Intermittent Fasting: A Fleeting Fad or a Healthy Fettle?

Starving was in fashion during my growing years. It was all about tea and toast diet or cabbage soup diet and the quick weight loss with caloric restriction and then the inevitable weight gain, back to baseline and then some more.

The last few years of the internet, our patients seem to have many doctors. Those of us who choose to practice traditional medicine have become relegated to becoming legal drug dealers.

Everyone is selling patients quick ways and diets to help them lose weight. Some of these diets are totally unhealthy and dangerous plans and some have a basis in science.

Everyone is selling patients quick ways and diets to help them lose weight. Some of these diets are totally unhealthy and dangerous plans and some have a basis in science.

Is there really a science to all of this?

I will address intermittent fasting as this is something that has long existed and especially with our cultural background (desi) it is most likely the best and easy way to regain a lot of the lifestyle induced loss of health.

So what is intermittent fasting?

It is not a diet.

It is a pattern of eating.

History of intermittent fasting:

Fasting has been recorded in the bible. It is a part of the Hindu culture and also a part of Islam and many other religions cultures.

Medically it was discovered very early even before biblical times in the Hippocratic era. It was found that fasting helped seizures. In fact, it was a therapeutic intervention though much was not recorded about it.

The first therapeutic use recorded well, was the use of fasting in seizures treatment in 1911. Twenty adults and children were put through fasting and were noted to have fewer seizures in 2 to 3 days of the fast.

The initial reports included a family doc and a fitness guru. They realized that fasting was the “cure” for a lot of ailments.

The real documented study was done in Harvard by Drs. Cobb and Lennox. They found that a diet low in carbs made the body get its energy from acid forming fats. Soon it became apparent when carbohydrates were so low in proportion to the fats, 2 fatty acids called acetone and beta-hydroxybutyric acid, appear. So they deduced anything that induced what is called ketonemia would help with the health benefits of a fast (this finding also led to the birth of the ketogenic diet).

So how does intermittent fasting work?

Every cell has a cellular organelle called the lysosome. In biochemistry, it is considered the janitor of the cell. What does it do? It takes away the broken cells and replaces nutrients that the cells need.

Just like a janitor comes in after office hours to clean up the mess and then replaces soap and towels for use the next working day.

A significant disease from the loss of function of the lysosome is Tay-sachs disease marked by severe neuro degeneration and muscle weakness, ataxia, speech, and mental disorders. So lysosome function is crucial for our health.

So when you fast there is what is known as autophagy. This means the cells that are defective get eaten up. This job is done by the lysosome. So waste is removed but new nutrients are also brought in.

Changes seen with fasting:

Loss of food leads to decreased insulin and therefore increasing the breakdown of the fat stores. This leads to ketone (acidic fats) formation from the liver and from fat cells. The fatty acids are a great source of energy just not an efficient one. It is impossible to get to ketosis in the presence of insulin. Therefore any food you eat that increases insulin reduces ketosis. (Protein and carbohydrates).

Other hormones affected are the gonadotropins decrease (the body does not want you to reproduce if you have no food for survival).

Human growth hormone or HGH goes up helping release of the fatty acids for energy.

Metabolic changes noted:

Fat mass goes down, LDL particles size goes down (though initially LDL goes up and then down).

The triglycerides go down:

C reactive protein (a nonspecific marker of inflammation) goes down.
The Brain becomes sharp helping you probably look for your next “kill” (survival mode). Fasting done in both Type I and Type II mice showed regeneration of the islet cells the β cells.

Types of Fasting:

There are several ways to do fasting but some most studied are below.

1.Time restricted feeding or Intermittent fasting.

2. Alternate day fast.

3. Fasting mimicking diet ( calorie restricted eating for 3 to 5 days every month).

Water fast ( best studied in the inpatient setting for resolution of hypertension).

Before adopting a fast the goal is to establish why one would be doing this?

1.Reduce disease burden

2. Weight loss


4.Religious belief

Okay enough of the kidding we all want to look young and lose weight so how do you do this?
The 2 main types of fasting studied with significant weight loss are Intermittent (IF) and Alternate day fasting (AFD).

Intermittent fasting leads to 0.25 kg/week weight loss and the alternate day fast leads to 0.75kg/week weight loss.

The total caloric intake is reduced by 33% in IF and 40 % in ADF.

Intermittent fasting is best done over a period of 13 to 16 hours, which means you eat for 11 hours or the best method is eating in a 6 hour window.

Most people tend to fast in the morning and then eat later in the day. Studies have shown that breakfast still remains the best way to break your overnight fast. So eating at 10 am and stopping by 5 Pm as the last meal is the most helpful. The benefits of fasting are best when done this way.

So hours you can choose to eat are:

8 AM to 2 PM

10 AM to 4 PM

3 PM to 10 PM

Choose a window you are most likely to be successful at initially.

Though some people say it is okay to drink water, tea and coffee during the fasting window this has not been established. I would recommend using a keto meter and checking your ketones if you choose to drink any beverage during the fasting hours, at least for now.

Caution with fasting:

It is important to establish why you are doing the fast.

Eating unhealthy foods in the feeding window will and can lead to lifestyle induced disease process.

So choosing healthier foods ad libitum during your eating window would be the best.

The process is to reduce the visceral fat and therefor reduce insulin resistance and circulating lipoprotein particles. So if you are not losing weight it is because you are still not doing it right for you.

For the greatest success you need either a lot of discipline or great support or the right window of eating.

Conditions studied:

Most studies are done without a control.

Only 3 studies exist with a control. So there is not broad application for disease processes that has been well studied. The best study out there is the FEEL GOOD study: Fasting and Enhanced Expression of Longevity Genes during Food Abstinence (FEELGOOD) trial.

Some of the diseases fasting have been potentially shown to help:

1.Inflammatory disease like asthma and Rheumatoid arthritis.

2.Demyelination diseases like multiple sclerosis ( more ketogenic).

3.Metabolic disorders like hypertension( best with a water fast) , hyperlipidemia, type II diabetes.

4.Seizure disorder.


As physicians the best way to establish intermittent fasting for our patients is in a group setting.

Steps to get started:

1.Get a support group started.

2.Establish goals

3.Decide the window of feeding.

4.Most important is to change the home environment.

5.Prepare the foods.

Remember fasting improves both health span and lifespan.

So if you are struggling with multiple medical issues or find it very difficult to lose weight, you need to change your environment first. You cannot establish this way of eating if you are surrounded by people who love to eat and will not support you. The whole family has to be aware to eat at a certain time.

Cleaning out the pantry and freezer of junk foods is another way to change the environment.

f a close member of the family continues to have unhealthy eating habits and eating at all times it can jeopardize the initial efforts. There goes the 2 Am emotional snacking!

f a close member of the family continues to have unhealthy eating habits and eating at all times it can jeopardize the initial efforts. There goes the 2 Am emotional snacking!

So intermittent fasting has stood the test of time. In this world of abundance it is important to realize the choices we make help not only us but the next generation, when they do not have to take care of our health as we age because we did not choose to do the right thing through our life.

So as is always less is more, less food leads to more health and life span.

Disclaimer: This article is for information purposes only. It should not be construed as medical advice and no doctor patient relationship has been established.

Nisha Chellam is a functional medical internist and practices exclusively functional medicine and anti-aging medicine in Michigan.