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Intermittent fasting: Surprising update

POSTED JUNE 29, 2018, 6:30 AM , UPDATED DECEMBER 12, 2019, 12:00 AM

Monique Tello, MD, MPH

Contributing Editor

There’s a ton of incredibly promising intermittent fasting (IF)

research done on fat rats. They lose weight, their blood
pressure, cholesterol, and blood sugars improve… but they’re
rats. Studies in humans, almost across the board, have shown
that IF is safe and incredibly e ective, but really no more
e ective than any other diet. In addition, many people nd it
di cult to fast.

But a growing body of research suggests that the timing of the fast is key, and can make IF a more
realistic, sustainable, and e ective approach for weight loss, as well as for diabetes prevention.

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 Mosley’s TV documentary Eat Fast, Live Longer and
book The Fast Diet, followed by journalist Kate Harrison’s book The 5:2 Diet based on her own
experience, and subsequently by Dr. Jason Fung’s 2016 bestseller The Obesity Code. IF generated a
steady positive buzz as anecdotes of its e ectiveness proliferated.

As a lifestyle-leaning research doctor, I needed to understand the science. The Obesity Code seemed
the most evidence-based summary resource, and I loved it. 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, ber,
healthy protein, and fats, and avoid sugar, re ned grains, processed foods, and for God’s sake, stop
snacking. Check, check, check, I agree. The only part that was still questionable in my mind was the
intermittent fasting part.

Intermittent fasting can help weight loss

IF makes intuitive sense. The food we eat is broken down by enzymes in our gut and eventually ends
up as molecules in our bloodstream. Carbohydrates, particularly sugars and re ned grains (think
white ours and rice), are quickly broken down into sugar, which our cells use for energy. If our cells
don’t use it all, we store it in our fat cells as, well, fat. But sugar can only enter our cells with insulin, a
hormone made in the pancreas. Insulin brings sugar into the fat cells and keeps it there.

Between meals, as long as we don’t snack, our insulin levels will go down and our fat cells can then
release their stored sugar, to be used as energy. We lose weight if we let our insulin levels go down.
The entire idea of IF is to allow the insulin levels to go down far enough and for long enough that we
burn o our fat.

Intermittent fasting can be hard… but maybe it doesn’t have to be

Initial human studies that compared fasting every other day to eating less every day showed that
both worked about equally for weight loss, though people struggled with the fasting days. So, I had
written o IF as no better or worse than simply eating less, only far more uncomfortable. My advice
was to just stick with the sensible, plant-based, Mediterranean-style diet.

New research is suggesting that not all IF approaches are the same, and some are actually very
reasonable, e ective, and sustainable, especially when combined with a nutritious plant-based diet.
So I’m prepared to take my lumps on this one (and even revise my prior post).

We have evolved to be in sync with the day/night cycle, i.e., a circadian rhythm. Our metabolism has
adapted to daytime food, nighttime sleep. Nighttime eating is well associated with a higher risk of
obesity, as well as diabetes.

Based on this, researchers from the University of Alabama conducted a study with a small group of
obese men with prediabetes. They compared a form of intermittent fasting called “early time-
restricted feeding,” where all meals were t into an early eight-hour period of the day (7 am to 3
pm),or spread out over 12 hours (between 7 am and 7 pm). Both groups maintained their weight (did
not gain or lose) but after ve weeks, the eight-hours group had dramatically lower insulin levels and
signi cantly improved insulin sensitivity, as well as signi cantly lower blood pressure. The best part?
The eight-hours group also had signi cantly decreased appetite. They weren’t starving.

Just changing the timing of meals, by eating earlier in the day and extending the overnight fast,
signi cantly bene ted metabolism even in people who didn’t lose a single pound.

So, is this as good as it sounds?

