;[60][61]
  2. The postabsorptive state, lasting for up to 18 hours, whenglucagonis secreted and the body usesliver glucose reserves as a fuel source;[4][62][60]
  3. The fasted state, transitioning progressively toother reserves, such as fat, lactic acid, and alanine, as fuel sources,when the liver glucose reserves are depleted, occurring after 12 to 36 hours of continued fast;[61][63][64]
  4. The shift from preferentiallipid synthesisand fat storage, to themobilizationof fat (in the form offree fatty acids), metabolized intofatty acid-derived ketonesto provide energy.[61][65][66]Some authors call this transition the "metabolic switch".[1][62][67]

A 2019 review of weight-change interventions, including alternate day fasting, time-restricted feeding, exercise and overeating, found thatbody weight homeostasiscould not precisely correct "energetic errors" – the loss or gain of calories – in the short-term.[68]

Another pathway for effects of meal timing on metabolism lies in the influence of thecircadian rhythmover theendocrine system,especially onglucose metabolismandleptin.[69]Preliminary studies found that eating whenmelatoninis secreted – during darkness and commonly when sleeping at night – is associated with increased glucose levels in young healthy adults, and obesity and cardiovascular disorders in less healthy individuals.[70]Reviews on obesity prevention concluded that "meal timing appears as a new potential target in weight control strategies" and suggest that "timing and content of food intake, physical activity, and sleep may be modulated to counteract" circadian and metabolic genetic predispositions to obesity.[71][72]

Intermittent feeding

[edit]

Other feeding schemes, such ashypocaloric feeding[73]and intermittent feeding, also called bolus feeding were under study.[74]A 2019 meta-analysis found that intermittent feeding may be more beneficial for premature infants, although better designed studies are required to devise clinical practices.[75]In adults, reviews have not found intermittent feeding to increase glucose variability or gastrointestinal intolerance.[76][77]A meta-analysis found intermittent feeding had no influence ongastric residual volumes and aspiration,pneumonia, mortality nor morbidity in people with a trauma, but increased the risk of diarrhea.[74][77]

Food production

[edit]

Intermittent fasting, or "skip-a-day" feeding, is supposedly the most common feeding strategy forpoultryinbroiler breeder farmsworldwide, as an alternative to adding bulky fibers to the diet to reduce growth. It is perceived as welfare-reducing and thus illegal in several European countries including Sweden. Intermittent fasting in poultry appears to increase food consumption but reduce appetitive behaviors such as foraging.[78]

Religious fasting

[edit]
Main article:Fasting in religion

Some different types of fastings exist in some religious practices.[2][11]These include theBlack FastofChristianity(commonly practiced duringLent),Vrata(Hinduism),Ramadan(Islam),Yom Kippur(Judaism),Fast Sunday(The Church of Jesus Christ of Latter-day Saints),Jainfasting, andBuddhist fasting.[2][11][12]Religious fasting practices may only require abstinence from certain foods or last for a short period of time and cause negligible effects.[11]

Hinduism

[edit]

AVrata/Nombuis observed either as an independent private ritual at a date of one's choice, as part of a particular ceremony such as wedding, or as a part of a major festival such asDiwali(Lakshmi, festival of lights),Shivaratri(Shiva),Navratri(Durga or Rama), Kandasashti (Muruga),Ekadashi(Krishna, Vishnuavatars).[79][80][81][82]

Christianity

[edit]

In Christianity, many adherents ofChristian denominationsincluding Catholics, Lutherans, Methodists, Anglicans, and the Orthodox, often observe theFriday Fastthroughout the year, which commonly includes abstinence from meat.[83]Throughout the liturgical season of Lent (and especially onAsh WednesdayandGood Friday) in theChristian calendar,many Christians practice a form of intermittent fasting in which one can consume twocollationsand one full meal; others partake of the Black Fast, in which no food is consumed until sundown.[84][85]

Buddhism

[edit]

In Buddhism, fasting is undertaken as part of the monastic training ofTheravadaBuddhist monks, who fast daily from noon to sunrise of the next day.[86]This daily fasting pattern may be undertaken by laypeople following theeight precepts.[86][87]

Islam

[edit]

