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Eat, Fast, Lose? New book suggests alternate day fastingAlternate-day fasting and metabolic rate -
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R Foundation for Statistical Computing. R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; Download references. The study is funded by the AustrianScience Fund FWF Austria for grants PB28, PB27 and PB28 Frank Madeo. No funding or sponsorship was received for the publication of this article.
All named authors meet the International Committee of Medical Journal Editors ICMJE criteria for authorship for this article, take responsibility for the integrity of the work as a whole and have given their approval for this version to be published. Harald Sourij, Norbert J. Tripolt, Slaven Stekovic, Sabrina Schröder, Frank Madeo, Barbara Obermayer-Pietsch, Thomas R.
Pieber designed the study protocol; Jasmin Url, Peter N. Pferschy and Felix Aberer have made substantial contribution to acquisition of data. Norbert J. Tripolt and Harald Sourij wrote the clinical protocol and obtained authorization from the Ethics Committee and wrote the manuscript.
Albrecht Schmidt, Ewald Kolesnik, Nicolas Verheyen performed and evaluated the echocardiographic examinations. Sophie H. Narath and Regina Riedl are responsible for statistical analyses. Harald Sourij is the principal investigator of the trial. Thomas R.
Pieber and Frank Madeo are the chief investigators of this trial. All authors read and approved the final manuscript. Tripolt, Slaven Stekovic, Felix Aberer, Jasmin Url, Peter N.
Pferschy, Sabrina Schröder, Nicolas Verheyen, Albrecht Schmidt, Ewald Kolesnik, Sophie H. Narath, Regina Riedl, Barbara Obermayer-Pietsch, Thomas R. Pieber, Frank Madeo and Harald Sourij have nothing to disclose. The trial is conducted in accordance with the ethical principles of the Declaration of Helsinki, International Council for Harmonisation Good Clinical Practice GCP and the applicable country-specific regulatory requirements.
Informed consent was obtained from all individual participants included in the study. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4. Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Tripolt, Felix Aberer, Jasmin Url, Peter N. Pferschy, Barbara Obermayer-Pietsch, Thomas R. Institute of Molecular Biosciences, University of Graz, Graz, Austria. Center for Biomarker Research in Medicine, CBMed, Graz, Austria.
Jasmin Url, Peter N. Pferschy, Sophie H. Narath, Barbara Obermayer-Pietsch, Thomas R. Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria. Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria.
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Tripolt, N. et al. Intermittent Fasting Alternate Day Fasting in Healthy, Non-obese Adults: Protocol for a Cohort Trial with an Embedded Randomized Controlled Pilot Trial. Adv Ther 35 , — Download citation. Received : 17 May Published : 25 July Issue Date : August Anyone you share the following link with will be able to read this content:.
Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Download PDF. Methods We will perform a prospective cohort study with an embedded randomized controlled trial RCT including 90 healthy subjects.
Planned outcomes The aim of this project is to investigate the effects of ADF on human physiology and molecular cellular processes. Trial registration NCT; registered 24 November The efficacy and safety of β-nicotinamide mononucleotide NMN supplementation in healthy middle-aged adults: a randomized, multicenter, double-blind, placebo-controlled, parallel-group, dose-dependent clinical trial Article Open access 08 December Obesity management: sex-specific considerations Article Open access 08 February Effect of oat supplementation interventions on cardiovascular disease risk markers: a systematic review and meta-analysis of randomized controlled trials Article Open access 03 January Use our pre-submission checklist Avoid common mistakes on your manuscript.
Introduction Background Intermittent fasting, alternate day fasting ADF and further forms of periodic caloric restriction are not really methods of energy deprivation, because—at least theoretically—persons could eat double on the second day. Methods Study Design The InterFast trial is a cohort study with an integrated randomized controlled pilot trial.
