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Research Q: Does intermittent fasting have an impact on risk factors for disease?

Do intermittent diets provide physiological benefits over continuous diets for weight loss?
The authors did a systematic review of human clinical trials that involved intermittent fasting. The authors categorized the data by sample size, participant characteristics, the dropout rate, the duration of the study, and any changes that occurred such as weight loss or other health indicators. In most of the trials they evaluated, the participants were overweight or obese. The duration between each publication ranged usually from 12-13 weeks.

One finding that relates to my nutritional controversy is that intermittent fasting has been shown as an effective method for weight loss. There was no weight gain in any of the publications the authors reviewed. There was also a decrease in body size and adiposity and thus a decrease in BMI. However, when comparing intermittent fasting to calorie restriction, the publications showed that there was no significant difference in the weight loss between the two. A weakness of the study was that the authors could not draw conclusions of the effect of intermittent fasting on physical activity or hormone concentrations such as thyroid or sex hormones.

The authors also compared glucose homeostasis between intermittent fasting and calorie restriction. They saw there was inconsistent results from different publications. They compared it to calorie restricting diets and saw similar results which suggests that even if there is improvement in glucose homeostasis, intermittent fasting is comparable to calorie restriction. Because the controversy wasn't comparing calorie restriction to intermittent fasting, this finding can be considered a strength because it does show that intermittent fasting may have an effect on risk factors. However, it may be a result of the reduction of calories instead of the timing of when one eats.

From the systematic review, the authors cannot determine whether intermittent fasting is better than calorie restriction. This is also a result of the difference in trials between each publication and various participant characteristics. The majority of the publications did not perform follow up with the participants so long term effects of intermittent fasting cannot be determined.

The systematic review best supports the side of the controversy that intermittent fasting may or may not have an impact of risk factors on disease. There has not been enough controlled studies that show similar results to make a conclusion regarding this.

Meal Timing and Frequency
This review looked at epidemiological and clinical evidence linking eating patterns with health risk factors. They looked at eating frequency rather than the quality of one’s diet. Of the many eating patterns the authors looked at, one of them included intermittent fasting. They looked at two different methods of intermittent fasting. Alternate day fasting is when one eats less than 25% of their baseline energy intake one day followed by another day where they eat ad libitum. Periodic fasting is when one fasts once or twice a week and eat ad libitum the other days of the week.

Findings relevant to my nutrition controversy is that body weight decreased significantly among the participants. They saw that the effect of intermittent fasting on LDL cholesterol concentrations varied. Some studies stated there was a reduction while others stated there was no effect. The authors proposed the variable results may be a result of the participants’ baseline cholesterol levels. Those that had elevated levels showed a decrease. They also saw that the HDL cholesterol levels had no change and that triglyceride concentrations decreased.These findings can be considered a weakness because there is no clear effect intermittent fasting has on the cholesterol levels. There are variable results so no conclusions can be made.

The authors saw that there was also no effect on fasting glucose concentrations in healthy individuals but it can be beneficial for those who have prediabetes. There was a decrease in fasting glucose concentration in those with prediabetes. The authors saw there was a decrease in fasting insulin. The decrease in fasting insulin did not only apply to those who had prediabetes. They saw that those who had a greater average daily restriction had greatest decrease in insulin. Those that had the greatest weight loss had greater change in insulin resistance. A strength of this finding is that intermittent fasting may have an effect on decreasing insulin.

The authors concluded that intermittent fasting may lower triglyceride concentration and can be beneficial for lowering blood pressure. It can also be effective in decreasing fasting insulin and insulin resistance. Overall, the findings do not support my controversy because they state that there should be additional trials done to see if these effects are long term. Thus no conclusions in regards to intermittent fasting and health risk factors can be made.

Effects of intermittent fasting on body composition and clinical health markets in humans
The review looked at the effect of intermittent fasting on improving body composition and risk factors associated with disease. They looked into three methods of intermittent fasting: alternate-day fasting, whole-day fasting, and time-restricted feeding.

With alternate day fasting, there was decrease in weight and fat mass. Some studies showed decrase in fat-free mass while others saw no changes. A study suggest that on fasting days, one should eat a small meal to help retain lean-mass. A strength of this study is that there are some findings that show alternate day fasting reduces total cholesterol, triglycerides, and LDL cholesterol. The majority of the studies showed no difference in HDL concentrations. Due to the findings showing increasing LDL particle size, alternate day fasting may reduce cardiovascular disease. There are variable results because studies used different experimental designs, durations, and the participants shared different characteristics. There was also variation in fasting days. Some studies allowed up to 25% of baseline energy intake while other studies did not allow any calorie intake.

