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=== Weight loss and health biomarkers === === Weight loss and health biomarkers ===
There is some limited evidence that intermittent fasting produces ] comparable to a ].<ref name="Cioffi2018" /><ref name="Sainsbury2018" /><ref name=harris /><ref>{{cite journal |last1=Davis |first1=C S |last2=Clarke |first2=R E |last3=Coulter |first3=S N |last4=Rounsefell |first4=K N |last5=Walker |first5=R E |last6=Rauch |first6=C E |last7=Huggins |first7=C E |last8=Ryan |first8=L |title=Intermittent energy restriction and weight loss: a systematic review |journal=European Journal of Clinical Nutrition |date=25 November 2015 |volume=70 |issue=3 |pages=292–299 |doi=10.1038/ejcn.2015.195 |pmid=26603882}}</ref><ref name="Freire2019" /><ref name="Thom2017">{{cite journal |last1=Thom |first1=G |last2=Lean |first2=M |title=Is There an Optimal Diet for Weight Management and Metabolic Health? |journal=Gastroenterology |date=May 2017 |volume=152 |issue=7 |pages=1739–1751 |doi=10.1053/j.gastro.2017.01.056 |pmid=28214525 |type=Review|url=http://eprints.gla.ac.uk/137779/7/137779.pdf }}</ref> Alternate day fasting does not affect ],<ref name="Tinsley2015" /><ref name="VLCD">{{cite journal |last1=Alhamdan |first1=BA |last2=Garcia-Alvarez |first2=A |last3=Alzahrnai |first3=AH |last4=Karanxha |first4=J |last5=Stretchberry |first5=DR |last6=Contrera |first6=KJ |last7=Utria |first7=AF |last8=Cheskin |first8=LJ |title=Alternate-day versus daily energy restriction diets: which is more effective for weight loss? A systematic review and meta-analysis. |journal=Obesity Science and Practice |date=September 2016 |volume=2 |issue=3 |pages=293–302 |doi=10.1002/osp4.52 |pmid=27708846|pmc=5043510 }}</ref> although one review found a small decrease.<ref>{{cite journal |last1=Roman |first1=YM |last2=Dominguez |first2=MC |last3=Easow |first3=TM |last4=Pasupuleti |first4=V |last5=White |first5=CM |last6=Hernandez |first6=AV |title=Effects of intermittent versus continuous dieting on weight and body composition in obese and overweight people: a systematic review and meta-analysis of randomized controlled trials. |journal=International Journal of Obesity |date=October 2019 |volume=43 |issue=10 |pages=2017–2027 |doi=10.1038/s41366-018-0204-0 |pmid=30206335|hdl=10757/624649 }}</ref> Intermittent fasting does not affect ].<ref name="Veronese2019">{{cite journal |last1=Veronese |first1=N |last2=Reginster |first2=JY |title=The effects of calorie restriction, intermittent fasting and vegetarian diets on bone health. |journal=Aging Clinical and Experimental Research |date=June 2019 |volume=31 |issue=6 |pages=753–758 |doi=10.1007/s40520-019-01174-x |pmid=30903600 }}</ref> Alternate day fasting improves ] and ] ] similarly to a ] for overweight or obese individuals.<ref name="Cioffi2018" /><ref name="harris"/><ref name="Anton2018" /><ref name="mattson17" /> IF is also investigated for ] and ] management.<ref name="Papamichou2019">{{cite journal |last1=Papamichou |first1=D |last2=Panagiotakos |first2=DB |last3=Itsiopoulos |first3=C |title=Dietary patterns and management of type 2 diabetes: A systematic review of randomised clinical trials. |journal=Nutrition, metabolism, and cardiovascular diseases : NMCD |date=June 2019 |volume=29 |issue=6 |pages=531-543 |doi=10.1016/j.numecd.2019.02.004 |pmid=30952576 |type=Systematic review}}</ref><ref name="Zubrzycki2018">{{cite journal |last1=Zubrzycki |first1=A |last2=Cierpka-Kmiec |first2=K |last3=Kmiec |first3=Z |last4=Wronska |first4=A |title=The role of low-calorie diets and intermittent fasting in the treatment of obesity and type-2 diabetes. |journal=Journal of physiology and pharmacology : an official journal of the Polish Physiological Society |date=October 2018 |volume=69 |issue=5 |doi=10.26402/jpp.2018.5.02 |pmid=30683819 |type=Review |quote=These beneficial effects arise not only from the loss of body mass, but also from the activation of metabolic pathways specific to fasting conditions. IF interventions induce a metabolic shift that has the potential to positively alter body composition. This switch represents a shift from preferential lipid synthesis and fat storage to the mobilization of fat. It typically occurs in the third phase of fasting (i.e., 12 – 36 hours after the last meal) when glycogen in the hepatocytes (though not in muscles) becomes depleted. Around that time, accelerated lipolysis in adipose tissue produces increased plasma levels of FFAs, which contribute to the increased synthesis of fatty acid-derived ketones in the liver, kidney, astrocytes, and enterocytes. IF regimens are a potential method of treatment for obesity and related metabolic conditions, including T2D and metabolic syndrome.