Table 1 Visit overview Full size table. Study design. Full size image. Flow chart enrolment. Strengths and Limitations of this Study This is the first prospective cohort study with an embedded randomized intervention trial that will be conducted to investigate short- and mid- to long-term effects of ADF on human physiology and molecular cellular processes in healthy subjects.
The methods for analysis of the outcomes are precise and reliable. Glucose levels are assessed using CGM. Dissemination Plan We anticipate that the results of this study will be disseminated through peer-reviewed journals and national and international academic conferences.
Discussion Clinical research studies of ADF with robust designs and high levels of clinical evidence are sparse. Trial Status The first patient was included on 8 April References Faris MA, Kacimi S, Al-Kurd RA, Fararjeh MA, Bustanji YK, Mohammad MK, et al.
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Increases in norepinephrine generally lead to larger amounts of fat being available for your body to burn. Fasting leads to a rise in the amount of norepinephrine in your bloodstream 26 , Fasting can help decrease insulin levels and boost blood levels of human growth hormone and norepinephrine.
These changes can help you burn fat more easily and help you lose weight. Many people believe that skipping meals will cause your body to adapt by lowering its metabolic rate to save energy. However, some older studies have shown that fasting for short periods can actually increase your metabolism , not slow it down 30 , This increase is thought to be due to the rise in the hormone norepinephrine, which promotes fat burning.
Still, more high quality, recent studies are needed to evaluate how intermittent fasting may impact metabolism. Fasting for short periods can slightly boost your metabolism. However, fasting for long periods may have the opposite effect.
When you lose weight, your metabolic rate goes down. Part of this is because losing weight causes muscle loss, and muscle tissue burns calories around the clock. Severe calorie restriction over a long period can cause your metabolic rate to drop, as your body enters so-called starvation mode.
Your body does this to conserve energy as a natural defense against starvation 34 , Participants followed a calorie-restricted diet and intense exercise regimen to lose large amounts of weight The study found that 6 years later, most of them had regained nearly all of the weight they had lost.
However, their metabolic rates had not gone back up and remained around calories lower than you would expect for their body size. Other studies investigating the effects of calorie restriction on weight loss have found similar results. The drop in metabolism due to weight loss can amount to hundreds of calories per day 37 , This confirms that starvation mode is real and can partly explain why many people who lose weight end up regaining it.
However, currently there is no quality research available looking at the long-term effects of intermittent fasting diets on metabolic rate. More research is needed. Muscle is metabolically active tissue that helps keep your metabolic rate high.
This helps you burn more calories , even at rest 39 , Unfortunately, most people lose both fat and muscle when they lose weight A review found that intermittent fasting was more effective at retaining muscle during weight loss than a traditional low calorie diet However, results have been mixed.
A more recent review found intermittent fasting and continuous calorie restriction to have similar effects on lean body mass 5 , One recent study found no difference between the lean body mass of people who were fasting and people on continuous calorie restriction after 8 weeks.
However, at 24 weeks, those in the fasting group had lost less lean body mass 6. Larger and longer studies are needed to find out if intermittent fasting is more effective at preserving lean body mass.
Intermittent fasting may help reduce the amount of muscle you lose when you lose weight. However, the research is mixed. In clinical trials, calorie restriction could reduce the risk factors of diseases and improve patient's health.
However, a link has been found between continuous caloric restriction and harmful factors about human health Overall, calorie restriction has many limitations, particularly on healthy humans. Alternate-day fasting ADF , as a new calorie restriction method for obesity patients, has been proved to improve human health-related outcomes 9 , 19 — ADF may be an effective alternative for weight loss because this diet only requires calorie counting every other day 21 , In principle, some reports showed that adverse effects of ADF were minimal, such as mild headache or substantial hunger and light-headedness The ADF method has gotten more and more popular in the past decade.
Some books of ADF became a bestseller; to some extent, these books also promote the popularity of weight-loss methods Hitherto, it has been published more than a million copies in the United States and the United Kingdom The body weight fluctuations made a great influence on people's physiology indexes.
