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Tuesday, March 7, 2017

Potential benefits and harms of fasting

Abstract (as presented by the authors of the scientific work):

"Intermittent energy restriction (IER) has become popular as a means of weight control amongst people who are overweight and obese, and is also undertaken by normal weight people hoping spells of marked energy restriction will optimise their health. This review summarises randomised comparisons of intermittent and isoenergetic continuous energy restriction for weight loss to manage overweight and obesity. It also summarises the potential beneficial or adverse effects of IER on body composition, adipose stores and metabolic effects from human studies, including studies amongst normal weight subjects and relevant animal experimentation. Six small short term (<6 month) studies amongst overweight or obese individuals indicate that intermittent energy restriction is equal to continuous restriction for weight loss, with one study reporting greater reductions in body fat, and two studies reporting greater reductions in HOMA insulin resistance in response to IER, with no obvious evidence of harm. Studies amongst normal weight subjects and different animal models highlight the potential beneficial and adverse effects of intermittent compared to continuous energy restriction on ectopic and visceral fat stores, adipocyte size, insulin resistance, and metabolic flexibility. The longer term benefits or harms of IER amongst people who are overweight or obese, and particularly amongst normal weight subjects, is not known and is a priority for further investigation."

Covered topics (the letter size corresponds to the frequency of mentioning in the text):

Conclusions (as presented by the authors of the scientific work):

"This review highlights a lack of high quality data to inform adherence and benefits or harms of IER vs. CER. Research findings and gaps in the evidence comparing IER to CER for weight control and metabolic health are summarised in Table 3. The few randomised comparisons of IER vs. CER amongst overweight and obese subjects report equivalent weight loss, with one trial of a two day low carbohydrate IER reporting greater reductions in body fat compared to CER [13]. These studies were not powered to detect a difference in loss of weight or fat, thus study finding are suggestive but not conclusive of no difference between IER and CER. No studies to date have tested whether IER can prevent weight gain amongst normal weight subjects, however IER regimens based on alternate days of total fasting or marked energy restriction (70% restriction) have not been well tolerated amongst normal and overweight populations (BMI 20–30 kg/m2 ) [15,40]. This review highlights numerous gaps in knowledge of the effects of IER vs. CER on ectopic and visceral fat stores, adipocyte size, FFM, insulin resistance, REE and metabolic flexibility, particularly amongst normal weight subjects. In the absence of these data, we have drawn on findings of short term studies and highlighted some potential beneficial or adverse effects. The variable and sometimes adverse effects of IER on fat stores and metabolism in some rodent models reported in this review are a concern. However, this may relate in part to shifts in night and day eating patterns and circadian rhythm [55], which may not translate to the human situation. Future IER research requires two types of randomised comparison trials. Firstly, longer term RCTs of IER and CER (>6 months) to show whether IER is sustainable long term and has long term benefits or yet undiscovered harmful effects on weight, body composition, and metabolic health compared to CER. Secondly, detailed metabolic proof of principle studies in controlled conditions to assess the effects of IER and matched isoenergetic CER on FFM, hepatic and intramuscular fat stores, insulin sensitivity and metabolic flexibility using robust methodology such as DXA, MRI and insulin clamps. These studies need to assess the metabolic effects of IER during restricted and feed phases of the diet to fully characterise its biological effects amongst people of any weight. Well documented differences in metabolic responses to periods of fasting and marked energy restriction between pre-menopausal women (i.e., increased ketones and free fatty acids) compared to men and post-menopausal women suggest possible different metabolic responses, and perhaps better tolerance to IER within certain populations [85]. Future IER studies should include males, older subjects, individuals with morbid obesity or type 2 diabetes, as well as normal weight subjects. There is also a need to explore optimum patterns of restriction, e.g., two days per week, alternate days, five days per month [86] or other permutations and the best mode of restriction on the restricted and intervening days (e.g., low carbohydrate, low protein). The popularity of IER within the general public coupled with the gaps in the evidence we have identified indicate that IER deserves further rigorous study. We do not know conclusively whether long term IER is a safe effective method of weight control for subjects who are overweight or obese or whether IER may confer health benefits to people of any weight independent of weight loss. High quality research comparing long term outcomes of IER and CER are required to ascertain any true benefits or detrimental effects which IER may have for controlling weight and improving metabolic health in the population."

Full-text access of the referenced scientific work:

Harvie M, Howell A. Potential Benefits and Harms of Intermittent Energy Restriction and Intermittent Fasting Amongst Obese, Overweight and Normal Weight Subjects-A Narrative Review of Human and Animal Evidence. Behav Sci (Basel). 2017 Jan 19;7(1). pii: E4. doi: 10.3390/bs7010004. Review. PubMed PMID: 28106818.


Prof. Atanas G. Atanasov (Dr. habil., PhD)

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