Health
Curious about intermittent fasting? Here’s what experts say you should know
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What are the benefits of intermittent fasting?
Intermittent fasting is becoming more widely discussed, with research still emerging. This week, Dr. Jason Fung, a nephrologist and expert on intermittent fasting, shares his tips on who should fast and how to do it.
Intermittent fasting (IF) isn’t a new way to eat, but researchers and experts say it’s an area that has potential.
It is important to know that research on intermittent fasting “is still in its infancy,” said Amy Kirkham, an assistant professor in the University of Toronto’s clinical cardiovascular health department. She has also led several studies on time-restricted eating, a form of IF.
Intermittent fasting is generally defined as the cycle of eating and then fasting.
The length of fasting can vary, depending on the person or approach.
“The idea is not deprivation or to go into excess, but to balance the feeding and the fasting because both are very essential for us,” Dr. Jason Fung, a nephrologist and author of several books on IF, told CBC’s The Dose guest host Dr. Peter Lin.
Anar Allidina, a registered dietitian based in Richmond Hill, Ont., says that intermittent fasting is “like a reset” for our bodies. The break from eating prompts our bodies to cleanse itself and get rid of more old cells, she adds.
Fung and others say there is some promising research showing the health benefits of IF, like improved cardiovascular health.
Research has shown that many of the health benefits of fasting are usually seen between the 14 to 16-hour mark, says Allidina.
“Studies have shown that during this time that you’re fasting, [it] can have really important markers in your metabolic health, for example with cholesterol, with blood sugars and inflammation. So it can really help with lowering those levels,” she said.
But before you even consider fasting, Allidina and Fung emphasized that it isn’t for everyone.
So if you’re interested, here’s what experts say you should know about intermittent fasting.
Is it safe?
For most people, it is absolutely safe to pause eating for periods of time, says Allidina.
“Giving your body that break is absolutely OK and it’s actually good for you,” she said.
Those who shouldn’t try intermittent fasting are:
- Anyone with a history of an eating disorder.
- Anyone who is underweight or malnourished.
- Pregnant women.
- Women who are breastfeeding.
- Children.
Allidina and Fung recommend speaking with your health-care provider before trying intermittent fasting.
Is there only one way to intermittently fast?
There are several different approaches to intermittent fasting.
Time-restricted eating (TRE) is a common way as it limits when you eat your meals and snacks to a specific time period.
Fung says the most common fasting strategy is 16 hours of fasting and eating within an eight-hour time period.
“So you might eat for example from 11 a.m. to 7 p.m. or you might do it early, say 9 a.m. until 4 p.m. There’s various ways to do it, but that’s one of the more popular schedules,” he said.
Another approach is the 5:2 method, where you eat normally for five days and then restrict calories two days a week to about 500 calories a day for women and 600 calories for men.
Alternate day fasting, or ADF, is when someone consumes food during an eight-hour period and then doesn’t eat the next day, which translates to roughly 36 hours of fasting.
Fung adds there is flexibility with intermittent fasting.
“There’s pluses and minuses of all of those strategies. So it’s not like one is right and one is wrong. It’s finding what really works for you,” he said.
Are there health benefits?
Yes, but it depends on the length of the fast and fasting type.
Anecdotally, Fung and Allidina have heard from people who tried intermittent fasting that they feel more alert and energized, and less tired.
Research on other health benefits is varied.
University of Illinois researchers who published a review of clinical trials found that the three major types of intermittent fasting — TRE, the 5:2 diet and ADF — can cause “mild to moderate weight loss” in those who were overweight and obese.
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They said that mild to moderate weight loss was a change of about one to eight per cent from baseline. But, they said ADF and the 5:2 diet are “the only fasting approaches that produce clinically significant weight loss,” according to their review published in the peer-reviewed Annual Review of Nutrition journal in 2021.
They went on to say that these regimens “may also improve” some aspects of cardiometabolic health such as blood pressure.
Korean researchers who published their systemic review and meta-analysis in the peer-reviewed Nutrients journal in 2020 found that time-restricted eating can help some shed some pounds and have better cardiovascular health.
Fung says people may lose weight while fasting because the body uses two different types of energy: sugar and fat.
When the body runs out of glucose (the main type of sugar in the blood), it’ll turn to fat stores, a process known as metabolic switching.
Yet, there is research — including a study published a week ago in the Journal of the American Heart Association — that suggests intermittent fasting approaches may not be better for weight loss than restricting calories.
A study published in the New England Journal of Medicine last year showed that among 139 obese participants, time-restricted eating with calories restricted was “not more beneficial” than daily calorie restriction.
Other researchers who led a randomized clinical trial and published results in 2020 found that time-restricted eating did not show significantly different weight loss nor cardiometabolic benefits compared to the controlled group.
