Intermittent Fasting

Intermittent Fasting
What is Intermittent Fasting?

Simply put, intermittent fasting is a dieting strategy or eating pattern which times all your daily food
intake into a specific number of contiguous hours to produce an extended fasting phase which
can go up to 24 hours. For example, one might choose to time all their meals within an 8 hour window
everyday. For the remaining 16 hours, they would have only water, black coffee or tea (items with no
calorific value). Hence, this would result in an intermittent fast of 16 hours every day.
Intermittent Fasting does not specify calorie count or macro split. Hence it is not a diet per se. It is a time
based strategy people use for various health and convenience benefits.
To some extent, everyone uses intermittent fasting because we generally tend to sleep for 7-8 hours and
it results in a 8-9 hour fast. The most popular variants of Intermittent fasting seem to be:
● 16:8 fast (Fasting window of 16 hours including sleep time, followed by an eating window of 8
hours per day)
● Eat-stop-eat or 5:2 fast (Whole day spent fasting twice a week)
Science behind Fasting

After several hours pass without caloric food intake, our body leaves the fed state and enters a fasted
state. Whether we are fasting or in fed state, our body needs to maintain blood glucose levels in order to
function. In humans, depending upon their level of physical activity, 12 to 24 hours of fasting typically
results in a 20% or greater decrease in serum glucose1 and depletion of the hepatic glycogen,
accompanied by a switch to a metabolic mode in which non-hepatic glucose, fat-derived ketone bodies
and free fatty acids are used as energy sources2. Different sets of hormones assist our metabolic
processes that either cause breakdown of any tissue (fat, muscle, bone etc) or growth. These processes
are called catabolism and anabolism. While both can occur simultaneously at different tissues, one set of
hormones hinders the other set like a seesaw. Anabolic hormone like Insulin helps in both fat storage and
muscle growth. Insulin increases on intake of any food and Glucagon(which can trigger fat and muscle
breakdown) decreases. Glucagon increases and Insulin decreases during fasting which causes
breakdown of fat to provides the energy(ATP) we need during intermittent fasting. This fueling
mechanism undergoes further changes if the fasting is continued more than 2-3 days but that is not
relevant to intermittent fasting where the fasting window is usually upto to 24 hours. So we do lose fat
while fasting because we use fat stores as energy when food intake is stopped and glycogen is getting
depleted. However, our body is smart enough to store any excess energy as fat and replenish fat stores
during our eating window. So there is no real contest to the fact that energy equations hold good no
matter which dieting strategy we use.
1
"Fasting: Molecular Mechanisms and Clinical Applications - NCBI - NIH." 16 Jan. 2014,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3946160/. Accessed 28 Aug. 2018.
2
"How does the body adapt to starvation? (video) | Khan Academy." 15 Jun. 2014,
https://www.khanacademy.org/test-prep/mcat/biomolecules/fat-and-protein-metabolism/v/how-does-the-
body-adapt-to-starvation. Accessed 28 Aug. 2018.
Intermittent fasting is therefore a method used to prolong fasted state where catabolic process of fat
breakdown for energy happens along with other hormonal changes that might be beneficial for health.
However, our body is an extremely smart complex system with lots of counterbalances and
personalizations. One solution does not fit all.
Who is it for?
While anyone could use this strategy, most people use it for the following reasons
● They are on a caloric deficit diet (trying to lose fat) but they find bigger meals more satisfying
than smaller frequent meals
● They find certain times inconvenient to eat. Eg. Some people do not feel like eating in the
morning or while they are at work.
● They would believe there will be hormonal benefits of this practice for their fitness goal (fat loss,
blood sugar regulation)
The fasting and eating window should be selected according to the lifestyle one follows so that it is
convenient and sustainable. The factors to consider for this are:
● Training intensity and timing
● Routine social activities and personal preferences
Who should avoid it?

