Adapted from Medscape, What do we know about intermittent fasting by Carla Martinez Nov 28 2022
A session was dedicated to intermittent fasting at the 63rd Congress of the Spanish Society of Endocrinology.
In animal studies it has been shown that the same number of calories consumed in the morning result in greater weight loss/less fat deposition compared to when the same number of calories are consumed in the late afternoon or evening. Results in humans are less consistent though. My comment: perhaps because they watch television and have well stocked cupboards and fridges!
In humans who ate late, they reported twice as much hunger as the early eaters and energy expenditure and body temperature both reduced by 5%. Thus early eating seems to be more favourable.
Intermittent fasting regimes can very greatly in the window of opportunity allowed for feeding. Researchers found that being consistent with whatever schedule they followed resulted in reduced body weight, an improvement in metabolic efficiency, sleep duration and sleep quality, cardiovascular health, level of mood and quality of life. My comment: so many of us work variable shifts or have different wake and sleep times, feeding times and exercise patternson work days compared to off days.
Caloric restriction with a generous ten hour eating window resulted in weight, blood pressure and lipid improvements in people who had metabolic syndrome. Even in healthy subjects such as firemen who worked 24 hour shifts, limiting food intake to ten hours resulted in a reduction in HbA1c, LDL and diastolic blood pressure.
Dr Labayen is working on the Extreme Project which is testing obese people from Navarra and Grenada in Spain. There are 200 subjects, evenly spread between men and women, and they are advised to follow a Mediterranean diet and consume all their food within an 8 hour eating window. They are divided into early eaters, late eaters and free choice of eating window eaters. How easy the diet is to maintain and its effectiveness on body measurements and any side effects are being measured.
So far there have been fewer side effects than expected with night time hypoglycaemia more pronounced in the early eating group. There is more fat and muscle loss in the time restricted eating subjects compared to a control group who are not restricting their eating time, and the window time has not made any difference. Cardiovascular factor improvement seems to be the most noticeable effects.
Rafael de Cabo PhD, on the other hand primarily works with animals, particularly monkeys and mice. Perhaps, as these animals are not free to cheat on their diet, the effects have shown to be much better than in humans. Fasting has been shown in animals to improve cardiovascular disease, diabetes, cancer, and neurodegenerative disorders. A smaller eating window produces more positive effects than a larger window. Circadian rhythms improve, they eat fewer calories overall, weight and body fat reduces, blood pressure, oxidative stress, inflammation, and arteriosclerosis all are reduced. Hunger is also reduced. These effects occur whether the animals are obese or not. The difficulty is transferring these results to the general public. Currently there are at least 50 human trials underway with increasingly larger cohorts and different forms of intermittent fasting are tried out.
Around one in four UK adults is living with obesity. Previous research has established that the most effective way to lose weight is through behaviour change with diet and physical activity counselling. It has not been clear whether one to one sessions or group sessions produce the better outcome. Thus a review of 7 studies which included 2,576 participants from the UK, US, Australia, Germany and Spain was done.
The study looked at the outcome of reaching at least a 5% reduction in body weight after a year. This means that a person of 100kg would lose 5kg.
Compared to one to one sessions, people in group sessions:
Lost on average 1.9kg more weight
Were 58% more likely to lose at least 5% of their body weight
Group classes had 12-55 hours treatment time and those in one to one sessions had 2.5 to 11 hours.
The costs of treating people in groups is also lower than one to one sessions. The quality of life of people who are obese would be more likely to improve and their would be fewer cases of diabetes, heart disease, stroke, and cancer that all require medical treatment.
NICE are intending to publish revised guidelines on the treatment of obesity in 2023.
Healthcare professionals can now confidently say that group educational programmes are at least if not more effective than one to one sessions when referring or advising patients. Social support in groups and more intensive interventions may account for greater success but for some people eg who are anxious in groups or who need translators, or even just patient preference, will mean that one to one sessions will still need to be offered. Further research into what specific factors improve results would be helpful.
After considerable number crunching a low carb colleague has come to the very reasonable conclusion that the worst food in the world for weight gain is the fried potato in its several incarnations.
In the USA French Fries are what we in the UK call Chips. In the USA Chips are what we in the UK call Crisps.
These are ubiquitous and difficult to avoid particularly if you eat in fast food restaurants. Even if you order a sandwich you may be given a side order of chips or crisps.
Tucker explains that the vegetable and seed oils that these items are fried in play havoc with the appetite control centres of your brain. This article serves as a reminder, since we are all still at least trying to keep to our New Year’s Resolutions, why it would be better to avoid having them on your plate or hand in the first place. And just the one or two….who are you kidding?