To evaluate the effects of ADF for adults, we performed a systematic review and meta-analysis of randomized controlled trials RCTs. A systematic review of RCTs was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist Our study searched PubMed to March , EMBASE to March , and the Cochrane Controlled Trials Register, looking for studies about the effect of ADF on the metabolism of the human body.
Furthermore, we also reviewed original references for including texts. RCTs that met the following criteria were included: a the studies should have a connection with the topic: the effect of ADF on the metabolism of the human body obese or nonobese humans , b full text of the study could be provided, or c precise data could be extracted, and there are similar indicators between the ADF group and the control group in every RCT.
The following studies were excluded: a not RCT, such as abstract, review, or comment or b incomplete data study. Furthermore, we included the most recently published study if studies described identical experiments.
Besides, every study would be included if different measures were evaluated. Table 1 shows the specific inclusion and exclusion criteria. Table 1. Criteria for considering studies for the review based on the population, intervention, comparator, outcomes, and study designs PICOS structure.
The Cochrane risk of bias tool was used to determine the quality of the retrieved RCTs The quality items were selective outcome reporting, blinding, allocation concealment, incomplete outcome data, random sequence generation, and other sources of bias.
A graph summarizing the risk of bias was generated based on discussions among the authors, as shown in Figure 1. Then, according to the guidelines published in the Cochrane Handbook for Systematic Reviews of Interventions v.
All of the authors participated in the quality assessment of all RCTs and agreed with the results. Meanwhile, the differences between each RCT were bridged through discussion among authors.
All reviewers independently assessed whether the study was suitable or not according to the criteria. The following information was collected: a the general data in the test; b name of the first author; c time of publication; d the design of study and size of the sample e.
Meanwhile, our team cross-checked references and data of each included study to ensure there is no overlapping data.
The data were carried out using the RevMan version 5. The changes in the weight, BMI, TC, LDL, TG, HDL, FBS, fat mass, lean mass, SBP, DBP, total calorie intake, and HOMA-IR were analyzed concerning the differences of each RCT between the entry and endpoint.
We utilized the I 2 statistic to analyze inconsistent results, reflecting the proportion of heterogeneity across trials. In this meta-analysis, it is unnecessary to have ethical approval and patient consent because all of the data were acquired from articles that have already been published.
Meanwhile, a subgroup analysis was conducted according to the lengths of intervention time ADF 8W and ADF 12W in patients Table 2.
One hundred and thirty-two articles were discovered by retrieval in each database. After scrutinizing their abstracts and titles, studies were discontinued. Twenty-four studies were ruled out for a lack of useful data. Finally, seven articles containing seven RCTs 9 , 19 , 33 — 37 that analyzed the effect of ADF on the metabolism of the human body were included in our analysis.
A detailed flowchart showing the selection process is shown in Figure 2. Table 3 shows the baseline characteristics of the studies. Figure 2. Flowchart of the study selection process.
RCT, randomized controlled trials. All of the seven studies included in the meta-analysis were RCT. Figure 1 presents a graphical summary of the risk bias. Besides, all of the studies described the randomization process.
All articles had an appropriate number of participants to analyze. The funnel plot displayed the conclusion of a qualitative estimation of publication bias Figure 3.
Figure 3. Funnel plot of the studies included in our meta-analysis. MD, mean difference; SE, standard error. Seven RCTs involving participants contained meaningful data on weight in the ADF group and in the control group. It proved that compared with the control group Figure 4 , the ADF group showed statistically significant reductions in weight.
Figure 4. Forest plots showing changes between two groups in A weight, B body mass index BMI , C total calorie intake; SD, standard deviation; IV, inverse variance; CI, confidence interval; df, degrees of freedom.
Four RCTs involving participants contained meaningful data on BMI 82 in the ADF group and 54 in the control group. The result proved that the ADF group showed statistical differences in BMI compared with the control group Figure 4.