Some people have a tendency to binge after a fasting window or find it inconvenient to consume the
required amounts of food within a short window of time. This might result in deviating from their desired
goals. Such people should avoid IF simply because of these reasons.
The following sets of people should avoid it without proper medical consultation and monitoring:
● Pregnant women
● Breastfeeding women
● Underweight person
● Child
● Person with any medical condition currently under treatment
Things to know while using IF

1. Adequate water intake is crucial for our wellbeing.
2. Respect your bodily cues: Sleep quality, immunity, energy levels and hormonal changes can
happen due to this dieting strategy. Hence it can affect our health and quality of life. These
changes may not be generic for all humans.
3. Exercise and fasting: Intense exercise during the fasting window or exercise immediately after a
large meal in the eating window might be troublesome. It is important to change and regulate the
timings to your overall benefit.
4. Nutrient dense diet is still required: Intermittent fasting does not condone wolfing down empty
calories during the eating window. As always, your body cannot perform at its best without the
fulfillment of micronutrients(vitamins, minerals) and essential macronutrients(fats, proteins).
5. Managing hunger pangs: Our body secretes hunger hormones according to the timing we are
used to. Hence, it is natural to feel hunger pangs when we increase our fasting window. Zero
calorie beverages like water, coffee or tea (*without any milk/sugar/cream etc) can help us tide
over these hunger pangs. Coffee has proven3 useful for suppressing appetite.
Intermittent Fasting: What the scientific studies reveal
The hormonal benefits of Intermittent Fasting strategy is widely acclaimed. The concept of intermittent
fasting is not new. Humans have practiced it as part of religion or due to other reasons for years. This is a
widely debated topic among the nutritionists and researchers with highly polarized studies. It is therefore
important to analyze research papers objectively to understand the proven hormonal benefits of this
strategy. The main points to note while reading such a paper/article are:
● Animal studies do not directly translate to humans.4 Recently a presentation5 (based on
experiments of IF on rats) at the european society of endocrinology concluded that IF decreases
pancreatic islet mass and increases insulin resistance. However, as it is not possible to
extrapolate this effect on humans. The method of study on rats is also in question6 by other
experts as not enough details are known.
● Effect on hormones can vary for male/female subjects as well as lean/obese subjects and age of
the subjects.
● The nutrition of the test subjects during the entire day must be equated to determine the effect of
fasting alone. This is a common point of failure for many studies that try to make a case
for/against intermittent fasting. Substantial misreporting of calorie intake by test subjects can
skew the results of studies.
Insulin, Diabetes and Fat loss

For obese diabetic subjects, studies7 show that Intermittent fasts over periods of days have been shown
to improve glucose tolerance. However, for healthy, normal weight middle aged men and women, a study8
shows that insulin sensitivity decreases and worsens morning glucose tolerance with a longer fasting
window when the food intake is maintained equal. It cites that the reduced glucose tolerance is reversible
and has no long term effects. Another study9 showed that normal weight women showed reduced glucose
tolerance to alternate day fasts than normal weight men. Yet another study10 on normal weight men
showed increased glucose tolerance after being subject to intermittent fasts.
The subjects that maintained same caloric intake along with intermittent fasting maintained their weight
over 6 months. This is contrary to the claim that intermittent fasting causes weight loss by itself. While
3
"Effect of different amounts of coffee on dietary ... - Wiley Online Library." 29 Nov. 2012,
https://onlinelibrary.wiley.com/doi/full/10.1002/oby.20190. Accessed 28 Aug. 2018.
4
"Are animal models predictive for humans? - NCBI - NIH." 15 Jan. 2009,
5
"Intermittent fasting for three months decreases ... - Endocrine Abstracts." https://www.endocrine-
abstracts.org/ea/0056/ea0056p519. Accessed 27 Aug. 2018.
6
"expert reaction to unpublished poster presentation on diabetes and ...." 19 May. 2018,
http://www.sciencemediacentre.org/expert-reaction-to-unpublished-poster-presentation-on-diabetes-and-
fasting-as-presented-at-the-european-society-of-endocrinology-annual-meeting-ece-2018/. Accessed 27
Aug. 2018.
7
"T HE - Metabolism - Clinical and Experimental." http://www.metabolismjournal.com/article/0026-
0495(66)90029-1/pdf. Accessed 27 Aug. 2018.
8
"Impact of Reduced Meal Frequency Without Caloric ... - NCBI - NIH."
9
"Glucose tolerance and skeletal muscle gene expression ... - NCBI - NIH."
https://www.ncbi.nlm.nih.gov/pubmed/15833943. Accessed 28 Aug. 2018.
10
"Effect of intermittent fasting and refeeding on insulin action in ... - NCBI."
there is no significant weight loss benefit, the study11 found a significant modification of body composition,
including reductions in fat mass; significant increases in blood pressure and in total, LDL-, and HDL-
cholesterol concentrations; and a significant decrease in concentrations of cortisol.
Autophagy and Longevity