In another study published in 2017 in the peer-reviewed JAMA, researchers did not find alternate-day fasting better for weight loss or weight maintenance compared with daily calorie restriction.
Kirkham says more studies on intermittent fasting are needed.
“We certainly do need more research to really fully understand all the different parameters and its potential health effects and certainly its safety within specific populations,” said Kirkham, who was recently awarded funding by Diabetes Canada to research which intermittent fasting period best impacts blood-sugar control.
More research is needed on intermittent fasting approaches, especially on the long-term effects, according to several researchers who have published studies.
If I want to try it out, how can I start?
Before anyone starts intermittent fasting, Allidina suggests people ensure their diet is full of essential nutrients.
“Once that’s done, then you can bring in the intermittent fasting slowly, starting with the 12-hour fasting and increasing it up to 14 to 15 to see how you feel with that,” she said.
She adds that fasting doesn’t need to happen every single day in the beginning, as it will take time to build it into your schedule.
There are also free apps that can help people keep track of their intermittent fasting, Kirkham says.
Most people cope with the eating schedule change after that first week, she adds. When starting out, it’s important to remember that minor symptoms like headaches, feeling hungry or irritability are common.
“It may be a bit of a shock to the system initially, but I think if you try it for two weeks … and if you don’t feel better then maybe you have your answer,” said Kirkham.
“Like any health intervention, it’s not a one-size-fits-all.”
The Current19:05Calls for greater access to life-saving treatment for stroke
When Marleen Conacher was taken to a hospital for major stroke treatment for the second time in a week in 2021, she wasn’t treated with a clot-busting drug like she was previously given at North Battleford Hospital in Saskatchewan.
Instead, she was transported directly to Royal University Hospital in Saskatoon, where a stroke team performed an endovascular thrombectomy (EVT).
The procedure involved passing small devices through one of the arteries in her groin, and then using suction, or tubes called stents to pull the stroke-causing blood clot out.
“I don’t recall when they, they put the little claw-like thing up through my groin and it went up through the artery and, and into my brain,” she said. “But I do remember feeling when they had got to it and were pulling it out.”
“It was a great deal of pressure. It did not hurt, but it was a great deal of pressure,” she told The Current‘s Matt Galloway.
Within a few days of the stroke, Conacher was out of the hospital, walking on her own and ready to go shopping.
She said she doesn’t think about the stroke much these days.
“I don’t spend a lot of time, you know, thinking about having a stroke or whatever or that time,” she said. “I just thank the good Lord that I am here.”
EVT procedures are a relatively new option in the field of ischemic stroke treatment. In 2015, a study known as the escape stroke trial led by the University of Calgary’s Hotchkiss Brain Institute found that, overall, positive outcomes for stroke patients increased from 20 per cent to 55 per cent thanks to EVTs.
Today, EVTs are used in about 25 to 30 major hospitals across Canada — and according to the senior study author and stroke specialist Dr. Michael Hill, it’s had a “massive treatment effect.”
“People would come in and they were paralyzed on one side, they couldn’t speak or they were severely affected, and they were leaving the hospital in two or three days,” he told Galloway.
“That was a visible change … whereas [before] people would have stayed many days and weeks for their recovery and rehab, if they survived at all.”
Speed is critical
Hill said the key to this procedure’s success is speed, as “10 or 15 minutes makes a difference.”
That’s why a patient is often greeted at the door by a team of emergency department nurses, physicians and the stroke specialist.
“When we’re alerted to a stroke or suspected stroke syndrome and we’re meeting somebody in the emergency room, we’re hustling to get there and be there before the patient or just after the patient arrives,” said Hill, who is a neurologist at the Foothills Medical Centre in Calgary.
WATCH: Dr. Michael Mayich explains how clots that cause strokes can be removed
Dr. Michael Mayich at the London Health Sciences Centre’s University Hospital explains how a new medical device from Vena Medical is used to remove clots in the brain that cause a stroke and reverse those symptoms.
From there, medical personnel conduct a clinical and imaging assessment to confirm if a patient has a blood clot and where it may be.
If the clot is in a location that is “amenable to a vascular treatment,” then an EVT will be offered.
Sedation can be approached in two ways, he said.
“Sometimes, patients are completely co-operative and we can do it completely awake. Sometimes they require some degree of sedation to keep them still.”
“You can imagine it’s important to do this procedure with your head relatively still. You can’t have them thrashing around.”
A game-changer
Hill said EVTs have a lot of potential in improving stroke treatment, as positive outcomes are a lot more frequent.
“So it’s terrific, right? We get people back to their lives,” he said.
