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.
Experts say there aren’t hard and fast rules with intermittent fasting and that it can be adapted to your work or social schedule. (Mediteraneo/Adobe Stock)
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.
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.
Before you start intermittent fasting, registered dietitian Dr. Anar Allidina recommends making sure your diet is made up of healthy foods and essential nutrients. (Kirk Pennell/CBC)
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.”
Patients who are older, don’t speak English, and don’t have a high school education are more likely to experience harm during a hospital stay in Canada, according to new research.
The Canadian Institute for Health Information measured preventableharmful events from 2023 to 2024, such as bed sores and medication errors,experienced by patients who received acute care in hospital.
The research published Thursday shows patients who don’t speak English or French are 30 per cent more likely to experience harm. Patients without a high school education are 20 per cent more likely to endure harm compared to those with higher education levels.
The report also found that patients 85 and older are five times more likely to experience harm during a hospital stay compared to those under 20.
“The goal of this report is to get folks thinking about equity as being a key dimension of the patient safety effort within a hospital,” says Dana Riley, an author of the report and a program lead on CIHI’s population health team.
When a health-care provider and a patient don’t speak the same language, that can result in the administration of a wrong test or procedure, research shows. Similarly, Riley says a lower level of education is associated with a lower level of health literacy, which can result in increased vulnerability to communication errors.
“It’s fairly costly to the patient and it’s costly to the system,” says Riley, noting the average hospital stay for a patient who experiences harm is four times more expensive than the cost of a hospital stay without a harmful event – $42,558 compared to $9,072.
“I think there are a variety of different reasons why we might start to think about patient safety, think about equity, as key interconnected dimensions of health-care quality,” says Riley.
The analysis doesn’t include data on racialized patients because Riley says pan-Canadian data was not available for their research. Data from Quebec and some mental health patients was also excluded due to differences in data collection.
Efforts to reduce patient injuries at one Ontario hospital network appears to have resulted in less harm. Patient falls at Mackenzie Health causing injury are down 40 per cent, pressure injuries have decreased 51 per cent, and central line-associated bloodstream infections, such as IV therapy, have been reduced 34 per cent.
The hospital created a “zero harm” plan in 2019 to reduce errors after a hospital survey revealed low safety scores. They integrated principles used in aviation and nuclear industries, which prioritize safety in complex high-risk environments.
“The premise is first driven by a cultural shift where people feel comfortable actually calling out these events,” says Mackenzie Health President and Chief Executive Officer Altaf Stationwala.
They introduced harm reduction training and daily meetings to discuss risks in the hospital. Mackenzie partnered with virtual interpreters that speak 240 languages and understand medical jargon. Geriatric care nurses serve the nearly 70 per cent of patients over the age of 75, and staff are encouraged to communicate as frequently as possible, and in plain language, says Stationwala.
“What we do in health care is we take control away from patients and families, and what we know is we need to empower patients and families and that ultimately results in better health care.”
This report by The Canadian Press was first published Oct. 17, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
CALGARY – Alberta’s health minister says a new agency responsible for primary health care should be up and running by next month.
Adriana LaGrange says Primary Care Alberta will work to improve Albertans’ access to primary care providers like family doctors or nurse practitioners, create new models of primary care and increase access to after-hours care through virtual means.
Her announcement comes as the provincial government continues to divide Alberta Health Services into four new agencies.
LaGrange says Alberta Health Services hasn’t been able to focus on primary health care, and has been missing system oversight.
The Alberta government’s dismantling of the health agency is expected to include two more organizations responsible for hospital care and continuing care.
Another new agency, Recovery Alberta, recently took over the mental health and addictions portfolio of Alberta Health Services.
This report by The Canadian Press was first published Oct. 15, 2024.
Rana Van Tuyl was about 12 weeks pregnant when she got devastating news at her ultrasound appointment in December 2020.
Her fetus’s heartbeat had stopped.