Everyone knows how hard it is to shift body fat after having a baby. A recent study suggests that adopting a low carb diet featuring plentiful meat/poultry/fish and animal fats was more successful than having a low carb diet based mainly around plant foods.
Readers who are keen to shed their post holiday season weight gain may also find this information useful.
Low-carbohydrate diets (LCD) have been considered a popular dietary strategy for weight loss. However, the association of the low-carbohydrate dietary pattern with postpartum weight retention (PPWR) in women remains unknown.
The present study involved 426 women from a prospective mother-infant cohort study.
Overall, animal or plant LCD scores, which represent adherence to different low-carbohydrate dietary patterns, were calculated using diet intake information assessed by three consecutive 24 h dietary surveys.
PPWR was assessed by the difference of weight at 1 year postpartum minus the pre-pregnancy weight. After adjusting for potential confounding variables, women in higher quartiles of total and animal-based LCD scores had a significantly lower body weight and weight retention at 1 year postpartum (P < 0.05). The multivariable-adjusted ORs of substantial PPWR (≥5 kg), comparing the highest with the lowest quartile, were 0.47 (95% confidence interval 0.23–0.96) for the total LCD score (P = 0.021 for trend) and 0.38 (95% confidence interval 0.19–0.77) for the animal-based LCD score (P = 0.019 for trend), while this association was significantly attenuated by rice, glycemic load, fish, poultry, animal fat and animal protein (P for trend <0.05).
A high score for plant-based LCD was not significantly associated with the risk of PPWR (P > 0.05). The findings suggested that a low-carbohydrate dietary pattern, particularly with high protein and fat intake from animal-source foods, is associated with a decreased risk of weight retention at 1 year postpartum. This association was mainly due to low intake of glycemic load and high intake of fish and poultry.
Adapted from Co-enzyme Q10 in Cardiovascular and Metabolic Diseases: Current State of the Problem, by Vladlena I Zozina et al. Current Cardiology Reviews 2018 Aug: 14(3) 164-174.
Co-enzyme Q10 (CoQ10) is an essential compound of the human body. There is growing evidence that it is tightly linked to cardiometabolic disorders. Supplementation can be useful in a variety of chronic and acute disorders. This review article discusses its role in hypertension, ischemic heart disease, myocardial infarction, heart failure, viral myocarditis, cardiomyopathies, cardiac toxicity, dyslipidaemia, obesity, type 2 diabetes mellitus, metabolic syndrome, cardiac procedures and resuscitation.
CoQ10 is made in the inner membrane of the mitochrondia. These are the little batteries which power your cells. It exists as ubiquinone which is oxidised and ubiquinol which is does not have oxygen attached. It is a key component of electron transfer in ATP production, which is how cellular energy is generated.
It is also an intercellular anti-oxidant. It also plays a role in cell growth and differentiation. There are many diseases and degenerative states associated with CoQ10 deficiency such as type 2 diabetes, atherosclerosis, hypertension, dyslipidaemia, muscular dystrophy, Alzheimer’s disease and Parkinson’s disease.
Administration of selenium and CoQ10 in a group of elderly people over 4 years resulted in significantly reduced cardiovascular mortality over the next ten years. This new review aims to sum up current possibilities in a variety of conditions with an analysis of the impact on health and quality of life.
CoQ10 is found in all organs but the highest concentrations are in the heart, kidneys, liver and muscles.
Three out of four patients with heart disease have low levels of CoQ10, particularly in ischaemic heart disease and cardiomyopathy.
In 2010 31% of all adults had hypertension. This rate is rising, particularly in low income countries.
CoQ10 has a direct effect on the lining of blood vessels, the endothelium, which dilates the blood vessels in hypertensive people and so reduces blood pressure. It also has a blood pressure lowering effect via the angiotensin effect in sodium retention and lowers aldosterone. Blood pressure can be lowered as far as normal levels with CoQ10 and has been measured as reducing systolic bp by 11 mmHg and diastolic by 7mmHg.
Giving 300mg daily of CoQ10 has been shown to reduce inflammatory markers and raise anti-oxidant enzyme activity. It is well known that a pro-inflammatory effect is a major component of chronic disease.
In 2013 cardiovascular diseases were a worldwide leading cause of death causing about a third of all deaths. A randomised study showed that in patients with myocardial infarction and hyperlipidaemia, supplementation resulted in lower blood pressure and a beneficial rise in HDL. After primary angioplasty after a heart attack, patients with higher levels of CoQ10 had better ventricular performance at 6 months follow up.