Several studies show that caloric restriction improves longevity. A study12 comparing continuous and
intermittent energy restriction was conducted on young overweight women and found both approaches to
be equally effective. Autophagy is engaged to varying degrees in varying tissues even over the course of
a normal day with an 8 hour overnight fast. However, a study13 on mice suggests that a 24 hour to 48 hour
fast probably have the strongest autophagy effect. For humans, it is not clear that intermittent fasting
provides any benefit over caloric restriction14 for autophagy and longevity. Though popular websites
promoting fasting assert definitively that intermittent fasting promotes autophagy and longevity, this
article15 highlights the need for further studies in this area.
Growth Hormone
Another aspect of fasting is that it triggers the release of HGH(human growth hormone). It is found to be
released before we wake up in the morning. Food intake is found to suppress it while continued fasting is
found to increase its levels multifold via spontaneous bursts of HGH16. As we grow older, HGH levels
drop. It has anabolic properties of triggering growth and protecting against loss of muscle mass but in
fasted state17 it has the additional effect of enhancing fat breakdown(lipolysis)and glycogen breakdown to
maintain blood glucose levels18. The increased secretion of this hormone is the main reason behind the
“fountain of youth” or anti-aging19 perspective towards Intermittent Fasting. However, external
supplementation of HGH is found to be risky20.
However, all the studies linked above are conducted on normal weight or obese males. Not enough
fasting related studies feature female subjects and measure growth hormone. Most well known articles21
11
"A controlled trial of reduced meal frequency without ... - NCBI - NIH."
12
"The effects of intermittent or continuous energy restriction ... - NCBI - NIH." 5 Oct. 2010,
13
"Short-term fasting induces profound ...." 14 Aug. 2010,
14
"Long-Term Calorie Restriction Enhances Cellular ... - Science Direct."
https://www.sciencedirect.com/science/article/pii/S2211124715014837. Accessed 28 Aug. 2018.
15
"Fasting or caloric restriction for Healthy Aging - NCBI - NIH." 29 Apr. 2013,
16
"Fasting enhances growth hormone secretion and ... - NCBI - NIH."
17
"Fasting enhances growth hormone secretion and ... - NCBI - NIH."
18
"Evidence for increased sensitivity of fuel mobilization to growth ... - NCBI."
19
"Growth hormone and aging: A challenging controversy - NCBI - NIH."
20
"Growth hormone, athletic performance, and aging - Harvard Health." 19 Jun. 2018,
https://www.health.harvard.edu/diseases-and-conditions/growth-hormone-athletic-performance-and-
aging. Accessed 29 Aug. 2018.
21
"Fasting and growth hormone - Diet Doctor." 24 Oct. 2016, https://www.dietdoctor.com/fasting-and-
growth-hormone. Accessed 29 Aug. 2018.
supporting intermittent fasting for women are quoting a study22 which is not based on fasting induced
growth hormone at all! They were injected doses of this hormone and the subjects are men and women
aged 65 to 88 years.
Resistance Training and Intermittent Fasting