}}</ref> Breakfast skipping is associated with increased risks of type 2 diabetes.<ref>{{cite journal |last1=Ballon |first1=A |last2=Neuenschwander |first2=M |last3=Schlesinger |first3=S |title=Breakfast Skipping Is Associated with Increased Risk of Type 2 Diabetes among Adults: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. |journal=The Journal of nutrition |date=1 January 2019 |volume=149 |issue=1 |pages=106-113 |doi=10.1093/jn/nxy194 |pmid=30418612 |type=Systematic review}}</ref> There is some limited evidence that intermittent fasting produces ] comparable to a ].<ref name="Cioffi2018" /><ref name="Sainsbury2018" /><ref name=harris /><ref>{{cite journal |last1=Davis |first1=C S |last2=Clarke |first2=R E |last3=Coulter |first3=S N |last4=Rounsefell |first4=K N |last5=Walker |first5=R E |last6=Rauch |first6=C E |last7=Huggins |first7=C E |last8=Ryan |first8=L |title=Intermittent energy restriction and weight loss: a systematic review |journal=European Journal of Clinical Nutrition |date=25 November 2015 |volume=70 |issue=3 |pages=292–299 |doi=10.1038/ejcn.2015.195 |pmid=26603882}}</ref><ref name="Freire2019" /><ref name="Thom2017">{{cite journal |last1=Thom |first1=G |last2=Lean |first2=M |title=Is There an Optimal Diet for Weight Management and Metabolic Health? |journal=Gastroenterology |date=May 2017 |volume=152 |issue=7 |pages=1739–1751 |doi=10.1053/j.gastro.2017.01.056 |pmid=28214525 |type=Review|url=http://eprints.gla.ac.uk/137779/7/137779.pdf }}</ref> Alternate day fasting does not affect ],<ref name="Tinsley2015" /><ref name="VLCD">{{cite journal |last1=Alhamdan |first1=BA |last2=Garcia-Alvarez |first2=A |last3=Alzahrnai |first3=AH |last4=Karanxha |first4=J |last5=Stretchberry |first5=DR |last6=Contrera |first6=KJ |last7=Utria |first7=AF |last8=Cheskin |first8=LJ |title=Alternate-day versus daily energy restriction diets: which is more effective for weight loss? A systematic review and meta-analysis. |journal=Obesity Science and Practice |date=September 2016 |volume=2 |issue=3 |pages=293–302 |doi=10.1002/osp4.52 |pmid=27708846|pmc=5043510 }}</ref> although one review found a small decrease.<ref>{{cite journal |last1=Roman |first1=YM |last2=Dominguez |first2=MC |last3=Easow |first3=TM |last4=Pasupuleti |first4=V |last5=White |first5=CM |last6=Hernandez |first6=AV |title=Effects of intermittent versus continuous dieting on weight and body composition in obese and overweight people: a systematic review and meta-analysis of randomized controlled trials. |journal=International Journal of Obesity |date=October 2019 |volume=43 |issue=10 |pages=2017–2027 |doi=10.1038/s41366-018-0204-0 |pmid=30206335|hdl=10757/624649 }}</ref> Intermittent fasting does not affect ].<ref name="Veronese2019">{{cite journal |last1=Veronese |first1=N |last2=Reginster |first2=JY |title=The effects of calorie restriction, intermittent fasting and vegetarian diets on bone health. |journal=Aging Clinical and Experimental Research |date=June 2019 |volume=31 |issue=6 |pages=753–758 |doi=10.1007/s40520-019-01174-x |pmid=30903600 }}</ref> Alternate day fasting improves ] and ] ] similarly to a ] for people who are overweight, obese or have ].<ref name="Cioffi2018" /><ref name="harris"/><ref name="Anton2018" /><ref name="mattson17" /><ref name="Papamichou2019">{{cite journal |last1=Papamichou |first1=D |last2=Panagiotakos |first2=DB |last3=Itsiopoulos |first3=C |title=Dietary patterns and management of type 2 diabetes: A systematic review of randomised clinical trials. |journal=Nutrition, Metabolism, and Cardiovascular Diseases |date=June 2019 |volume=29 |issue=6 |pages=531-543 |doi=10.1016/j.numecd.2019.02.004 |pmid=30952576 |type=Systematic review}}</ref>


