I noticed this
year’s Medscape Physician Lifestyle & Happiness Report (2018) included
information regarding which physicians wanted to lose weight (47% of physicians
surveyed expressed that they want to lose weight), whether more women or men
wanted to lose weight (52% of women physicians versus 45% of men physicians
wanted to lose weight), and the percentage of physicians who exercised
regularly (35% of physicians reported they exercised 2-3 times a week). This
got me thinking about how it might be challenging for busy physicians, to make
time for exercise and healthy eating. It wouldn’t be far-fetched to imagine a
scenario in which a physician gained a few pounds during a particularly busy
period in life, while juggling her career, marriage, and children, all while
trying to nurture healthy habits.
Not
too long after I read that Medscape report, I came across the concept of
intermittent fasting. “Fasting” can mean many things to many people. The word
fasting initially conjured up thoughts of painstaking and unpleasant self-deprivation,
and it didn’t sound healthy. Some anorexics have been known to describe their
non-eating behaviors as “fasting.” Yet, on the other hand, my pious and trim maternal
grandmother has fasted every Tuesday for the last 40 years. For her, fasting on
Tuesdays is eating only fruit and drinking water before the sun comes up and
then abstaining from eating and drinking until the sun goes down again. Similar
to the Catholic concept of giving up something for Lent, this once a week
fasting exercise helps my grandmother connect with her spirituality and bring
herself into a spirit of mindfulness, gratefulness and prayer, while
acknowledging all her blessings. I didn’t have negative associations with this type
of religious fasting. Rather, I’ve always respected my grandmother’s
discipline. Then there is my dad, a busy internist with so many patients per
day that, quite often, he simply doesn’t have enough time to eat multiple meals.
However, he generally touts going through the day without eating much as
something he’s proud of because it helps him limit his caloric intake and
maintain his weight. With all these associations swimming around in my head
regarding fasting, I was intrigued, and since I was trying to lose a few pounds
before my wedding, my curiosity compelled me to, at least, do my own research about
intermittent fasting. Was there
something to fasting after all?
Intermittent Fasting
Intermittent fasting is the concept of fasting for 14 to 16
hours and eating during the remaining 10 or 8 hours (14:10 or 16:8). The goal
is to help people consume less calories while optimizing some hormones related
to weight control. In addition to the above strategies, there are other ways to
do intermittent fasting: the Eat-stop-eat method (do one or two 24 hour fasts
per week, i.e. not eating from dinner one night until dinner the following
night, aka eating one meal a day); and the 5:2 diet (only eat 500-600 calories
on two days a week, but eat normally the other 5 days). As long as people don’t
eat much more than usual during meals, when it’s a feeding time, these
strategies should help people reduce daily caloric intake, resulting in reduced
belly fat and overall weight loss.
Intermittent Fasting affects hormones and may hasten fat
burn and weight loss
Fasting has consequences on the hormonal state of the body.
The main hormones affected by fasting are insulin, human growth hormone (HGH)
and Norepinephrine.
Fasting causes
insulin to decrease (eating increases insulin) and lower levels of insulin
facilitate fat burning. HGH may have up
to a five-fold increase with fasting; among other things, growth hormone aids
in fat loss and muscle gain. The nervous system releases norepinephrine during
a fast, and this hormone causes body fat to break down into free fatty acids
that can be burned for energy. Although, recently, some dieticians popularized
the weight loss benefits of eating 5-6 small meals to “keep the metabolism
revved up,” fasting for relatively short periods of time may actually increase
fat burn. However, fasting for long periods of time (over 48 hours) can
suppress metabolism. This idea may have led to the popularization of the
concept of not eating too few calories (or consuming below your BMR) lest you
go into “starvation mode,” which really doesn’t happen unless you fast for over
48 hours.
Intermittent fasting makes caloric restriction easier
Eating fewer calories than you burn has been a proven
strategy for weight-loss. Many studies have found that on average, diet has
more of an impact on weight-loss than exercise. Sticking to a low calorie diet
is easier said than done because it requires calorie counting. With intermittent
fasting, the weight loss does not require calorie counting because the feeding
timings mediate an overall reduction in caloric intake, naturally, by skipping
meals during the fasting times. In addition to the short-term hormonal changes
propagated by intermittent fasting, people on this plan lose weight because
they are eating less calories per day. A 2014 review by Barnosky et al. found
that intermittent fasting reduced body weight by 3-8% over a period of 3 to 24
weeks. People lost about 0.55 pounds per week with intermittent fasting. The
subjects also lost 4-7 % of their waist circumference, suggesting that they
lost belly fat. These results show that intermittent fasting can be a useful
weight loss tool.
Intermittent fasting helps maintain muscle tone
One of the negative consequences of dieting is that it might
lead to decreased muscle mass along with decreased fat. A 2011 review by K.A.
Varady found that intermittent calorie restriction (as in intermittent fasting)
led to the same amount of weight loss as continuous caloric restriction (a
traditional diet), but with less loss in muscle mass.
My Conclusions
Reading all this about intermittent fasting certainly
sounded compelling, so much so, that I decided to try it for myself. It’s only
been a week so far, but it has not been too difficult. It’s much easier than
counting calories, grams of carbs, or grams of protein. Since I am also strength
training these days, I was eager to find an eating plan that may help me maintain
muscle mass while still restricting overall calories for my weight loss goals,
and, preferably, one that did not force me to eat a crazy protein to carbs
ratio. Intermittent fasting works for me so far!
Is this a weight loss solution for busy physicians?
It sounds quite likely that it would be effective. In fact,
it seems like my dad was doing intermittent fasting all along all these years
when he would eat a late “lunch,” at 3 pm, consisting of a danish from a box of
pastries that one of the nurses brought in and one banana, which he grabbed
from a conference, followed by a well-balanced home-cooked dinner in front of
the TV late in the evening. He would have only been eating from 3pm to 11pm (8
hours). While it’s not for everyone, because of its customizability, intermittent
fasting does sound like a convenient eating plan for anyone with a busy
schedule, physicians and patients alike!
Meghana Agni
DUCOM 2018
For more information about Intermittent Fasting, visit Intermittent Fasting 101 — The Ultimate Beginner's Guide:
https://www.healthline.com/nutrition/intermittent-fasting-guide
Barnosky AR, Hoddy KK, Unterman TG, Varady KA. Intermittent
fasting vs daily calorie restriction for type 2 diabetes prevention: a review
of human findings. Translational Research. 2014;164:302-311.
Gunnars
Kris. How intermittent fasting can help you lose weight. Authority Nutrition on
Healthline. https://www.healthline.com/nutrition/intermittent-fasting-and-weight-loss.
June 4, 2017. Accessed April 17, 2018.
Santos HO, Macedo RCO. Impact of intermittent fasting on the
lipid profile: Assessment associated with diet and weight loss. Clinical
Nutrition ESPEN. 2018;24:14-21.
Peckham, Carol. Medscape Physician Lifestyle & Happiness Report 2018. Medscape. https://www.medscape.com/slideshow/2018-lifestyle-happiness-6009320#20. January 10, 2018. Accessed April 17, 2018.
Persynaki A, R.D, Karras, Spyridon, M.D., Ph.D, Pichard, Claude,
M.D., Ph.D. Unraveling the metabolic health benefits of fasting related to
religious beliefs: A narrative review. Nutrition. 2016;2017;35:14-20.
Varady KA. Intermittent versus daily calorie restriction: which
diet regimen is more effective for weight loss? Obesity Reviews.
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