For many people, New Year is a time to adopt new habits as a renewed commitment to personal health. Enthusiastic fitness buffs pack into gyms and grocery stores filled with shoppers eager to try out a new diet. But, are these diets scientific evidence-based? In a review article published in the New England Journal of Medicine, Mark Mattson, professor of neuroscience at Johns Hopkins University School of Medicine, explains what intermittent fasting does. Mattson, who has studied the health impact of intermittent fasting for 25 years, and adopted it himself for about 20 years, believes that “intermittent fasting could be part of a healthy lifestyle.” His new article is intended to clarify the science and clinical applications of intermittent fasting in ways that may help physicians guide patients who want to try it. Intermittent fasting, he clarifies, fall generally into two categories: daily time-restricted feeding, which narrows eating times to six-eight hours per day, and so-called 5:2 intermittent fasting, in which people limit themselves to one moderate-sized meal two days each week. An array of animal and some human studies have shown that alternating between times of fasting and eating supports cellular health, probably by triggering an age-old adaptation to periods of food scarcity called metabolic switching. Such a switch occurs when cells use up their stores of rapidly accessible, sugar-based fuel, and begin converting fat into energy in a slower metabolic process. Mattson says studies have shown that this switch improves blood sugar regulation, increases resistance to stress, and suppresses inflammation. Because most Americans eat three meals plus snacks each day, they do not experience the switch, or the suggested benefits. In the article, Mattson notes that four studies in both animals and people found intermittent fasting also decreased blood pressure and lipid levels, and rested heart rates. Evidence is also mounting that intermittent fasting can modify risk factors associated with obesity and diabetes, says Mattson. Two studies at the University Hospital of South Manchester NHS Foundation Trust of 100 overweight women showed that those on the 5:2 intermittent fasting diet lost the same amount of weight as women who restricted calories, but did better on measures of insulin sensitivity and reduced belly fat than those in the calorie-reduction group. Recently, he adds, preliminary studies suggest that intermittent fasting could benefit brain health too. A multicentre clinical trial at the University of Toronto in April found that 220 healthy, nonobese adults who maintained a calorie restricted diet for two years showed signs of improved memory in a battery of cognitive tests. While far more research needs to be done to prove any effects of intermittent fasting on learning and memory, Mattson says if that proof is found, the fasting – or a pharmaceutical equivalent that mimics it – may offer interventions that can stave off neurodegeneration and dementia. “We are at a transition point where we could soon consider adding information about intermittent fasting to medical school curricula alongside standard advice about healthy diets and exercise,” he says. Mattson acknowledges that researchers do “not fully understand the specific mechanisms of metabolic switching and that “some people are unable or unwilling to adhere” to the fasting regimens. Yet, he argues that with guidance and some patience, most people can incorporate them into their lives. It takes some time for the body to adjust to intermittent fasting, and to get beyond initial hunger pangs and irritability that accompany it. “Patients should be advised that feeling hungry and irritable is common initially and usually passes after two weeks to a month as the body and brain become accustomed to the new habit,” Mattson adds. To manage this hurdle, he suggests that physicians advise patients to gradually increase the duration and frequency of the fasting periods over the course of several months, instead of “going cold turkey.” As with all lifestyle changes, says Mattson, it's important for physicians to know the scientific evidence so they can communicate potential benefits, harms, and challenges, and offer support.