Four RCTs involving participants contained meaningful data on total calorie intake 72 in the ADF group and 66 in the control group. It demonstrated that the ADF group showed statistically significant reductions in total calorie intake compared with the control group Figure 4.
Five RCTs involving participants contained meaningful data on TC in the ADF group and 71 in the control group. We found significant differences between the ADF group and the control group in the TC Figure 5.
Figure 5. Forest plots showing changes between two groups in A total cholesterol TC , B triglycerides TG , C low-density lipoprotein LDL , D high-density lipoprotein HDL , E fasting blood sugar FBS , F homeostasis model assessment-insulin resistance HOMA-IR ; SD, standard deviation; IV, inverse variance; CI, confidence interval; df, degrees of freedom.
Five RCTs involving participants contained meaningful data on TG in the ADF group and 90 in the control group. The result proved that the ADF group showed significant differences in TG compared with the control group Figure 5.
Four RCTs involving participants contained meaningful data on LDL 90 in the ADF group and 61 in the control group. The result proved that the ADF group showed significant differences in LDL compared with the control group Figure 5. Five RCTs involving participants contained meaningful data on HDL in the ADF group and 71 in the control group.
The result showed that it was no statistical difference in terms of HDL between the two groups Figure 5. Four RCTs involving participants contained meaningful data on FBS 88 in the ADF group and 56 in the control group.
The model showed no marked differences between the ADF group and the control group in the change of FBS Figure 5. Three RCTs involving participants contained meaningful data on HOMA-IR 55 in the ADF group and 46 in the control group.
Compared with the control group, the ADF group showed no meaningful difference in HOMA-IR Figure 5. Six RCTs involving participants contained meaningful data on fat mass in the ADF group and in the control group. In terms of lean mass, five RCTs had an appropriate sample size of patients 89 in the ADF group and 73 in the control group.
Figure 6. Forest plots showing changes between two groups in A fat mass, B lean mass, C systolic blood pressure SBP , D diastolic blood pressure DBP ; total calorie intake; SD, standard deviation; IV, inverse variance; CI, confidence interval; df, degrees of freedom.
Four RCTs involving participants contained meaningful data on SBP and DBP 90 in the ADF group and 85 in the control group. A random-effects model was chosen to estimate changes between the two groups.
Recently, the most commonly used diet strategy for weight loss is calorie restriction. In many parts of the world, ADF is an age-old way that includes many forms. For example, Ramadan is a form of ADF and abided by Muslims all around the world If someone wants to lose weight, it is generally recommended to restrict diets and exercises in clinical practice guidelines 39 , The traditional methods of losing weight such as the daily calorie restriction , although the effect is affirmative, the control and compliance are poor Based on this foundation, intermittent fasting regimens, especially ADF protocols, are being proposed in many pieces of literature 9 , 19 , 33 — The important unsolved issue is whether the effects of ADF can play a role for people who want to lose weight.
This quantitative meta-analysis summarized the evidence from RCTs. We performed this meta-analysis from seven studies, including participants, to evaluate the effect of ADF on weight loss for at least 1 month.
In this case, we selected some meaningful indexes of many diverse indicators to illustrate this difference between the two groups. Based on our results, ADF was the positive influential method on the physiology, body composition, and parameters for obesity or a normal human.
For the first time, this meta-analysis suggested that ADF is a potentially superior alternative to daily calorie restriction in normal-weight and overweight subjects. Just the way we assumed, the ADF strategy was effectively reduced body-related biomarkers, such as weight, BMI, and so on.
Compared with the complete calorie restriction method, ADF had a lower capacity for weight management. In animal experiments, weight loss can redistribute fat in the ADF group without losing lean mass New research showed that exercise plus ADF would experience the largest reductions in cardiometabolic risk factors, with the least decrease in lean mass compared with ADF alone Also, it could be suggested as an alternative option for daily calorie restriction CR in treating nonalcoholic fatty liver disease On the one hand, the decrease of liver enzymes might be explained by an improvement in visceral fat or steatosis of the liver in animal and human experiments.