I was very curious about this, so I asked the opinion of metabolic expert Dr. Deborah Wexler, Director
of the Massachusetts General Hospital Diabetes Center and associate professor at Harvard Medical
School. Here is what she told me. “There is evidence to suggest that the circadian rhythm fasting
approach, where meals are restricted to an eight to 10-hour period of the daytime, is e ective,” she
con rmed, though generally she recommends that people “use an eating approach that works for
them and is sustainable to them.”
So, here’s the deal. There is some good scienti c evidence suggesting that circadian rhythm fasting,
when combined with a healthy diet and lifestyle, can be a particularly e ective approach to weight
loss, especially for people at risk for diabetes. (However, people with advanced diabetes or who are on
medications for diabetes, people with a history of eating disorders like anorexia and bulimia, and
pregnant or breastfeeding women should not attempt intermittent fasting unless under the close
supervision of a physician who can monitor them.)

4 ways to use this information for better health

1. Avoid sugars and re ned grains. Instead, eat fruits, vegetables, beans, lentils, whole grains, lean
proteins, and healthy fats (a sensible, plant-based, Mediterranean-style diet).
2. Let your body burn fat between meals. Don’t snack. Be active throughout your day. Build muscle
tone.
3. Consider a simple form of intermittent fasting. Limit the hours of the day when you eat, and for
best e ect, make it earlier in the day (between 7 am to 3 pm, or even 10 am to 6 pm, but de nitely
not in the evening before bed).
4. Avoid snacking or eating at nighttime, all the time.

Sources
E ect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among
Metabolically Healthy Obese Adults: A Randomized Clinical Trial. JAMA Internal Medicine, May 2017.

Alternate-day fasting in nonobese subjects: e ects on body weight, body composition, and energy
metabolism. American Journal of Clinical Nutrition, January 2005.

The Obesity Code, by Jason Fung, MD (Greystone Books, 2016).

Intermittent fasting interventions for treatment of overweight and obesity in adults: a systematic
review and meta-analysis. JBI Database of Systematic Reviews and Implementation Reports, February
2018.

Metabolic E ects of Intermittent Fasting. Annual Review of Nutrition, August 2017.

Early Time-Restricted Feeding Improves Insulin Sensitivity, Blood Pressure, and Oxidative Stress Even
without Weight Loss in Men with Prediabetes. Cell Metabolism, May 2018.

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COMMENTS TOPICS

41 Diet and Weight Loss | Health

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POSTED AUGUST 25TH, 2018 AT 7:09 PM

Je

Every study seems to support cognitive and health bene ts for IF. Studies are coming out showing
it may help stave o heart disease and it’s even been shown to halt or possibly reverse brain-
related diseases such as Alzheimer’s. If in doubt, check out Jason Fung’s youtube videos along with
a couple of youtube researchers who do wonderful analytics, an American who lives in Japan who
goes by, “Things I’ve Learned” and Thomas DeLauer’s IF material. I’ve been doing IF myself for a
few months now and I feel better, more energy, better sleep, and controlled weight.

POSTED AUGUST 23RD, 2018 AT 8:11 AM

Christine

I just started intermittent fasting. Can I take diatomaceous earth while in my fasting state?

POSTED AUGUST 21ST, 2018 AT 2:22 PM

ZK
I started IF a month ago and I feel great. I lost weight, I feel “lighter,” more awake, and more
energetic. I plan to make IF a part of my life.

I eat from 12PM to 8PM. I feel that skipping breakfast is the easiest thing to do. I used to go to a
bakery every morning – I’ve stopped that. If I get a little hungry in the morning, I use co ee as an
appetite suppressant. On most days I don’t even think about breakfast and before I know it, it’s
noon!

I’ve been good about not eating past 8PM. Okay, If I’m out for dinner or at a party, I might go past
8PM…but I don’t kill myself over it. Some days if I have a big lunch (crispy duck with basil or
cheeseburger), I won’t eat until the following day.

I’m 43 years old and not a big guy (5’7″) but I could use some trimming around the gut. When I
started IF I was 169 lbs and I’m now at 165 lbs…so losing 1-2 lbs per week.
One important thing: I herniated a disc in my lower back a couple months ago so I’m not
exercising. I don’t know how things will change (appetite, blood sugar, fatigue, etc) once I resume
weights and start riding my bike to work again.

