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CME / ABIM MOC / CE

Is Intermittent Fasting Beneficial?

  • Authors: News Author: Miriam E. Tucker; CME Author: Charles P. Vega, MD
  • CME / ABIM MOC / CE Released: 1/28/2022
  • THIS ACTIVITY HAS EXPIRED
  • Valid for credit through: 1/28/2023
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Target Audience and Goal Statement

This activity is intended for primary care physicians, endocrinologists, nurses and other members of the healthcare team who care patients considering intermittent fasting.

The goal of this activity is to assess the efficacy of intermittent fasting on weight loss and metabolism.

Upon completion of this activity, participants will:

  • Assess how intermittent fasting may improve metabolic outcomes
  • Evaluate the efficacy of intermittent fasting on anthropometric and metabolic outcomes
  • Outline implications for the healthcare team


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News Author

  • Miriam E. Tucker

    Freelance writer, Medscape

    Disclosures

    Disclosure: Miriam E. Tucker has disclosed no relevant financial relationships.

CME Author

  • Charles P. Vega, MD

    Health Sciences Clinical Professor of Family Medicine
    University of California
    Irvine School of Medicine
    Irvine, California

    Disclosures

    Disclosure: Charles P. Vega, MD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: GlaxoSmithKline; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.

Editor/CME Reviewer

  • Amanda Jett, PharmD, BCACP

    Associate Director, Accreditation and Compliance
    Medscape, LLC

    Disclosures

    Disclosure: Amanda Jett, PharmD, BCACP, has disclosed no relevant financial relationships.

Nurse Planner

  • Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP

    Associate Director, Accreditation and Compliance
    Medscape, LLC

    Disclosures

    Disclosure: Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP, has disclosed no relevant financial relationships.


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CME / ABIM MOC / CE

Is Intermittent Fasting Beneficial?

Authors: News Author: Miriam E. Tucker; CME Author: Charles P. Vega, MDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED

CME / ABIM MOC / CE Released: 1/28/2022

Valid for credit through: 1/28/2023

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Clinical Context

Intermittent fasting has become a popular method for weight loss and improving metabolic outcomes, and the authors of the current study describe some of the metabolic effects of intermittent fasting that might promote these outcomes. Intermittent fasting depends on a concept labeled as “metabolic switch,” which involves a change from dependence on glucose derived from the liver during typical dieting to ketones derived from adipose cells during fasting.

The metabolic switch can improve glucose regulation and reduce inflammation. The stress state of fasting also increases autophagy, which removes damaged molecules to prevent against further metabolic stress and can also reduce oxidative stress. Given these physiologic changes, intermittent fasting may yield substantial long-term health benefits; however, there are no long-term modern randomized trials of intermittent fasting over the long term. Even short-term studies of intermittent fasting have been heterogenous in their methodology and outcomes. The current review of meta-analyses by Patikorn and colleagues was performed to draw more definitive conclusions regarding the benefits of intermittent fasting.

Study Synopsis and Perspective

Intermittent fasting can lead to weight loss and other health benefits, at least in the short term, new research suggests.

Combined results from a total of 130 clinical trials show that intermittent fasting could help reduce weight, body mass index (BMI), body fat, "bad" cholesterol, fasting blood sugar, and blood pressure (BP), among other risk factors associated with obesity.

Two specific types of intermittent fasting were associated with significant weight loss and other health benefits. One, called modified alternate-day fasting (MADF), involves alternating one day of eating as usual with consuming no more than 600 calories the next day.

The other, called the "5:2 diet" is similar but involves 2 days per week of zero calories or very low-calorie eating and 5 days of normal eating.

Less beneficial were time-restricted eating, involving fasting 12 to 24 hours per day, and "zero calorie alternate-day fasting," where no food is consumed every other day.

"Our results support the role of intermittent fasting, especially [MADF], in adults with overweight or obesity as a weight loss approach with other health benefits. But individuals have to consult their doctors first," lead author of the research, Chanthawat Patikorn, of Chulalongkorn University in Thailand said.

There is a major snag; however: Most of the studies lasted only about 3 months.

Among those lasting longer, the weight loss seemed to level off by about 6 months, either because the body adapted to the eating pattern or because the participants could not stick to the diets.

"We are still lacking data to see if these could work in the long-term. We see weight loss and improved metabolic profiles but we still don't know if intermittent fasting can lead to reduced death or cardiovascular events," Patikorn said.

On the other hand, "I would say that if the patient is interested in doing intermittent fasting, there is no evidence that it's a bad thing."

