In the United States alone, someone dies from a diabetes related causes every 10 seconds. This statistic is highly disturbing, especially because at least 80% of chronic illnesses can be prevented with proper lifestyle and diet modifications.
In order to prevent the onset of diabetes, it is not only important to monitor what we eat (as we saw in previous articles here and here), but it is also important to modify when we eat. A hundred years ago, the average American ate 1.5 times per day. Now, that number is approaching 6 feeding episodes per day. Snacking has been come a staple of American society and in some parenting circles, it is considered borderline child abuse to not provide children snacks in between every meal. Moreover, we tend to start eating early in the morning and continue to eat late into the day. One study, conducted by Dr. Satchin Panda, found that the median daily intake duration (the amount of time people spent eating) was 14.75 hours per day. In other words, if the average person had breakfast at 8 am, he would have his last intake of food at 10:45 pm! Contrast this with our evolutionary ancestors, who would generally hunt and gather only during daylight hours, which would severely restrict possible feeding times. So, not only are we eating a less healthy diet overall, we are also eating more frequently and over a broader time range each and every day.
With that introduction, we will now see the implications this is having on our health and why intermittent fasting can help reverse the epidemic rise in diabetes we have been experiencing.
What is intermittent fasting?
Intermittent fasting is a type of cyclical and controlled eating pattern that alternates between feeding and fasting states. This can take shape in many different ways. For example, the most extreme version is called 'alternate day fasting,' which entails eating food every other day. Even within this group, some eat nothing at all on the alternate day while some eat a reduced calorie diet of only 500 calories. Yet another variation of this diet has participants fast for 24 hour periods two days out of the week. The warrior diet recommends eating only fruits and vegetables during the day while eating one large meal at night. The 5/2 diet recommends for a person to eat normally 5 days out of the week while restricting intake to 500-600 calories the remaining two days.
My favorite form of intermittent fasting, and also the easiest in my opinion, is known as time-restricted feeding. This simply means that one only eats within a certain time frame each day. For example, if one is practicing an 8 hour feeding window, they might have a brunch at 11:00 o'clock, lunch around 3:00pm and dinner at 6:30 pm. For the remaining 16 hours of the day, this person would be fasting.
One important distinction to make is that intermittent fasting is not a 'starvation diet.' Starvation is the involuntary absence of food, which can cause significant suffering and even death. However, fasting is the voluntary withholding of food. In the case of intermittent fasting, food is readily available, but one chooses not to consume it. Because this is the case, intermittent fasting is not a diet, but rather a pattern of eating that can be sustained over several years or even an entire lifetime.
Why does intermittent fasting work?
In order to understand why intermittent fasting works, we have to understand the way in which the body stores and burns fats in the body. This process is dictated by various hormones in our body, the predominant one being insulin. If you want to make a person fat, one of the most effective ways to do so is to inject him with insulin. If you know a friend or family member that is diabetic and injects insulin, they likely gained weight after starting its use. In fact, when insulin was first discovered in the early 1920s, it was used exclusively by farmers to fatten their farm animals!
Moreover, high insulin secretion has long been associated with obesity. Obese people secret much higher levels of insulin than do those of normal weight. In lean subjects, insulin levels quickly return to baseline after a meal, but in the obese, these levels remain elevated. Insulin levels are almost 20 percent higher in obese subjects.
From a dietary perspective, what causes your insulin to spike? Blood sugar. What causes your blood sugar to spike? Carbohydrates. The more refined the carbohydrates are (like in candy, highly processed foods, and soda), the more quickly it spikes your blood sugar. When blood sugar is high, your body releases insulin, which drives excess sugar in the bloodstream to be stored in your fat cells, especially the ones around your midsection.
In short, when we eat, especially foods higher in refined carbohydrates (i.e. high glycemic load foods), insulin levels spike in our bodies. Insulin is the hormone that signals fat cells to "open its doors" and store sugar away as fat.
"There's no possibility of storing fat in fat cells unless insulin opens the receptors, and only eating sugar can make that happen." -Dr. David Ludwig
Conversely, when we are fasting, blood sugar and insulin levels drop, which signals our body to start burning fat instead storing it.
Eating ---> insulin spike ---> fat storage mode
Fasting ---> low insulin ---> fat burning mode
Moreover, each time we eat, we are spiking our blood sugar and producing insulin, especially when we eat highly refined carbohydrates (known as high glycemic load foods). The more often we produce insulin, the less sensitive the insulin receptors get. When insulin receptors are less sensitive, the body has to produce higher amounts of insulin to have the same effect, eventually leading to a condition called insulin resistance. It's kind of like how, over time, we have drink more and more coffee to achieve the same effect. The higher amounts of insulin in our bloodstreams keeps our bodies in a fat storage mode instead of the desired fat burning mode that is triggered from having lower insulin levels.
Therefore, having regular fasting periods re-sensitizes our body to the effects of insulin. Just like how going on a coffee fast will increase your body's sensitivity to caffeine. For more on this topic, watch this video and this video.
Intermittent Fasting and Diabetes
In the previous section of this article, I explained the mechanism by which insulin resistance forms. Unfortunately, there comes a point in which our bodies become so insulin resistant that we barely respond to the normal effects of insulin. This condition is otherwise known as type 2 diabetes. This keeps us in a state of perpetual high blood sugar, which over the long term, leads to a wide array of health issues including heart disease, kidney issues, liver problems, hearing loss, vision loss, etc.
However, this downward spiral can be reversed with the help of a low carbohydrate diet, such as the ketogenic diet, and through intermittent fasting. In addition to what we eat, however, diabetes may also be mitigated by when we choose to eat.
A recent study split pre-diabetic men into two groups, one eating all food between 8am and 8 pm, while the other group at the same amount of food split into three meals, but only between 8am and 2 pm. After completing this eating pattern for 5 weeks, there was a 7 week "washout" period and the two groups switched their eating schedules. It turned out that moving to an earlier eating period resulted in lower mean insulin levels, lower insulin resistance, and improved blood pressure!
Another couple studies (here and here) demonstrated that those who intermittent fast may process, metabolize, and clear fats and sugar more effectively after meals, thus reducing the risk of diabetes and heart disease. Moreover, a review of data available showed that intermittent fasting, among other benefits helped reduce concentrations of triglycerides, glucose, and insulin. The authors of the review concluded that " these preliminary findings show promise for the use of time restricted feeding in modulating a variety of metabolic disease risk factors."
One study published in the World Journal of Diabetes instructed diabetic patients to fast for 16 hours per day for a period of two weeks. These patients not only lost weight, but they also significantly reduced blood sugar levels. Yet another study demonstrated that fasting decreased blood sugar by 12% and lowered insulin levels by over 50%!
Three additional studies (here, here, and here) demonstrated that intermittent fasting was as effective or more effective than continuous calorie restriction in various measures including average blood sugar, insulin, insulin resistance, and weight loss.
While we are lacking a gold standard, randomized controlled trial to validate the merits of intermittent fasting and diabetes, it has nonetheless proven that it can be an effective strategy to aid in reversing type 2 diabetes.
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