The reviewed ] were conducted mostly on overweight or obese middle-aged women from the US and the UK, with or without diabetes, limiting interpretation of the results. Intermittent fasting has not yet been studied in children, the elderly, or underweight people, and could be harmful in these populations.<ref name="Cioffi2018" /><ref name="harris"/><ref name="NIA2018" /><ref name="harris2">{{cite journal |doi=10.1016/j.cmet.2013.12.008 |pmid=24440038 |pmc=3946160 |title=Fasting: Molecular Mechanisms and Clinical Applications |journal=Cell Metabolism |volume=19 |issue=2 |pages=181–92 |year=2014 |last1=Longo |first1=Valter D |last2=Mattson |first2=Mark P }}</ref> Intermittent fasting, although under active research, is not recommended for non-overweight individuals.<ref name="NIA2018" /> The long-term sustainability of the intermittent fasting effects is unknown, as of 2018.<ref name="NIA2018" /><ref>{{cite journal |last1=Harris |first1=L |last2=McGarty |first2=A |last3=Hutchison |first3=L |last4=Ells |first4=L |last5=Hankey |first5=C |title=Short-term intermittent energy restriction interventions for weight management: a systematic review and meta-analysis. |journal=Obesity Reviews |date=January 2018 |volume=19 |issue=1 |pages=1–13 |doi=10.1111/obr.12593 |pmid=28975722}}</ref><ref>{{cite journal |last1=Headland |first1=M |last2=Clifton |first2=PM |last3=Carter |first3=S |last4=Keogh |first4=JB |title=Weight-Loss Outcomes: A Systematic Review and Meta-Analysis of Intermittent Energy Restriction Trials Lasting a Minimum of 6 Months. |journal=Nutrients |date=8 June 2016 |volume=8 |issue=6 |pages=354 |doi=10.3390/nu8060354 |pmid=27338458|pmc=4924195 }}</ref> Intermittent fasting has not yet been studied in children, the elderly, or underweight people, and could be harmful in these populations.<ref name="Cioffi2018" /><ref name="harris"/><ref name="NIA2018" /><ref name="harris2">{{cite journal |doi=10.1016/j.cmet.2013.12.008 |pmid=24440038 |pmc=3946160 |title=Fasting: Molecular Mechanisms and Clinical Applications |journal=Cell Metabolism |volume=19 |issue=2 |pages=181–92 |year=2014 |last1=Longo |first1=Valter D |last2=Mattson |first2=Mark P }}</ref> Intermittent fasting is not recommended for people who are not overweight.<ref name="NIA2018" /> The long-term sustainability of intermittent fasting is unknown, as of 2018.<ref name="NIA2018" /><ref>{{cite journal |last1=Harris |first1=L |last2=McGarty |first2=A |last3=Hutchison |first3=L |last4=Ells |first4=L |last5=Hankey |first5=C |title=Short-term intermittent energy restriction interventions for weight management: a systematic review and meta-analysis. |journal=Obesity Reviews |date=January 2018 |volume=19 |issue=1 |pages=1–13 |doi=10.1111/obr.12593 |pmid=28975722}}</ref><ref>{{cite journal |last1=Headland |first1=M |last2=Clifton |first2=PM |last3=Carter |first3=S |last4=Keogh |first4=JB |title=Weight-Loss Outcomes: A Systematic Review and Meta-Analysis of Intermittent Energy Restriction Trials Lasting a Minimum of 6 Months. |journal=Nutrients |date=8 June 2016 |volume=8 |issue=6 |pages=354 |doi=10.3390/nu8060354 |pmid=27338458|pmc=4924195 }}</ref>