“We were both shattered,” says Van Tuyl, who lives in Nanaimo, B.C., with her partner. Her doctor said she could surgically or medically pass the pregnancy and she chose the medical option, a combination of two drugs taken at home.
“That was the last I heard from our maternity physician, with no further followup,” she says.
But complications followed. She bled for a month and required a surgical procedure to remove pregnancy tissue her body had retained.
Looking back, Van Tuyl says she wishes she had followup care and mental health support as the couple grieved.
Her story is not an anomaly. Miscarriages affect one in five pregnancies in Canada, yet there is often a disconnect between the medical view of early pregnancy loss as something that is easily managed and the reality of the patients’ own traumatizing experiences, according to a paper published Tuesday in the Canadian Medical Association Journal.
An accompanying editorial says it’s time to invest in early pregnancy assessment clinics that can provide proper care during and after a miscarriage, which can have devastating effects.
The editorial and a review of medical literature on early pregnancy loss say patients seeking help in emergency departments often receive “suboptimal” care. Non-critical miscarriage cases drop to the bottom of the triage list, resulting in longer wait times that make patients feel like they are “wasting” health-care providers’ time. Many of those patients are discharged without a followup plan, the editorial says.
But not all miscarriages need to be treated in the emergency room, says Dr. Modupe Tunde-Byass, one of the authors of the literature review and an obstetrician/gynecologist at Toronto’s North York General Hospital.
She says patients should be referred to early pregnancy assessment clinics, which provide compassionate care that accounts for the psychological impact of pregnancy loss – including grief, guilt, anxiety and post-traumatic stress.
But while North York General Hospital and a patchwork of other health-care providers in the country have clinics dedicated to miscarriage care, Tunde-Byass says that’s not widely adopted – and it should be.
She’s been thinking about this gap in the Canadian health-care system for a long time, ever since her medical training almost four decades ago in the United Kingdom, where she says early pregnancy assessment centres are common.
“One of the things that we did at North York was to have a clinic to provide care for our patients, and also to try to bridge that gap,” says Tunde-Byass.
Provincial agency Health Quality Ontario acknowledged in 2019 the need for these services in a list of ways to better manage early pregnancy complications and loss.
“Five years on, little if any progress has been made toward achieving this goal,” Dr. Catherine Varner, an emergency physician, wrote in the CMAJ editorial. “Early pregnancy assessment services remain a pipe dream for many, especially in rural Canada.”
The quality standard released in Ontario did, however, prompt a registered nurse to apply for funding to open an early pregnancy assessment clinic at St. Joseph’s Healthcare Hamilton in 2021.
Jessica Desjardins says that after taking patient referrals from the hospital’s emergency room, the team quickly realized that they would need a bigger space and more people to provide care. The clinic now operates five days a week.
“We’ve been often hearing from our patients that early pregnancy loss and experiencing early pregnancy complications is a really confusing, overwhelming, isolating time for them, and (it) often felt really difficult to know where to go for care and where to get comprehensive, well-rounded care,” she says.
At the Hamilton clinic, Desjardins says patients are brought into a quiet area to talk and make decisions with providers – “not only (from) a physical perspective, but also keeping in mind the psychosocial piece that comes along with loss and the grief that’s a piece of that.”
Ashley Hilliard says attending an early pregnancy assessment clinic at The Ottawa Hospital was the “best case scenario” after the worst case scenario.
In 2020, she was about eight weeks pregnant when her fetus died and she hemorrhaged after taking medication to pass the pregnancy at home.
Shortly after Hilliard was rushed to the emergency room, she was assigned an OB-GYN at an early pregnancy assessment clinic who directed and monitored her care, calling her with blood test results and sending her for ultrasounds when bleeding and cramping persisted.
“That was super helpful to have somebody to go through just that, somebody who does this all the time,” says Hilliard.
“It was really validating.”
This report by The Canadian Press was first published Oct. 15, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
