Intermittent Fasting: Debunked?

So this particular study is a little bit outside my wheelhouse from the typical critical care data that I routinely appraise. I did find it quite interesting and worth my time to dissect because I have looked into intermittent fasting in the past. It is easy for me to admit that it is impossible for me to actually do intermittent fasting. Ok, nothing is impossible but I just don’t think it’s worth it for me. I am a creature of habit and my daily routine includes making Cuban coffee with milk and some sugar every morning as soon as I wake up. This is a routine that I will not negotiate getting rid of at this time. I know the rules of intermittent fasting include drinking black coffee but this is not something that brings me joy. Enough about me. Let’s dive into the article.

How do they define intermittent fasting?

The title of the article is “calorie restriction with or without time-restricted eating in weight loss”. It was published on 21 April of 2022 in the New England Journal of Medicine. I am not sure whether it is free for you all to download. Click the link in the citation below to figure out if this is free or not for you. I know that the title does not say “intermittent fasting” but the way the authors define this is “time-restricted eating is an intermittent fasting regimen that involves a shortened period of time for eating within each 24 hour period.” The authors went about performing the study as they explain in the introduction because they were not happy with the quality of previous studies looking at this weight loss strategy.

How many calories were the intermittent fasting and those not consuming?

When you read the methods you’ll find the first limitation of the study. These were trial participants in China. Whether these data are applicable to Americans remains to be seen. They tried to control the diets of these patients during the 12 months of the trial. Men following a diet of 1500 to 1800 kcal per day. Women consumed between 1200 to 1500 kcal per day. They took into account the percentage of calories from carbohydrates, protein and fat. The patients who were in the intermittent fasting group called the “time-restricted eating group” consumed their calories within an eight hour period. This took place from 8 AM to 4 PM each day. This is slightly different than the intermittent fasting windows that I have seen before which are usually in the late afternoon towards the evening. This was chosen because of the cultural differences of when the Chinese consume their largest meal. I am not going to bore you with how they received education and follow up for the trial.

What did they find in these two groups?

All in all, they recruited a total of 139 patients. 69 of them were in the intermittent fasting group and 70 of them were in the daily calorie restriction group. In my opinion, they were quite adherent to their regimens and calorie intake. When you look at the primary outcome of weight loss when can see that there’s no difference between the two groups at either six months or 12 months. The patient did lose weight in both groups though. It is just that one was not better than the other. This even applied to different subgroups which included the sex, BMI, and adherence to the prescribed diet.

When it comes to body composition, both groups did about the same. There were no substantial differences. Both groups lost lean mass, abdominal fat, subcutaneous fat, and liver fat. In addition, there’s no difference in the blood pressure, triglycerides, total cholesterol, the breakdown of cholesterol by HDL and LDL, and the other outcomes between the two groups. A strength here is that they follow the patients for an entire year. A limitation of the study, however is that they could not mention how many calories were being burned by the patient. Physical activity was also not controlled.

Wrapping up if Intermittent Fasting is all it’s hyped up to be.

All in all, intermittent fasting did not have any benefits over the regimen of daily calorie restriction. Simply cutting down on the calorie intake will get the job done based on this. I know some people will swear by intermittent fasting. To those people I say that I am happy they’ve found something that helps them out. I don’t have a dog in this fight and just wish everyone well in their journey to get healthier. After all, we know about how detrimental obesity is for patients in the current pandemic.

Citation to Intermittent Fasting

Liu D, Huang Y, Huang C, Yang S, Wei X, Zhang P, Guo D, Lin J, Xu B, Li C, He H, He J, Liu S, Shi L, Xue Y, Zhang H. Calorie Restriction with or without Time-Restricted Eating in Weight Loss. N Engl J Med. 2022 Apr 21;386(16):1495-1504. doi: 10.1056/NEJMoa2114833. PMID: 35443107.
Link to Article

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