=== Other effects === === Other effects ===

Revision as of 17:00, 28 October 2019

Umbrella term for various meals timing schedules cycling between voluntary fasting and non-fasting over a given period This article is about intentional fasting. For involuntary fasting, see eating disorder. For fasting before a clinical or surgical intervention, see preoperative fasting.
Intermittent fasting is a strategy for meals timing scheduling.

Intermittent fasting, also known as intermittent energy restriction, is an umbrella term for various meal timing schedules that cycle between voluntary fasting (or reduced calories intake) and non-fasting over a given period. Non-caloric, and sometimes low-caloric, drinks can be used during intermittent fasting, contrary to strict fasting which disallows fluid intake in some religious practices.

Three methods of intermittent fasting are alternate-day fasting, periodic fasting, and time-restricted feeding. Intermittent fasting may be similar to a calorie restriction diet. Although being studied in the 21st century as a practice to possibly reduce the risk of diet-related diseases, intermittent fasting is also regarded as a fad.

The science concerning intermittent fasting is preliminary and inconclusive. The American Heart Association (AHA) states that intermittent fasting may produce weight loss, reduce insulin resistance, and lower the risk of cardiometabolic diseases, although its long-term sustainability is unknown. The US National Institute on Aging (NIA) recommends against intermittent fasting because of uncertainties about its effectiveness and safety, particularly for the elderly.

Diverse forms of intermittent fasting exist in various religious practices, including Vrata in Hinduism, Ramadan fasting (Islam), Yom Kippur fasting and other jewish fasts (Judaism), Orthodox Christian fasting, Fast Sunday (LDS Church), and Buddhist fasting.

Types

An alternate day fasting schedule, that alternates between usual eating (feast days) and fast days with reduced or no calories

Three methods of intermittent fasting are alternate-day fasting, periodic fasting, and time-restricted feeding:

  • Alternate-day fasting involves alternating between a 24-hours "fast day" when the person eats less than 25% of usual energy needs, followed by a 24-hour non-fasting "feast day" period. It is the strictest form of intermittent fasting because there are more days of fasting per week. There are two subtypes:
    • Complete alternate-day fasting (or total intermittent energy restriction), where no calories are consumed on fast days.
    • modified alternate-day fasting (or partial intermittent energy restriction) which allows the consumption of up to 25% of daily calorie needs on fasting days instead of complete fasting.
  • Periodic fasting or whole-day fasting involves any period of consecutive fasting of more than 24h, such as the 5:2 diet where there are 1 or 2 fast days per week, to the more extreme version with several days or weeks of fasting. During the fasting days, it may be allowed approximately 500 to 600 calories or about 25% of regular daily caloric intake instead of complete fasting.
  • Time-restricted feeding involves eating only during a certain number of hours each day. Skipping a meal and the 16:8 diet (16 fasting hours cycled by 8 non-fasting hours) are examples. This schedule is thought to be leveraging the circadian rhythm.

Applications

The science concerning intermittent fasting is preliminary and uncertain due to an absence of studies on its long term effects. There is preliminary evidence that intermittent fasting may be effective for weight loss, may decrease insulin resistance and fasting insulin, and may improve cardiovascular and metabolic health, although the long term sustainability of these effects has not been studied.

The AHA recommends intermittent fasting as an option for weight loss and calorie control as part of an "intentional approach to eating that focuses on the timing and frequency of meals and snacks as the basis of a healthier lifestyle and improved risk factor management". For overweight people, fasting may be integrated into a wider dietary change, such as "placing snacks strategically before meals that might be associated with overeating", planning meals and snacks throughout the day to help manage hunger and control meal portions, and "promote consistent overnight fast periods". The AHA noted that eating some food on a fast day (instead of a complete fast) produced the greatest weight loss and decreases in insulin resistance, when at least 4% weight loss was achieved by obese individuals.

Although intermittent fasting showed weight loss success in several studies on obese or overweight individuals, the NIA does not recommend intermittent fasting for non-overweight individuals because of uncertainties about its effectiveness and safety, especially for older adults.

Usage trends

As of 2019, intermittent fasting is a common fad diet, attracting celebrity endorsements and public interest.

UK

Intermittent fasting (specifically the 5:2 diet) became popular in the UK in 2012 after the BBC2 television Horizon documentary Eat, Fast and Live Longer. Via sales of best-selling books, it became widely practiced.