DuringRamadan,Islamic practices are similar to intermittent fasting by not eating or drinking from dawn until sunset, while permitting food intake in the morning before dawn and in the evening after dusk for 30 days.[11][88][89]Ameta-analysison the health of Muslims during Ramadan shows significant weight loss during the fasting period of up to 1.51 kilograms (3.3 lb), but this weight was regained within about two weeks thereafter.[90]The analysis concluded that "Ramadan provides an opportunity to lose weight, but structured and consistent lifestyle modifications are necessary to achieve lasting weight loss."[90]One review found similarities between Ramadan and time-restricted feeding, with the main dissimilarity being the disallowance of water drinking with Islamic fasting.[91]In a 2020 review, Ramadan fasting caused a significant decrease inLDL cholesterollevels, and a slight decline intotal cholesterol.[89]

Iftar serving for fasting people in theImam Reza shrine

A review of the metabolic effects of fasting showed that religious fasting proved to be beneficial in terms of "body weight and glycemia, cardiometabolic risk markers, and oxidative stress parameters", where animals, in the study, that followed a diet regimen consistent with that of religious fasting, were observed to have weight loss in addition to "lowered plasma levels of glucose, triacylglycerols, and insulin growth factor-1".[11]Negative effects of Ramadan fasting include increased risk ofhypoglycemiain diabetics, as well as inadequate levels of certain nutrients.[11]Ramadan disallows fluids during the fasting period. This type of fasting would be hazardous for pregnant women, as it is associated with risks ofinducinglabor and causinggestational diabetes,although it does not appear to affect the child's weight.[92][93]For these reasons, pregnant women, as well as children who have not reached puberty, the elderly, those who are physically or mentally incapable of fasting, travelers, and breast-feeding mothers are often exempt from religious fasting – Ramadan being one example.[88]Ramadan diurnal intermittent fasting is associated with healthier lifestyle behaviors and a reduction in smoking rate by more than 50% among university students.[94]

Guidelines

[edit]

United States

[edit]

TheAmerican Heart Association(AHA) says that as with other "popular or fad diets", there is no good evidence of heart health benefits from intermittent fasting.[95]

TheAmerican Diabetes Association"found limited evidence about the safety and/or effects of intermittent fasting ontype 1 diabetes"and preliminary results of weight loss fortype 2 diabetes,and so does not recommend any specific dietary pattern for the management of diabetes until more research is done, recommending instead that "health care providers should focus on the key factors that are common among the patterns".[31]

TheNational Institute on Agingstates that although intermittent fasting showed weight loss success in several studies on obese or overweight individuals, it does not recommend intermittent fasting for non-overweight individuals because of uncertainties about its effectiveness and safety, especially for older adults.[10]

Europe

[edit]

Given the lack of advantage and the increased incidence of diarrhea, European guidelines do not recommend intermittent feeding for people in intensive care units.[74][77]

United Kingdom

[edit]

According toNHS Choices,people considering the 5:2 diet should first consult a physician, as fasting can sometimes be unsafe.[96][97]

New Zealand

[edit]

TheNew Zealand's Ministry of Healthconsiders that intermittent fasting can be advised by doctors to some people, except diabetics, stating that these "diets can be as effective as other energy-restricted diets, and some people may find them easier to stick to" but there are possible side effects during fasting days such as "hunger, low energy levels, light-headedness and poor mental functioning" and note thathealthy foodmust be chosen on non-fasting days.[32][98]

[edit]

As of 2019,intermittent fasting was a commonfad diet,attracting celebrity endorsements and public interest.[99]

UK and Australia

[edit]

Intermittent fasting (specifically the 5:2 diet) was popularized byMichael Mosleyin the UK and Australia in 2012[100][101]after theBBC2televisionHorizondocumentaryEat, Fast and Live Longer.[102][96][103][29]

North America

[edit]

In the United States, intermittent fasting became a trend inSilicon Valley, California.[104]It was the most popular diet in 2018, according to a survey by theInternational Food Information Council.[105][106]

Commercial activity

[edit]

As of 2019,interest in intermittent fasting led some companies to commercialize diet coaching,dietary supplements,and full meal packages.[104][107]These companies were criticized for offering expensive products or services that were not backed by science.[107][108]

See also

[edit]

References

[edit]
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