In an ideal world, of course it’s available everywhere because you don’t have a stroke just because you live in the middle of Calgary or the middle of Toronto, right?-Dr. Michael Hill, stroke physician
At the moment, EVTs aren’t available for all Canadians. Hill said the procedure is usually reserved for patients with the most severe forms of ischemic stroke, which occurs when the blood supply to part of the brain is interrupted or reduced.
“It’s a tertiary-level procedure. You’re not going to see it in a small, rural hospital,” he said.
But part of that has to do with the volume of cases needed in order to develop expertise in this field, and it’s big hospitals in major cities that tend to see the most patients.
“So if you’re just doing one a year, you’re more likely to have complications than you are to be successful,” he said. “Whereas if you’re doing 150 a year … everyone’s ready for these things to occur because you’re doing it so frequently.”
Still, it’s important to balance that expertise with availability.
“In an ideal world, of course [EVT is] available everywhere because you don’t have a stroke just because you live in the middle of Calgary or the middle of Toronto, right?” He said.
For the time being, Conacher is content with how the procedure turned out — it’s been nearly two years and the only major impact the stroke has had is a bit of memory loss.
Furthermore, as someone who saw her dad suffer paralysis in his left side due to stroke, she’s pleased with the way stroke treatment is evolving.
“If they had things like this, I think he would have been just as fine as I was,” she said.
Produced by Ines Colabrese.
Health
Study shows well-established protective gene for Alzheimer's only safeguards against cognitive decline in men – Sunnybrook Research Institute – Sunnybrook Hospital
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The gene variant is one of three that can affect the chances of a person developing Alzheimer’s disease.
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A new study led by Sunnybrook researchers has found that APOE ε2, a gene variant known to be protective against Alzheimer’s disease, is only protective in men and not women. The research was published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association today.
“Previous research has shown that women have an increased risk of developing Alzheimer’s disease,” says Dr. Jennifer Rabin, senior author of the study and a scientist in the Hurvitz Brain Sciences Program at Sunnybrook Research Institute. “Although factors such as longer survival may contribute to why women are more likely to develop the disease, recent research suggests biological mechanisms may also impact sex differences in Alzheimer’s risk and progression.”
APOE ε2 is one of three inherited gene variants that can affect the chances of a person developing Alzheimer’s disease. Having the APOE ε2 variant decreases risk, whereas having the APOE ε4 variant increases risk. APOE ε3, the most common variant, is believed to have a neutral effect on the disease.
The collaborative study team, which included researchers from Canada and the United States, looked at whether sex modifies the association between the protective APOE ε2 gene variant and cognitive decline, using publicly available data from cognitively unimpaired adults that were part of four observational research sources.
The authors found that across two independent samples of participants, men with APOE ε2 were more protected against cognitive decline compared to women with the same APOE ε2 variant. In addition, men with APOE ε2 were more protected compared to men with the neutral gene variant (APOE ε3/ε3). However, this was not the case in women. In women, those with APOE ε2 were no more protected than those with the neutral gene variant (APOE ε3/ε3). The reasons for these sex-specific effects remain unclear. However, one possibility is that declining estrogen levels that occur with menopause may be a contributing factor given that estrogen has neuroprotective effects.
“These results suggest that the longstanding view that APOE ε2 provides protection against Alzheimer’s disease may require reevaluation,” says Madeline Wood, a graduate student at Sunnybrook and lead author of the study. “Our findings have important implications for developing sex-specific strategies to prevent and treat Alzheimer’s disease, particularly given that women are at a higher risk than men.”
The authors say the next step in their research is to continue to replicate the findings in large and diverse samples and to further investigate the sex-specific effects of APOE ε2 on Alzheimer’s disease biomarkers.
Funding for this study was supported by The Harquail Centre for Neuromodulation, the Dr. Sandra Black Centre for Brain Resilience & Recovery, Canadian Institutes of Health Research, and the Alzheimer’s Society of Canada.
Media Contact:
Samantha Sexton
Communications Manager, Sunnybrook Research Institute
Samantha.sexton@sunnybrook.ca
Health
WHO says medium-risk adults do not need extra COVID jabs – The Jakarta Post – The Jakarta Post
Robin Millard (The Jakarta Post)
PREMIUM
Agence France-Presse/Geneva, Switzerland ●
Thu, March 30 2023
The World Health Organization said on Tuesday it is no longer recommending additional COVID-19 vaccine booster doses for regular, medium-risk adults as the benefit was marginal.
For such people who have received their primary vaccination course and one booster dose, there is no risk in having further jabs but the returns are slight, WHO’s vaccine experts said.
The United Nations health agency’s Strategic Advisory Group of Experts on Immunization (SAGE) issued updated recommendations after its regular biannual meeting.
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