When the authors looked into whole day fasting studies, they compared caloric restriction with intermittent fasting. When both groups consumed the same amount of calories, they had the same losses in body weight and body fat. However, similar to the alternate day fasting studies, the whole day fasting studies all had different variables. Some studies did one day of fasting while others had two days of fasting. Thus, it is difficult to definitively declare what eating pattern is superior and whether the timing itself plays a role or do the benefits they see a result of reducing calories that naturally comes with intermittent fasting.

With time restricted feeding, the participants had to fast for 20 hours a day and can only consume their food in four hours. There was a reduction in body weight and fat mass. There were mixed results on cardiovascular disease health risk factors. They saw there were higher concentrations of total cholesterol, LDL, and HDL in those who are 1 meal per day compared to those who ate a normal 3 meals per day. They also saw lower concentrations of triglycerides in those who ate one meal per day. Because there are a limited amount of studies regarding time restricted intermittent fasting, again, no clear conclusions can be drawn.

The authors also looked into studies regarding short-term fasting which usually consisted of 2 to 4 days without eating. Even though this time length is longer than the typical intermittent fasting studies, there was a study done on young adult men and they were examined at 6 and 12 hour intervals from hour 12 to hour 72 of fasting. They saw that between 12 and 24 hours there was an increase in plasma glycerol concentration. There was also an increase in fat oxidation and a decrease in glucose oxidation. This shows that short fasts from 18 to 24 hours may be able to breakdown stored triglycerides and fat oxidation. Another study showed increase in plasma fatty acids and B-hydroxybutyrate and decrease in plasma triglycerides. This indicates that fasting can lead to relying on fat for energy.

Alternate day fasting and whole day fasting  has been shown to reduce body weight, body fat, total cholesterol and triglycerides. However, more studies should be conducted to determine the optimal intermittent fasting practice and the long term effects of the fasting. Again, the overall findings do not support my controversy because they state that there should be additional trials done to see if these effects are long term. Thus no conclusions in regards to intermittent fasting and health risk factors can be made.

Metabolic Effects of Intermittent Fasting
This review looked at the health benefits and physiological mechanisms of intermittent fasting. They looked at both human studies and rodent models. In rodent studies using alternate day fasting, many publications saw that intermittent fasting was comparable to caloric restriction. It showed similar results in the reduction of body weight and fasting insulin and glucose concentrations. The rodent models also showed a decrease in plasma cholesterol, triglyceride concentrations, liver steatosis and inflammatory gene expression. This can be considered a strength because this does indicate that intermittent fasting may have an effect. However, this was done on a rat model and not humans so it cannot be directly applied. For modified fasting regimes where energy intake was limited to about 25% baseline energy on fasting days showed a decrease in visceral fat, leptin, and resistin and increase in adiponectin in mice. They also saw reduce adipocyte size, cell proliferation and levels of insulin-like growth factor.

In human studies, some studies showed improvements in LDL cholesterol and triglycerides. Other studies showed improvements in inflammatory markers like C-reactive protein, t umor necrosis factor, adiponectin, leptin and brain-derived neurotrophic factor. However, after evaluating the reviews, the authors state that the intermittent fasting regime was not superior to that of typical calorie restriction. A weakness of the findings is that more controlled studies have to be done to show the effects on health risk factors.

In rodent studies, time restricted feeding has shown to reduce body weight, total cholesterol, triglycerides, glucose, insulin, and improve insulin sensitivity. There were only four human trials done on this fasting regime. There was reduction in fasting glucose and improvement in LDL and HDL cholesterol.

The authors also looked into the relation of circadian biology to intermittent fasting. Consuming energy outside the normal feeding phase can cause a disruption in energy balance and will reset some peripheral clocks. There has been studies that show that disruption of circadian rhythms is associated with increase risk of cardiometabolic disease and cancer. Studies show that fasting regimens that reduce energy intake in the evening can synchronize food ingestion with times of optimal postprandial hormonal response.

They also looked at the relation of gut microbiota to fasting. Studies show that extended fasting period can lead to a reduction in gut permeability and can have positive impacts. Studies have been done on mice on energy expenditure when on an intermittent fasting regime and it showed increased locomotion and improved circadian activity rhythms. However, there is no data on intermittent fasting impact on humans in regards to energy expenditure.

An overall weakness of the findings is that there is limited data on the effect of intermittent fasting on diabetes, cardiovascular disease, cancer and other chronic diseases.

Distraction, not hunger, is associated with lower mood
Besides the scientific results of intermittent fasting, one has to consider the psychological dimension. The findings in the study relates to my nutritional controversy because despite the benefits that intermittent fasting can provide, one has to consider the anxiety, mood, anger, emotion, and concentration that can occur. The mechanisms linking these effects to food restriction are still unknown. However, there has been findings that dieting can impact the mood and performance of individuals.