In rat studies infusion of CoQ10 results in less cardiac damage when their cardiac vessels are occluded to provoke cardiac ischaemia.
Heart failure causes less blood to be pumped out of the heart with every heart beat. This can be from a combination of structural and functional heart problems. HF is the cause of a huge amount of hospitalisation and cardiac impairment. Deaths from HF range from 10% to 50% per year. The plasma level of CoQ10 has been found to predict mortality in HF patients. Supplementation has been found to be beneficial in raising the level and decreasing mortality rates.
CoQ10 helps the heart muscle beat with more power. 100mg given three times a day to HF patients showed a reduction in cardiovascular mortality (9% v 16%), all cause mortality (10% v 18%) and number f hospital stays. Exercise tolerance was improved at the end of 2 years observation.
In those patients on the waiting list for heart transplants, CoQ10 users had a significant improvement in functional status, clinical symptoms and quality of life. Although the drugs for HF are still essential, there can be some additional benefits to CoQ10 supplementation.
Atrial Fibrillation is increasing worldwide year on year and is associated with symptoms and mortality. Supplementation has been found to reduce arrhythmias after surgery or drugs to stimulate the heart muscle after surgery.
In mice studies survival rate was higher in those given CoQ10 than those who were not when they had viral myocarditis. In humans both CoQ10 and trimetazidine have been found to be effective.
Cardiomyopathy is associated with a high mortality and poor quality of life. It is linked to increased oxidative stress. Supplementation has been found to improve both cardiac structure and function. Fatigue and breathlessness improved. These studies have been done in both adults and children.
Cardiac toxicity is an unwelcome side effect for certain cancer drugs used in chemotherapy. CoQ10 and L-carnitine together have been found to be cardio-protective.
Supplementation has been found to reduce side effects of statins in heart failure patients. This is because statins deplete CoQ10 levels.
Although low CoQ10 has been found in type 2 diabetes patients, supplementation had no effect on glycaemic control, lipid profile or blood pressure. Triglyceride levels were reduced.
In patients with metabolic syndrome had a beneficial effect on insulin levels with supplementation.
Women with polycystic ovarian syndrome had a beneficial effect on glucose metabolism, and cholesterol levels with supplementation.
Studies have been done during and after cardiac surgery and in the management of post cardiac arrest care. In one study hypothermia plus supplementation resulted in considerably improved outcomes compared with hypothermia without supplementation. The three month survival was 68% v 29%.
Supplementation studies have shown a potential role in septic and haemorrhagic shock patients.
Further research needs to be done to establish the optimal doses to give for various conditions and situations.
Levels of 100 -300mg of CoQ10 per day seem to be effective for a wide range of problems.
A longitudinal study of women from Oakland California has been following 19 thousand of their offspring since the early 1960s.
So far 68 people have been diagnosed with colorectal cancer.
Risk factors include: obesity in the mother, weight gain during pregnancy, and a high birthweight. This suggests that uterine life has something to do with why this cancer develops. This could explain why there has been a relatively recent increase in colorectal cancer in younger aged adults. Unfortunately there is little you can do yourself about these factors.
Adapted from BMJ: Hiding unhealthy heart outcomes in a low fat diet trial: The Women’s health initiative randomised controlled dietary modification trial finds that post menopausal women with established coronary heart disease were at increased risk of an adverse outcome if they consumed a low fat “heart healthy” diet. by Timothy David Noakes. Open Heart. 2021.
The WHI trial was designed to test with the US Department of Agriculture’s 1977 Dietary Guidelines for Americans protects against coronary heart disease (CHD) and other chronic diseases.
The only significant finding was that post menopausal women with CHD randomised to a low fat diet in 1993 were at a 26% greater risk of developing additional CHD events compared to women eating the control diet. In 2017 an additional 5 years of follow up data was published. It found that the risk for this group of women had increased to 47-61%.
The authors sought to explain why this was but author Tim Noakes has looked at the evidence and his opinion is that the women who had consumed 13 years of a low fat/high carbohydrate diet had inadvertently succumbed to the features of insulin resistance. Their risk of type 2 diabetes went up almost eleven fold and metabolic syndrome went up six fold.
Dr Noakes advises that according to the principle of “do no harm” the practice of putting women on low carb diets if they are diagnosed with cardiovascular disease is certainly not evidence based and probably not ethical.
The WHI is one of the most expensive long term dietary intervention trials ever undertaken. It started in 1993. Although the advice was given to cut dietary fat, particularly saturated fat in 1977, the policy had never actually been tested regarding its effects on weight, CHD, cancer and type two diabetes.