In summary, I’m going to use some form of IF for the rest of my life and I highly recommend it. As
with anything check with your doctor and make sure it’s the right thing for you. Good luck!

POSTED AUGUST 20TH, 2018 AT 7:02 PM

Anna

Hey, Im 16 years old. Should I try this? I also use special app on my phone to count protein,
carbohydrates and fat, i understand that its really important for my body to work well and to have
everything for it. It won’t be so harmful to try if in my age as well? Some tips?

POSTED AUGUST 18TH, 2018 AT 5:06 AM

Enzo
Why do you conclude that evening fasting is better? Both the groups started the feeding time
window at 7am, so the di erent results are not related to the timing but to the duration of fasting.
Nothing new for us… this simply remarks the bene ts of restricted time feeding, indipendently
from time of the day.

As for eating early there are no evidence of the bene ts and also some studies that go against this
advice http://www.ergo-log.com/emphasisonbreakfast.html

Anectodally I nd more di cult to fast in the evening (have you ever tried to go to bed on an
empty stomach? )… without count that in the evening my self-control is really depleted after a
day of work and I want just to relax and enjoy a good dinner.

For me, the best and simplier to stick advices are:

– skip breakfast for intermittent fasting;
– eat ever at the same time like a swiss clock;
– eat fat at lunch and carbs at dinner.

POSTED AUGUST 18TH, 2018 AT 12:21 AM

Maggie

The timeframe doesn’t apply to people who work overnight/graveyard shifts.

POSTED AUGUST 16TH, 2018 AT 1:41 AM

Michael

Advice for us night workers wouldn’t go amiss.

POSTED AUGUST 8TH, 2018 AT 12:15 PM

Martin Jenkins

I am a 65-year-old male who started IF seven weeks ago. I only eat between noon and 8pm. I am
obese, but losing about a pound a week so far. Notably, except for time, I have not changed what I
eat at all. My diet was never terrible or great, and now it is the same, a mix of raw fruit sometimes
and a donut another time. But I only eat it during the appointed hours. Remarkably, I do not feel
hungry. I used to eat comfort breakfasts like pancakes or wa es, and I thought I would miss them.
But no, I truly am not hungry in the mornings. I often delay lunch, but I still stop eating at 8. That
alone probably has cut many calories of desserts. Bottom line: works for me so far.

POSTED AUGUST 6TH, 2018 AT 11:16 AM

Isaac Morales

60 year old and just started IF a week ago. I eat from noon to 8pm. The noon start works for me
because I’m not starting my day with the thought of food! I LOVE FOOD AND LOVE TO EAT! I am
moving away from some bad habits and it doesn’t seem that di cult for me with IF! Just one week
in and I do feel better. Can’t wait till I’ve got a month under my belt.

POSTED AUGUST 3RD, 2018 AT 6:53 AM

SKGarriott
I’m 63 years old and I have been following a daily 19 hour protocol called Fast 5, fast5.org for two
years. I eat lunch at 3pm and dinner at 7pm close my eating window at 8pm. I’ve lost 43 lbs and
kept it o , feel great and I am no longer pre diabetic. I eat what I want and don’t track anything. I
belong to a Facebook Intermittent fasting group called Fast Club and would to have you check it
out. Fasting is free and it works!

POSTED AUGUST 3RD, 2018 AT 1:19 PM

Monique Tello, MD, MPH

Wow, Impressive results, skgarriot! More and more evidence supports an overnight fast,
though sixteen hours works very well for most folks.

POSTED JULY 30TH, 2018 AT 5:14 AM

Michele
Basically, we have to skip dinner. A very old trick.
 POSTED AUGUST 3RD, 2018 AT 1:20 PM

Monique Tello, MD, MPH

Basically! Sixteen hours seems to work well for folks.