North America

In the United States, intermittent fasting became a fad among Silicon Valley companies. It was the most popular diet in 2018 according to a survey by the International Food Information Council. According to NHS Choices, people considering the 5:2 diet should first consult a physician, as fasting can sometimes be unsafe. A news item in the Canadian Medical Association Journal expressed concern that promotional material for the diet showed people eating high-calorie food, such as hamburgers and chips, and that this could encourage binge eating since the implication was that "if you fast two days a week, you can devour as much junk as your gullet can swallow during the remaining five days".

Commercialization

As of 2019, interest in intermittent fasting led some companies to commercialize diet coaching, dietary supplements, and full meal packages. These companies have been criticized for offering products or services that are expensive and not backed by science.

Research

Weight loss and health biomarkers

There is some limited evidence that intermittent fasting produces weight loss comparable to a calorie restricted diet. Alternate day fasting does not affect lean body mass, although one review found a small decrease. Intermittent fasting does not affect bone health. Alternate day fasting improves cardiovascular and metabolic biomarkers similarly to a calorie restriction diet for people who are overweight, obese or have metabolic syndrome.

Intermittent fasting has not yet been studied in children, the elderly, or underweight people, and could be harmful in these populations. Intermittent fasting is not recommended for people who are not overweight. The long-term sustainability of intermittent fasting is unknown, as of 2018.

Other effects

Night-time eating has been linked to impaired sleep quality. There is no evidence that fasting has any beneficial effect (prevention, treatment, drugs interaction) for cancer, and is thus not recommended in France, United Kingdom, and United States, although a few small-scale clinical studies suggest IF may reduce chemotherapy side-effects. Periodic fasting may have minor effect on chronic pain and mood disorders.

Athletic performance does not benefit from intermittent fasting. Overnight fasting before exercise increases lipolysis, but reduces performance in prolonged exercise (more than 60 min).

Adverse effects

Reviews of preliminary clinical studies found that short-term intermittent fasting may produce minor adverse effects, such as continuous feelings of weakness and hunger, headaches, fainting, or dehydration. However, the data remain sparse, as most studies did not analyze adverse effects specifically. A 2018 systematic review found no major adverse effect. Long-term, extreme periodic fasting may cause eating disorders or malnutrition, with increased susceptibility to infectious diseases. Intermittent fasting is not recommended for pregnant or breastfeeding women, or for children and adolescents during maturation.

Tolerance

Tolerance of a diet is a determinant of its potential effectiveness and maintenance of benefits obtained, such as weight loss or biomarker improvement. A 2019 review found that drop-out rates varied widely from 2% to 38% for intermittent fasting, and from 0% to 50% for a calorie restriction diet.

Mechanism

A 2019 review of weight-change interventions, including alternate day fasting, time-restricted feeding, exercise and overeating, found that body weight homeostasis could not precisely correct for "energetic errors" – the loss or gain of calories – in the short-term.

History

Fasting is an ancient tradition, having been practiced by many cultures and religions over centuries. A modern type of intermittent fasting, the 5:2 diet, began in the United Kingdom in 2012.

Religious fasting

Various forms of intermittent fasting exist in religious practices across the world. Religious fasting regimens include Vrata in Hinduism, Islamic fasting (Ramadan) (Islam), Yom Kippur fasting and other jewish fasts (Judaism), Orthodox Christian fasting, Fast Sunday (The Church of Jesus Christ of Latter-day Saints), and Buddhist fasting. Certain religious fasting practices only require abstinence from certain foods, while others, like the Jewish fast on Yom Kippur, last for a short period of time and would cause negligible effects on body weight.

In Buddhism, fasting is undertaken as part of the monastic training of Theravada Buddhist monks, who fast daily from noon to sunrise of the next day. This daily fasting pattern may be undertaken by laypeople following the eight precepts.

During Ramadan, Islamic practices are similar to intermittent fasting by not eating or drinking from sunrise until sunset, while permitting food intake in the morning before dawn and in the evening after dusk. A meta-analysis on 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 of Ramadan ending. The analysis concluded that "Ramadan provides an opportunity to lose weight, but structured and consistent lifestyle modifications are necessary to achieve lasting weight loss." One review found similarities between Ramadan and time-restricted feeding, with the main dissimilarity being the disallowance of water drinking with Islamic fasting. Negative effects of Ramadan fasting include increased risk of hypoglycemia in diabetics, as well as inadequate levels of certain nutrients.

Ramadan fasting disallowing fluids during the fasting period is hazardous for pregnant women, as it is associated with risks of inducing labour and causing gestational diabetes, although it does not appear to affect the child's weight.

See also

References

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