The phenomenon showed that ADF could promote hepatocyte restorative process when transient autophagy occurred to liver cells However, the exact molecular mechanisms that underlie fasting and liver autophagy need to be further studied and established The research suggested that ADF had effects on cardiovascular improvements.
As is known to all, alterations in cholesterol metabolism were known to be powerful predictors of developing cardiovascular events, even in the early stages of atherosclerosis For instance, abnormal cholesterol metabolism, including low intestinal cholesterol absorption and elevated cholesterol biosynthesis, played an important role in metabolic syndrome, obesity, and diabetes This diet strategy may also have cardioprotective effects in participants by reducing triacylglycerol and increasing LDL particle size and adiponectin concentration.
To our knowledge, the Mediterranean and certain low carbohydrate diets help maintain a healthy weight and reduce the risks of coronary heart disease. If ADF were combined with a Mediterranean diet or a low-carbohydrate diet, it would be meaningful to observe how it affects weight loss and cardiovascular outcomes in future studies 48 , To improve lipid, the combination of diet and exercise is more effective than diet or exercise alone Previous research has already demonstrated that glucose and insulin have been associated with obesity.
Thus, it is important to manage and control glucose levels and insulin resistance At the same time, the significant decrease in fasting insulin may potentially be attributed in part to the decline in body weight and the reduction in total body fat We found a significant reduction in lean mass in the ADF group.
This serves as a caution for patient populations at risk for sarcopenia because ADF could exacerbate muscle loss. Some studies indicated that ADF is the most beneficial diet strategy for lowering fasting insulin, glucose, and HOMA-IR.
However, there was no significant difference in insulin resistance between the two groups. It suggested that ADF plus exercise might reduce insulin resistance, which needs to be further elucidated Meanwhile, ADF did not result in a decline in bone mineral density or white blood cell count.
It might even have a trend to increase bone mineral density values for a long period 54 — In a recent study we founded, ADF likely makes little differences compared with continuous energy restriction, but ADF probably slightly reduces body weight and fat mass.
In additional analyses, no important differences were detected when comparing different types of ADF vs. nonconsecutive days Randomized control trials suggested that ADF is effective for weight loss, weight maintenance, and improving certain metabolic disease risk factors such as LDL cholesterol, blood pressure, and fasting insulin after 6 months ADF had some physiological benefits with similar daily calorie restriction ADF might lead to fat redistribution from visceral to subcutaneous depots in female mice Evidence suggested that plasma adiponectin was inversely proportional to visceral fat accumulation 65 , Thus, the redistribution in body fat by ADF may be linked to increases in plasma adiponectin observed.
The claim is Ketosis and Nutritional Ketosis fasting even BCAA for strength training fasting makes you Alternaet-day, sluggish, and prone to weight metaoblic following a refeed. Fastijg makes Alternae-day that depriving your body Alternate-day fasting and metabolic rate nutrients would have a metabolic-shutdown effect. But the meme is only half true. Sure, if you chronically restrict calories—or starve for many days on end—your metabolic rate will tank. Which means the lost weight will come back. But intermittent fasting—or periodically limiting calories—is a different beast altogether. IF, in fact, has radically different effects on human metabolism than long-term calorie restriction.
Mefabolic fasting ADF is a restrictive type metabolif intermittent Ketosis and Nutritional Ketosis that is Alternate-eay used for weight loss. However, its Sip your way to hydration safety is questionable. Here's what you need to know about the benefits and risks of ADF, plus some alternatives to the fasting regimen. Alternate-day fasting, as the name suggests, involves fasting every other day. So, if you were to follow this fasting schedule, you would eat normally one day and fast the next day.
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