POSTED JULY 25TH, 2018 AT 7:52 AM

T.

I function well with iF. 71 year old male. 151 lbs 5 foot 9. But maintaing my weight is tough. The
large meal appears to crowd my stomach to the point of moderate to extreme discomfort. What is
the solution? Thanks.

POSTED JULY 23RD, 2018 AT 12:26 PM

Monique Tello, MD, MPH

Hi Matilde, Yes, you are encouraged to drink uids while fasting. Water, tea, co ee, seltzer, and
even broth are all ne. You can put a dollop of cream in your co ee if you like as well. Check out
Jason Fung’s book Obesity Code (and just FYI, there are no bene ts to me for recommending
others’ writing…)

POSTED JULY 23RD, 2018 AT 11:20 AM

Cameron J.
Yep. Also good article here too Prediabetes Symptoms – Lark
(https://www.web.lark.com/prediabetes-symptoms/) (“Having prediabetes puts you at risk for
developing type 2 diabetes. As you might expect, prediabetes is a condition with higher blood
sugar, or blood glucose, than normal, but lower levels than in diabetes. It happens as your body
develops insulin resistance and is less able to regulate blood sugar levels properly. Every year, 5 to
10% of people with prediabetes develop diabetes”)

POSTED JULY 23RD, 2018 AT 10:44 AM

Matilde

A dumb question possibly, but is drinking water, tea or co ee (no sugars or milk or..) during fasting
or in between meals ok?

POSTED JULY 20TH, 2018 AT 5:00 PM

Monique Tello, MD, MPH

Thanks for this! It’s even more popular recently.

POSTED JULY 20TH, 2018 AT 4:59 PM

Monique Tello, MD, MPH

Thanks Shane!

POSTED JULY 20TH, 2018 AT 4:59 PM

Monique Tello, MD, MPH

Hi April, that’s wonderful for you, thanks for reading and sharing!

POSTED JULY 20TH, 2018 AT 4:58 PM

Monique Tello, MD, MPH

This is a new area, but the research that has come out since this article is also positive, and
promising. One example: In this June 2018 study of 23 people with obesity, 12 weeks of 8-hour
time-restricted feeding resulted a 2.6% decrease in body weight and a 7 point decrease in systolic
blood pressure, which was signi cant when compared to controls:
https://www.ncbi.nlm.nih.gov/pubmed/29951594

POSTED JULY 20TH, 2018 AT 4:51 PM

Monique Tello, MD, MPH

Thank you Dr. De Foa, for the metabolic details! We generally would not go into this kind of
speci c physiologic explanation, rather, we go big-picture, for clarity.

POSTED JULY 20TH, 2018 AT 4:50 PM

Monique Tello, MD, MPH

Thanks Tom and Wendy and Jim, Yes, this particular study emphasized earlier time-restricted
feeding, but I agree that for many people a 12 pm- 8 pm feeding window is more realistic, and if it’s
working, then why not?

POSTED JULY 20TH, 2018 AT 4:47 PM

Monique Tello, MD, MPH

Thanks, Zeeb, for sharing!

POSTED JULY 20TH, 2018 AT 4:47 PM

Monique Tello, MD, MPH

Hi Thea, That’s wonderful that IF has worked for you. Diets, and particularly fasting, can be very
triggering for others with a history of an eating disorder. People who have been in remission can
relapse. For more about what concerns and problems others have had, there is alot of information
out there, and for starters I recommend this thorough article from Psychology Today:
https://www.psychologytoday.com/us/blog/hunger-artist/201411/the-fast-diet-fast-route-
disordered-eating

POSTED JULY 11TH, 2018 AT 1:11 PM

Zeeb Ralston
great stu , I agree wholeheartedly, posted it on my facebook site and emailed it to most of my
mailing list. I am also a personal patient of Dr. Fung and can heartily vouch for his quali cations, his
focus and his abilities. Win Win Win! and yes, eating disorders I believe are easily conquered with
fasting, both Intermittent and extended.