The idea was to replace the calories from saturated fat with increased carbohydrates from grains, fruits and vegetables. The effect of this was to lower blood cholesterol concentrations. The trial did not seek to replace saturated fat with polyunsaturated fat as studies of this had been published in 2013 and 2016.
Nutritionists led the first year 18 group sessions followed by individual follow up every 3 months. Feedback was given so as to encourage low fat intake.
A low fat diet was not found to improve rates of breast cancer, colorectal cancer, and only resulted in 0.4 kg weight loss over the first 8 years of the trial. The more women adhered to the low fat diet, the more weight they gained. The women who ate high fat, lower carb diets, the more weight they lost.
Blood sugar started to deteriorate in the first year of the trial for the low fat diet group. Post menopausal women who went on statins were at a 49% increased risk of developing type two diabetes. A prior meta-analysis had found that there was a 9% chance of developing type two diabetes with statin use.
The 2017 report analysed women in subgroups: No CHD or hypertension. Hypertension only. and pre-existing CHD. The idea was to see who may benefit or lose the most from the low fat intervention.
Women with hypertension only had neither benefit or harm from the low fat diet. Women who had no pre-existing hypertension or CHD had a small reduction in CHD risk but this was off set by a higher risk of stroke.
Regarding another study, the ERA trial, women who were on HRT who reported that they ate the most saturated fat over the trial time of three years, found that their coronary atheroma did not progress. In fact there was a modest regression in coronary artery narrowing. Both those who ate the most polyunsaturated fat, and those who ate the highest amount of carbohyrate and therefore the lowest amount of total fat showed worsening of their coronary atheroma.
Statin use was similar in both groups who were randomised to each diet, low fat versus usual. Indeed more than 40 percent of the women in each group were on statins.
Only post menopausal women who do not have CHD or hypertension are safe to eat the low fat diet, the others can expect some negative effects.
The Women’s health study (WHS) was established between 1992 and 1995 at Harvard Medical School to look into the effects of aspirin and vitamin E on the risks of developing CHD or cancer in women who started off with neither condition.
The study showed no benefit for either treatment.
A 21 year follow up programme of over 2,800 of these women evaluated more than 50 different clinical, lipid, inflammatory and metabolic factors.
Results showed that the development of Type two diabetes, and not high cholesterol levels were important factors in the development of CHD. Hypertension gives a 4.58 fold increase in CHD. Obesity gives a 4.33 fold risk. These factors as well as type two diabetes and metabolic syndrome were more predictive of CVD than smoking.
A Lipoprotein Resistance Score was developed looking at various factors particularly VLDL and HDL and a high level produced a 6.4 fold risk of cardiovascular disease. This is worsened in insulin resistance. LDL scores only gave a 1.38 fold risk of CVD by comparison.
The Progression of Early Subclinical Atherosclerosis Study looked at HbA1c in people who did not have type two diabetes. The higher the HbA1c, the higher the risk of CVD and the risk even started below HbA1c levels of 5.5%.
Women who had low HDL levels was associated with a higher breast cancer incidence and all cause mortality after breast cancer as well as an increased risk of cancer specific and all cause mortality.
The Recovered Minnesota Coronary Experiment (RMCE) study found that people randomised to eat more polyunsaturated fat in place of saturated fat were at a 22% higher risk of death with each 0.78 mmol/L reduction in blood cholesterol. This effect was worse in the over 65s.
The Recovered Sydney Diet Heart Study (RSDHS) showed that replacement of dietary saturated fat with linoleic acid was also associated with raised all cause mortality with increased deaths from cardiovascular disease and coronary heart disease.
Lawrence ( Lawrence GD Perspective: the saturated fat- unsaturated oil dilemma: relations of dietary fatty acids and serum cholesterol, atherosclerosis, inflammation, cancer and all cause mortality. Adv Nutr. 2021; 12: 647-56) concluded: PUVAs are unstable to chemical oxidation and their oxidation products are harmful in a variety of ways. They can initiate inflammation that can have dire health consequences. If saturated fats are replaced by carbohydrates in the diet there would be no significant improvement in serum cholesterol and it can result in a more atherogenic lipoprotein profile. …It appears that saturated fats are less harmful than the common alternatives.
This set of findings from four different studies effectively ends the debate about which diet should be eaten to lower the risk of CVD, especially in those with insulin resistance.
Two diets shown to prevent the clinical features of IR leading to type two diabetes are the restricted low calorie diet developed by Lim et al (Lim et al. Reversal of type two diabetes; normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetalogica 2011;54:2506-14.) and the ad libitum low carbohydrate higher healthy fat ketogenic diet.(Hite AH et al. In the face of contradictory evidence: report of the dietary guidelines for Americans Committee. Nutrition 2010;26:915-24.)
