Intermittent Fasting

Time-Restricted Eating (TRE)

  
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“Fasting alone is more powerful in preventing and reversing some diseases than drugs.” Dr. Satchin Panda from the Salk Institute in the US said this a few years ago in the context of a review article on the benefits of fasting [1]. So, imagine if fasting and exercise could both be combined into a polypill…we could live longer and healthier lives anywhere in the world at pretty much minimal to no cost.

Fasting is an integral part of many religions. In Jainism for example, there are many different forms of fasting; from the daily chauvihar (eating only from sunrise to sunset) to the athai (8 days of fasting during the festival of paryushan), to more severe forms of fasting. Islam has one month of Ramadan/Ramzan, during which a large number of Muslims eat and drink nothing from dawn to dusk. In many forms of Hinduism, people fast during different days to appease multiple Gods and even monotheistic religions like Christianity and Judaism have their own forms of fasting.

Since one tenet of any religion has always been to help people live longer and healthier (both in mind and body), it is likely that the health benefits of fasting were evident even in the olden days, despite the absence of the kind of scientific data we look for today.

Intermittent fasting (InFa) is an umbrella term that incorporates alternate day fasting, the 5:2 method of fasting, in which we fast for 2 days a week and time-restricted eating (TRE), where the eating window is restricted to 6-12 hours daily.

I find TRE the simplest. I can skip breakfast, start lunch at 1 PM  and finish dinner by 9 PM, giving me an 8 hours feeding window with 16 hours of fasting.

While we are still waiting for that one breakthrough trial that will conclusively establish InFa’s scientific credentials, a large number of smaller preclinical and clinical studies have shown that any form of InFa has many proven and potential benefits. 

Drs. Rafael de Cabo and Mark P Mattson from Johns Hopkins University School of Medicine recently summarized the existing data on intermittent fasting in the New England Journal of Medicine [2]. The paper explains the physiologic basis of fasting, why evolutionary science suggests that we do not really need 3 meals a day and that restricted eating in any form helps not just with weight loss (which is the primary objective of most people who take up fasting) but improves a host of metabolic parameters that help us live longer and better. 

InFa and TRE in particular help with the following

a. Longevity

b. Reduced obesity

c. Better exercise endurance

d. Improved cognition

e. Better insulin sensitivity and diabetes control

f. Improved cardiovascular risk factors

g. Extended survival in cancers

h. Probable reduction the incidence of some cancers 

i. Probable reduction in the incidence and severity of Alzheimer’s and Parkinson’s

i. Probable reduction in symptoms and severity of asthma, multiple sclerosis, arthritis

i. Probable acceleration of healing and reduction in tissue damage during surgery.

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One word of caution though. When we look at studies comparing TRE and InFa with other methods, we need to be careful to see how the TRE has been done. One recent study [3] by Dr. Dylan Lowe and his colleagues from UCSF that found no difference between 8:16 TRE and controlled 3 meals a day, allowed the TRE participants to eat “ad libitum”, which means they were allowed to eat any amount of food they wanted, in the 8 hours “feeding window”. This makes no sense. While TRE does help with an automatic reduction in the calories consumed, that is not necessarily so. It is still possible to gorge on 3000-4000 calories in a window of 6-8 hours…and if all we eat are ultra-processed foods (UPFs) or calorie-dense items, it would defeat the very purpose of TRE. 

How do we start implementing InFa and TRE? Unfortunately most doctors find it impossible to prescribe non-pharmacologic interventions like fasting or physical activity that don’t involve a visit to the chemist or pharmacy. Many dietitians and nutritionists are trained to create meal plans, not to consider “not eating” as an option. 

Hence, we have to do this on our own. It can be a little difficult at first when we are used to 3 portions a day but a gradual plan helps. I stared with 12:12 for a month, then moved to 10:14 for another month and was at 8:16 for a couple of years. Over the last few months though, I have added a cappuccino in the morning and a small cut-fruit platter between 11 AM and 12 PM with controlled portions during the eating window to try and achieve an average calorie intake of 1800 per day.

So, what we have looked at so far in our Matka series that we can incorporate into our daily lives, avoiding fad diets and short-term solutions, to live long and healthy? 

1. Moving in any form.

2. Sensible eating. Eating as few UPF portions per day as possible and at least 4-5 portions of vegetables and fruits a day with some form of InFa, preferably some type of TRE.

And let’s not confuse weight loss and being healthy. While achieving ideal weight for age, height and sex is one part of being healthy, living longer and better involves a lot more. We don’t have to look like models or have two and four pack abs to live long and healthy and all those who are ripped are not necessarily healthy.

Coming back to Jains. Do Jains who practice chauvihar live longer and healthier? While Jains do live longer than other communities in India, this could be due to wealth, better education and improved access to healthcare, among other confounding reasons. A study comparing Jains who practice daily chauvihar versus those Jains who don’t may tell us if those for whom chauvihar TRE is a way of life are healthier and/or live longer than those who eat all day, and is an observational study just waiting to happen, if anyone is up for that. 

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Footnotes

1. Mattson MP, Allison DB, Fontana L, Harvie M, Longo VD, Malaisse WJ, Mosley M, Notterpek L, Ravussin E, Scheer FA, Seyfried TN, Varady KA, Panda S. Meal frequency and timing in health and disease. Proc Natl Acad Sci U S A. 2014 Nov 25;111(47):16647-53. doi: 10.1073/pnas.1413965111. Epub 2014 Nov 17. PMID: 25404320; PMCID: PMC4250148.

2. de Cabo R, Mattson MP. Effects of Intermittent Fasting on Health, Aging, and Disease. N Engl J Med. 2019 Dec 26;381(26):2541-2551. doi: 10.1056/NEJMra1905136. Erratum in: N Engl J Med. 2020 Jan 16;382(3):298. Erratum in: N Engl J Med. 2020 Mar 5;382(10):978. PMID: 31881139.

3. Lowe DA, Wu N, Rohdin-Bibby L, Moore AH, Kelly N, Liu YE, Philip E, Vittinghoff E, Heymsfield SB, Olgin JE, Shepherd JA, Weiss EJ. Effects of Time-Restricted Eating on Weight Loss and Other Metabolic Parameters in Women and Men With Overweight and Obesity: The TREAT Randomized Clinical Trial. JAMA Intern Med. 2020 Nov 1;180(11):1491-1499. doi: 10.1001/jamainternmed.2020.4153. Erratum in: JAMA Intern Med. 2020 Nov 1;180(11):1555. PMID: 32986097; PMCID: PMC7522780.