POSTED JULY 10TH, 2018 AT 9:50 AM

Richard Barnard

Jason Fung has a new book out: The Diabetes Code.

Dick

POSTED JULY 9TH, 2018 AT 9:09 PM

Thea
The disclaimer cautioning that people with a Hx of eating disorder shouldn’t attempt IF without
medical supervision is ubiquitous in articles like this one. However I have never seen anyone cite
any evidence as the foundation for this recommendation, nor even provide clinical anecdotes or a
thorough clinical rationale.

I believe this is a disservice to those, like me, with a history of eating disorder. It has made
experimenting with IF unnecessarily stressful. Despite my worry about what might happen
(reading all these baseless cautions), I went ahead and experimented. In my experience, contrary
to this “expert advice”, IF has been the most profoundly e ective intervention I’ve experienced for
my bulemia.

It has totally regulated my appetite and normalised my relationship with food. My obsessive
thoughts have completely subsided, my black and white thinking around food has gone, and I no
longer binge! This is amazing. For the rst time in my adult life I feel like I know what it is like to
have a normal relatinoship with food. I eat when I eat, a range of healthy whole foods and
occasional less healthy foods. In normal amounts. In manageable amounts. And when my meal is
over, I stop! Normal for others, a seeming impossibility for me (and, I’m guessing, others with
eating disorders).

I have struggled iwth the hell of an eating disorder for over 25 years, and I think it is negligent to
say that eating disorder is a contraindication for IF when there is NO EVIDENCE that this is the case,
and in fact I think IF has amazing potential as a therapy.

At least modify the disclaimer to state something like “people with a Hx of ED should approach IF
with caution, as there is no research as yet to show any potential adverse impact of IF. Seek clinical
supervision if in doubt.”

POSTED JULY 9TH, 2018 AT 1:32 PM

Herman Hamot
I’m reading this on iPhone 6C. I get nothing when clicking REPLY. How to resolve this?

POSTED JULY 5TH, 2018 AT 1:22 PM

Tom

Jerimiah, the linked study in the article

(https://www.sciencedirect.com/science/article/pii/S1550413118302535) speci cally studied
“eTRF”(Early Time-Restricted Feeding) from 8am – 2pm, and implies that eating earlier is better
than later. I haven’t read the study (it’s behind a damn Elsevier pay-wall), so I don’t know how
strongly they feel about early vs late, though. For me, personally, 12-8 is doable, and skipping
dinner (given the existence of a family and the desire to have dinner with said family) isn’t doable,
so I’m pleased to hear from you and April above that it’s working. Just starting!
POSTED JULY 5TH, 2018 AT 6:24 AM

Wendy

Hi Jerimiah

As a starting point you might like to start looking at the work of Professor Satchin Panda at the Salk
Intitute.

Personally, I have tried both and found the later eating window (12:00 – 18:00) easier to maintain
with good bene ts.

https://panda.salk.edu/
https://www.salk.edu/scientist/satchidananda-panda/
https://www.twitter.com/SatchinPanda/

POSTED JULY 4TH, 2018 AT 10:25 PM

J Lance De Foa, MD

You wrote, “But sugar can ONLY ENTER our cells WITH INSULIN, a hormone made in the pancreas.
INSULIN BRINGS SUGAR IN the fat cells and keeps it there.”

Are you unaware of insulin-INdependent GLUT1 channels present on MOST cells which let glucose
freely enter, driven by high concentration outside the cells to the lower concentration inside?

Also, hypo/aninsulinemic patients who NEED injected INSULIN to survive don’t su er from lack of
glucose entering cells. The main role of insulin for them is to shut o the ood of glucose and
ketones from the liver.

Insulin doesn’t “BRING” glucose in, it merely opens the insulin DEPENDENT GLUT4 channels on
muscle and fat cells to make it easier for glucose to ow from the higher serum to lower
intracellular concentration. Just like opening all the doors on a stadium let the fans ow in.