It is often recommended that heavy lifting must be timed so that you can eat after your workout. Anabolic
hormones are important for muscle recovery and muscle protein synthesis. Hence it makes sense that
after a resistance training session, the micro tears in the muscle will repair and grow the best if Insulin
increases and Glucagon decreases (by breaking a fast). Proper protein intake is also essential for
preserving and increasing muscle mass.
Studies regarding this are mostly performed on male subjects. The findings23 show that the combination of
resistance training and intermittent fasting caused more improvements in body composition than just
resistance training with equivalent calorie intake. A study24 that included female participant who strength
trained, showed improvement in body composition too.
Other studies2526 report no particular benefit but these studies either did not have any dietary guidelines or
relied on self reported calorie intake (which they mention could have substantial misreporting).
Female Hormones and Intermittent Fasting

Many articles27 use anecdotal accounts to suggest that Intermittent Fasting would cause hormone
imbalance for some women. They also quote some extreme studies28 on rats to support their theories
which cannot be equated. However, there is no scientific study that conclude this. Ramadan is a religious
intermittent fast undertaken by both sexes and a study29 on it found no significant effect on female
hormone levels.
However an interesting aspect is that fat tissue(adipose cells) have been found to be a major source of
estrogen30. Fat tissue plays a very valuable role in females for energy homeostasis, lipid metabolism,
immune response, and reproduction. Even after menopause, fat tissue plays an important role. Therefore
it makes sense that a healthy female body preserves more fat and resists fat loss. Fasting can therefore
22
"Growth hormone and sex steroid administration in ... - NCBI - NIH." 13 Nov. 2002,
23
"Effects of eight weeks of time-restricted feeding (16/8) on ... - NCBI - NIH." 13 Oct. 2016,
24
"Time-Restricted Eating In Women - A Pilot Study - Western University."
https://ir.lib.uwo.ca/cgi/viewcontent.cgi?article=1155&context=wurjhns. Accessed 28 Aug. 2018.
25
"Intermittent fasting combined with resistance training ... - NCBI - NIH."
26
"Time-restricted feeding in young men performing resistance ... - NCBI." 22 Aug. 2016,
27
"Is Intermittent Fasting Safe for Women? - OAWHealth." 15 Jan. 2018,
https://oawhealth.com/2018/01/15/is-intermittent-fasting-safe-for-women/. Accessed 28 Aug. 2018.
28
"Intermittent Fasting Dietary Restriction Regimen Negatively ... - PLOS." 29 Jan. 2013,
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0052416. Accessed 28 Aug. 2018.
29
"Effects of long-term fasting on female hormone levels ... - NCBI."
"Estrogen production and action. - NCBI - NIH." https://www.ncbi.nlm.nih.gov/pubmed/11511861.
30
Accessed 29 Aug. 2018.

trigger a different response in women compared to men and not enough studies test this to make a
definitive analysis.
Takeaways
● It can be used as a tool to improve body composition and other health factors coupled with a
nutritious diet and exercise
● Weight loss is not a direct result of IF but will happen if IF is paired with a calorie deficit diet.
● Improvements in Insulin sensitivity and glucose tolerance cannot be said to be achieved by IF
generically. Such benefits seem to be limited to obese diabetic subjects and it is unclear how long
these benefits persist after the fasting.
● The effect of intermittent fasting on hormones can depend on variety of other factors such as age,
sex and body composition. However, no lasting ill-effects are found and the results vary from no
effect to excellent.
● The hormonal benefits do not outweigh a bad diet or an unsustainable lifestyle. Having said that,
one must try a strategy for at least a period of 1 month to understand what works or does not
work for them.

Intermittent Fasting

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Intermittent Fasting

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Copyright:

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Intermittent Fasting

What is Intermittent Fasting?

Science behind Fasting

Who should avoid it?

Things to know while using IF

Insulin, Diabetes and Fat loss

Autophagy and Longevity

Resistance Training and Intermittent Fasting

Female Hormones and Intermittent Fasting

Accessed 29 Aug. 2018.

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