He did caution, however, that patterns where you consume nothing for long periods of time could pose a danger for people with diabetes who use insulin or are otherwise prone to low blood sugar (hypoglycemia).

Only two diets, modified alternate-day fasting and 5:2, were associated with weight loss of 5% or more of total body weight in adults with overweight or obesity.

With the 5:2 diet, the weight loss held up at 6 to 12 months. Modified alternate-day fasting was also associated with improvements at 2 to 12 months in heart disease risk factors such as total cholesterol, "bad" cholesterol, triglycerides, and BP.

The findings were published in the December 1 issue of JAMA Network Open.[1]

Another Trial Shows Modest Effect, Similar Endurance Problem

In a separate 1-year randomized trial published Nov. 17, 2021,[2] in PLOS One, researchers randomly assigned 300 adults with obesity to either a 5:2 diet with self-help instructions, the same diet plus 6 weekly group support sessions, or just standard advice about diet and physical activity.

The 5:2 self-help group stuck with it initially, but only a third were still following the diet by 6 months and only about a fifth by 1 year. Weight loss at 6 months and 1 year were similar between the 5:2 self-help and standard advice groups (about 4 pounds).

The 5:2 diet with group support was associated with more weight loss than 5:2 self-help at 6 weeks, but there was no difference at 1 year.

Looking at it more positively, 18% of the 5:2 self-help group had lost more than 5% of their body weight by 1 year, and participants gave the 5:2 plan favorable ratings.

The investigators of that study, Queen Mary University of London clinical psychology professor Peter Hajek and colleagues, concluded that "a suggestion to try 5:2 could be provided in a quick consultation and be useful especially for patients who had not benefitted from the standard advice."

Patikorn pointed out that thus far no studies have compared the different types of intermittent diets head-to-head, so "the best type of intermittent fasting is the one people can really stick to for the long term."

Study Highlights

  • Researchers evaluated health databases for meta-analyses of randomized controlled trials of intermittent fasting that were published before January 12, 2021.
  • Researchers included studies of the following forms of intermittent fasting:
    • Zero-calorie ADF, in which patients alternate between days of zero calories and ad libitum eating
    • MADF, in which patients alternate between days of zero to 40% of usual calories and ad libitum eating
    • The 5:2 diet, in which patients fast 2 days of the week and otherwise ate ad libitum
    • TRE, in which patients fast for 12 to 24 hours per day
  • The main study outcomes included weight management and other metabolic outcomes.
  • The current study involved 11 meta-analyses, including 130 randomized trials. The average number of trial participants across studies was 38, and the mean follow-up period was 3 months.
  • No meta-analysis was graded as high confidence in terms of quality; 64% were of moderate quality, and 36% were low-quality.
  • Half of the trials focused on MADF whereas 27% and 22% featured the 5:2 diet and TRE, respectively.
  • 40% of trials included data on body weight, and 33% and 14% addressed lipid and glycemic outcomes, respectively.
  • Only 3% of studies assessed patients with healthy weight.
  • 28 of 104 effects of intermittent fasting were statistically significant; 72% of these associations were based on very low-quality evidence.
  • Good evidence supports MADF in reducing BMI compared with usual diet.
  • Zero-calorie ADF and the 5:2 diet were associated with a reduction in fat-free mass compared with common dieting methods.
  • The 5:2 diet was associated with a lower mean fasting insulin level compared with a continuous energy restriction diet through 3 to 6 months.
  • 3 months of the 5:2 diet was associated with a mean 1.67-kg decrease in body weight among adults with overweight or obesity.
  • MADF was associated with reduced total cholesterol, low-density lipoprotein cholesterol (LDL-C), triglycerides, and blood pressure after 2 to 12 months of application.

Clinical Implications

  • The potential metabolic benefits of intermittent fasting depend on a switch from glucose derived from the liver during normal diet to ketones derived from adipose cells during fasting. The metabolic switch can improve glucose regulation and reduce inflammation. The stress state of fasting also increases autophagy, which removes damaged molecules to prevent against further metabolic stress and can also reduce oxidative stress.
  • In the current study by Patikorn and colleagues, MADF, in particular, was associated with lower BMI and blood pressure along with improved lipid values; however, intermittent fasting was associated with lower fat-free mass as well.
  • Implications for the healthcare team: The healthcare team can recommend intermittent fasting to appropriate patients as a means to reduce body weight and improve metabolic outcomes among patients with overweight and obesity.

 

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