In so far as insulin promotes de novo lipogenesis and suppresses lipolysis in adipocytes it DOES
help keep the fat inside. But in Hyperinsulinemia / Insulin Resistance with Impaired Glucose
Tolerance lipolysis may not be su ciently reduced and fatty acids and glycerin can be spilled at
the same time that Triglycerides are being formed & stored. In the liver the glycerin gets converted
to glucose producing hyperglycemia.

The system is dysregulated. There is no lack of insulin. There is just too much work for it to do, and
the system resists it also.

POSTED JULY 4TH, 2018 AT 1:41 PM

Håkon Dahle
I skip breakfast and have no issues with that. I also heard that eating in the evening could be an
advantage, because the body is at rest and all energy can be used for digestion. That is similar to
animals that rest and sleep after hunting and eating.

POSTED JULY 4TH, 2018 AT 1:30 PM

Jim
Jeremiah. Insulin is higher towards the evening, add to that your more sedentary when winding
down.

POSTED JULY 4TH, 2018 AT 11:56 AM

Emma Glaisher
I’ve been doing Moseley style 5:2 IF for 5 or 6 years now. I was attracted to it primarly because of
the suggested health bene ts, aside from the weight loss. My weight has pretty much maintained,
but my main hope is to avoid heart disease and cancer for as long as possible – 58 and still here!
Are the health bene ts still borne out by the research does anyone know?

POSTED JULY 4TH, 2018 AT 6:52 AM

April
I started IT about 6 weeks ago. I eat between 12 noon and 8 pm. This works best for me and I have
found easily sustainable. The results so far have blown my mind. I have an autoimmune disease
and struggled with bloating, multiple food intolerance, gut pain, frequent urination, sugar
cravings. All of these symptoms are gone. My hunger is controlled and I can enjoy lovely family
dinners again. I think ideally eating earlier in the day would be better, but due to my schedule this
works better for me and I am happy with the results.

POSTED JULY 4TH, 2018 AT 3:17 AM

Steve
IF was popular years before 2012 by Martin Berkhan and his Leangains diet.

POSTED JULY 3RD, 2018 AT 2:38 PM

Keith

Jeremiah, I don’t think the author is suggesting that TRF in the later hours of the day is bad, but
rather that it is DIFFICULT. The key nding in this study is that the 07:00-15:00 eaters had a reduced
appetite (in other words, didn’t nd it very hard to follow this regimen), whereas other approaches
have been found to be kind of di cult for some.
 It de nitely makes sense for you to stick with a system that is working well for you, although if you
are nding it hard maybe it would be worth it to experiment with shifting your eating window to
earlier in the day just to see how that goes.

POSTED JULY 3RD, 2018 AT 12:32 PM

Lucy
Hi, I’ve heard about intermittent fasting and was thinking about trying it. I’ve also been looking at
this red tea diet recently and was wondering what you thought about it.

POSTED JULY 2ND, 2018 AT 12:43 PM

Jerimiah
I would like to know what led you to the conclusion to recommend eating in the morning and
fasting in the evening instead of the other way around. You do not link any studies here that show
TRF in the morning is better than TRF in the evening. You do state “Nighttime eating is well
associated with a higher risk of obesity, as well as diabetes.” but I would hazard a guess that alot
people that snack into the evening have many other factors at play that could e ect their risk of
obesity and diabetes and are possibly not fasting at all. I have been doing TRF from 12-8pm every
day for almost a year and have seen vast improvements in my health, not least of which is a loss of
70 lbs, so it seems odd to read items 3 and 4 on your 4 ways to use this information for better
health. If you have evidence that supports the idea that TRF in the evening is bad then I would like
to see it and perhaps change my dieting habbits.

POSTED JULY 2ND, 2018 AT 11:40 AM

Shane
Nice simple advice here, easy to understand and consistent with most general dietary advice.
Thanks for this article.

Commenting has been closed for this post.

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