It is the ethical responsibility of those who manage those with cardiovascular disease or diabetes or other insulin resistance that they should NOT prescribe the never proven and now disproven low fat “heart healthy” DGA diet.
A survey of overweight adults from six countries in western Europe found that most strategies didn’t work.
The analysis was lead by diabetologist Dr Marc Evans from Cardiff said, ” It is important that we tackle Europe’s growing obesity problem to reduce hospitalisation from the multiple illnesses that result. Our survey results show that most adults with obesity are actively trying to address this, but most are unsuccessful whatever strategy they choose”.
The study looked at 1,850 adults from the UK, France, Germany, Italy, Spain and Sweden. All had BMIs of 30 or more. A quarter of the participants reported no ill effects from being overweight and the others commonly reported high blood pressure, lipid abnormalities and type two diabetes. 78.6% of them had tried to lose weight the previous year.
The most common methods used were: Calorie controlled or restricted diet 71.9%, an exercise programme 21.9%, drug treatment 12.3%, joining a gym 12%, using a digital health app 9.7%, alternative treatments 8.1%, weight loss service 7%, and cognitive behavioural therapy 2.1%.
The results were that 78% of those who attempted to lose weight did not lose 5% or more of their initial weight and some weighed more than this afterwards.
For those who tried calorie controlled or restricted diets 26.5% of people did lose weight but 17.1% of them gained weight.
For those who undertook an exercise programme 33.3% lost weight but 15.5% gained weight.
The gym goers lost weight 27% of the time but 32.4% gained. (We don’t know if this was muscle gain or fat gain though)
It seems that apart from baratric surgery few interventions achieve long term weight loss but an article in iScience published in 2021 found that health effects of obesity were considerably reduced or eliminated by having moderate or high levels of cardiorespiratory fitness. It argued that it might be better to emphasise the benefits of physical activity than stress weight loss as being the most important goal.
Meanwhile results from 80 thousand participants in the UK Biobank cohort show that more time spent in moderate to vigorous activity is associated with lower mortality. It doesn’t matter if you do these higher levels of activity in one go or in multiple bouts.
The National Office for Statistics from 2018 to 2020 show that men born in the poorest areas of the UK are expected to live ten years less than men from the most affluent areas. Poor men can expect to live a healthy life till the age of 52 and die around the age of 73. Wealthy men may expect to live in good health till they are 67 and die around the age of 83.
Women in the poorest areas can expect 19 fewer years in health compared to wealthier women. They can expect to be healthy in poor areas till they are 52 and this is 71 for wealthy women. Women in poor areas can expect to die around the age of 70 and wealthy women around the age of 86.
There has been a bit of a decrease in life expectancy generally in the last few years, pre-covid. David Finch of the Health Foundation says that improvement in incomes is needed to cope with the rising cost of living, secure jobs and decent housing.
My comment: What goes on at the doctor’s surgery and hospitals is just the tip of the iceberg regarding health. Housing, employment, a good diet, access to green spaces, social interaction, education, good transport, reduced pollution, clean water, freedom from violence, and good health behaviours such as diet and exercise habits, known collectively as the social determinants of health are much more important. Policies that will improve these factors are necessary to improve the situation. I would argue that living a healthy life is more important than an extra few years in a nursing home.
From Geobel A et al Journal of Clinical Investigation 1 Jul 2021
Many of the symptoms in fibromyalgia syndrome (FMS) are caused by antibodies increasing the activity of pain sensing nerves throughout the body according to new research led by the Institute of Psychiatry, Psychology and Neuroscience at King’s College London.
This is at odds of the currently held view that the condition arises centrally in the brain.
The researchers injected mice with antibodies of people who have FMS and saw that the mice rapidly developed increasing sensitivity to pressure and cold as well as reduced movement grip strength.
In contrast, mice who were injected with antibodies from healthy people were unaffected.
The injected mice recovered from their symptoms after a few weeks once they had cleared the antibodies from their systems. The researchers wonder if treatments that would reduced antibodies in patients with FMS could become an effective treatment.
Dr David Andersson, the lead investigator said, ” Treatment for FMS is currently focused on gentle aerobic exercise, and drug and psychological therapies designed to manage pain, although these have been proven to be ineffective in patients. There is an enormous unmet clinical need. Our work has uncovered a whole new area of possible therapeutic options and should give real hope to fibromyalgia patients”.
Diabetes Diet 