The authors were interested in investigating the relationship of mood and intermittent fasting because intermittent fasting will have less of an impact on a consumer's choice of food. For example, the "rules" of intermittent fasting is clear cut and one can only eat at certain periods of time and the type of food is not restricted. Thus, they expected that intermittent fasting would have a lower impact on mood and work performance.

A study with lean females looked at the mood, perceived work performance, and distraction on fasting and non-fasting days. Fasting days show lower positive mood and higher negative mood compared to non-fasting days. Distraction was taken account in the study to determine the amount of attention the participants needed to fast.

A weakness of the article is that intermittent fasting does not provide benefits in mood or perceived work performance compared to traditional dieting.This study supports the side of the controversy that intermittent fasting will not provide psychological benefits compared to calorie restriction.

Intermittent fasting promotes prolonged associate interactions
Intermittent fasting and dieting restriction has been shown to provide positive effects on physiological conditions and can improve some factors in disease. The findings in the study relate to my nutritional controversy because one has to take into consideration the impact of intermittent fasting on the cognitive functions of the brain.

There has been studies that show high caloric diets will deteriorate cognitive functions and conversely, caloric restriction can improve learning and memory in humans and animals. It has also been shown to promote synaptic plasticity.

The researchers looked into intermittent fasting on the metaplastic properties of synapses. They performed their research on male mice using whole day fasting, 16 hour fasting, and 12 hour fasting over a period of seven months.

The strengths of the article is that intermittent fasting has shown to provide a stress response in brain cells. There is upregulation of neurotrophic factors and there is cognitive augmentation. They saw that prolonged intermittent fasting will act as a behaviorial metaplastic signal that prepare synapses for late-associate interactions.16 hour and 24 hour fasting causes a change in metaplasticity signals but the researchers have not determined the molecular pathway of the mechanism.

This article supports the side of the controversy that intermittent fasting can provide physiological benefits and metaplastic signals which can improve memory formation.

Meal pattern alterations associated with intermittent fasting
Intermittent fasting has already been shown to have many physiological benefits and the researchers of this study were interested in how one's meal patterns as a result of intermittent fasting. This is related to my nutritional controversy because intermittent fasting can alter how one eats the meal, from initiation to duration and termination. It is important to observe the long-term effects intermittent fasting can provide on a participant.

By the end of the 70 days, both the intermittent fasting-high fat dieters and intermittent fasting-low fat dieters had larger first meals and had a higher first meal eating rate. The intermittent fasting-low fat dieters also ate the first meal for longer period of time.

The strength of the findings in the research is that they saw intermittent fasting will alter first meal size, duration and rate but the average meal size and average meal duration was influenced by whether the diet was high or low fat. Thus, intermittent fasting will have an effect on one's meal pattern. However, after restoring the mice to an ad libitum diet, they saw that following weight restoration, the effect on eating patterns has disappeared. These effects they saw were temporary and only when the mice were under an intermittent fasting protocol.

A weakness of the finding is that the trial was done on obese male mice. The authors acknowledged that there are sex-dependent differences in food intake and weight loss and advise that there should be further trials and studies conducted on female mice and on humans.

Increasing Neuroplasticity to Bolster Chronic Pain Treatment
The researchers were interested in the relationship of neuroplasticity and chronic pain. There has been findings that changes with the brain as a result of chronic pain can be reversed with clinical techniques. Chronic pain treatments can be combined with neurobiological strategies to improve memory retention. Many of these strategies are invasive but there can be other changes such as exercise, video games, calorie restriction, and intermittent fasting.

The findings in the paper is related to my nutrition controversy because the researchers were looking into how intermittent fasting can be used in chronic pain treatment. Intermittent fasting can increase synaptic plasticity and stimulate production of new neurons. Thus, it can play a role in age-related diseases and processes. A strong point is that there are implications that intermittent fasting can promote health-related benefits as well as a decrease in pain experience.

The weakness of the findings is that there has not been enough clinical treatment interventions with intermittent fasting to determine the definitive effect on chronic pain treatment. The authors implicated the relationship due to the underlying mechanisms that occur in intermittent fasting that can enhance neuroplasticity. During intermittent fasting, there is an increase in neurotrophic growth factors which will positively impact neuronal survival and synaptogenesis.

The findings from this paper does not lean towards any specific side of my controversy. The authors were reviewing past studies that were done and performing synthesis of past findings and the mechanisms that are known to determine what next steps should be taken in future clinical trials.