Reflecting On The 5:2 Diet & Intermittent Fasting

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Re: Reflecting On The 5:2 Diet & Intermittent Fasting

Postby JeffN » Mon Dec 09, 2019 7:00 am

The benefit reported was from the subjects (average BMI of 35) consuming 9% fewer calories which resulted in the weight loss & it’s related benefits, not from TRF having some magical benefit. No surprise.


Ten-Hour Time-Restricted Eating Reduces Weight, Blood Pressure, and Atherogenic Lipids in Patients with Metabolic Syndrome
Wilkinson et al., 2020, Cell Metabolism 31, 1–13 January 7, 2020 a 2019 Elsevier Inc.
https://doi.org/10.1016/j.cmet.2019.11.004

Summary

In animal models, time-restricted feeding (TRF) can prevent and reverse aspects of metabolic diseases. Time-restricted eating (TRE) in human pilot studies reduces the risks of metabolic diseases in otherwise healthy individuals. However, patients with diag- nosed metabolic syndrome often undergo pharma- cotherapy, and it has never been tested whether TRE can act synergistically with pharmacotherapy in animal models or humans. In a single-arm, paired-sample trial, 19 participants with metabolic syndrome and a baseline mean daily eating window of R14 h, the majority of whom were on a statin and/or antihypertensive therapy, underwent 10 h of TRE (all dietary intake within a consistent self- selected 10 h window) for 12 weeks. We found this TRE intervention improves cardiometabolic health for patients with metabolic syndrome receiving stan- dard medical care including high rates of statin and anti-hypertensive use. TRE is a potentially powerful lifestyle intervention that can be added to standard medical practice to treat metabolic syndrome
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Re: Reflecting On The 5:2 Diet & Intermittent Fasting

Postby JeffN » Sun Dec 22, 2019 4:53 pm

A review of a popular trend in Meal Timing

Are large dinners associated with excess weight, and does eating a smaller dinner achieve greater weight loss? A systematic review and meta-analysis
Access Volume 118, Issue 8 28 October 2017 , pp. 616-628
DOI: https://doi.org/10.1017/S0007114517002550
Published online by Cambridge University Press: 02 October 2017

Abstract

There are suggestions that large evening meals are associated with greater BMI. This study reviewed systematically the association between evening energy intake and weight in adults and aimed to determine whether reducing evening intake achieves weight loss. Databases searched were MEDLINE, PubMed, Cinahl, Web of Science, Cochrane Library of Clinical Trials, EMBASE and SCOPUS. Eligible observational studies investigated the relationship between BMI and evening energy intake. Eligible intervention trials compared weight change between groups where the proportion of evening intake was manipulated. Evening intake was defined as energy consumed during a certain time – for example 18.00–21.00 hours – or self-defined meal slots – that is ‘dinner’. The search yielded 121 full texts that were reviewed for eligibility by two independent reviewers. In all, ten observational studies and eight clinical trials were included in the systematic review with four and five included in the meta-analyses, respectively. Four observational studies showed a positive association between large evening intake and BMI, five showed no association and one showed an inverse relationship. The meta-analysis of observational studies showed a non-significant trend between BMI and evening intake (P=0·06). The meta-analysis of intervention trials showed no difference in weight change between small and large dinner groups (−0·89 kg; 95 % CI −2·52, 0·75, P=0·29). This analysis was limited by significant heterogeneity, and many trials had an unknown or high risk of bias. Recommendations to reduce evening intake for weight loss cannot be substantiated by clinical evidence, and more well-controlled intervention trials are needed.
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Re: Reflecting On The 5:2 Diet & Intermittent Fasting

Postby JeffN » Fri Jan 17, 2020 7:02 am

While the abstract says the IF groups did as well, the study proves different. This was a 2 year study. While the results are not spectacular, continuous energy restriction (CER) did best over the 2 types of fasting. While the WOWO group had a slight edge during the first few weeks, CER was the clear winner through out the rest of the year and at 12 months & at the 24 month follow up. (See the charts attached).

Impact of intermittent vs. continuous energy restriction on weight and cardiometabolic factors: a 12-month follow-up
International Journal of Obesity https://doi.org/10.1038/s41366-020-0525-7

Abstract
Background and objective Intermittent energy restriction continues to gain popularity as a weight loss strategy; however, data assessing it’s long-term viability is limited. The objective of this study was to follow up with participants 12 months after they had completed a 12-month dietary intervention trial involving continuous energy restriction and two forms of intermittent energy restriction; a week-on-week-off energy restriction and a 5:2 programme, assessing long-term changes on weight, body composition, blood lipids and glucose.

Subjects and methods
109 overweight and obese adults, aged 18–72 years, attended a 12-month follow-up after completing a 12-month dietary intervention involving three groups: continuous energy restriction (1000kcal/day for women and 1200 kcal/day for men), week-on-week-off energy restriction (alternating between the same energy restriction as the con- tinuous group for one week and one week of habitual diet), or 5:2 (500 kcal/day on modified fast days each week for women and 600 kcal/day for men). The primary outcome was weight change at 24 months from baseline, with secondary outcomes of change in body composition, blood lipids and glucose.

Results
For the 109 individuals who completed the 12-month follow-up (82 female, 15 male, mean BMI 33 kg/m2), weight decreased over time with no differences between week-on and week-off and continuous energy restriction or 5:2 and continuous energy restriction with −4.5 ± 4.9 kg for continuous energy restriction, −2.8 ± 6.5 kg for week-on, week-off and −3.5 ± 5.1 kg for 5:2. Total cholesterol reduced over time and glucose, HDL, LDL and triglycerides were unchanged.

Discussion and conclusion Intermittent energy restriction was as successful in achieving modest weight loss over a 24- month period as continuous energy restriction.

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Re: Reflecting On The 5:2 Diet & Intermittent Fasting

Postby JeffN » Mon Sep 28, 2020 12:47 pm

No benefit/difference but greater muscle loss, and decrease in activity and lower adherence

Effects of Time-Restricted Eating on Weight Loss and Other Metabolic Parameters in Women and Men With Overweight and Obesity. The TREAT Randomized Clinical Trial
JAMA Intern Med.
Published online September 28, 2020.
doi:10.1001/jamainternmed.2020.4153

Full Text (attached below)
https://jamanetwork.com/journals/inteme ... .29942.pdf

Key Points
Question: What is the effect of time-restricted eating on weight loss and metabolic health in patients with overweight and obesity?

Findings: In this prospective randomized clinical trial that included 116 adults with overweight or obesity, time-restricted eating was associated with a modest decrease (1.17%) in weight that was not significantly different from the decrease in the control group (0.75%).

Meaning: Time-restricted eating did not confer weight loss or cardiometabolic benefits in this study.

Abstract

Importance: The efficacy and safety of time-restricted eating have not been explored in large randomized clinical trials.

Objective: To determine the effect of 16:8-hour time-restricted eating on weight loss and metabolic risk markers.

Interventions: Participants were randomized such that the consistent meal timing (CMT) group was instructed to eat 3 structured meals per day, and the time-restricted eating (TRE) group was instructed to eat ad libitum from 12:00 pm until 8:00 pm and completely abstain from caloric intake from 8:00 pm until 12:00 pm the following day.

Design, Setting, and Participants: This 12-week randomized clinical trial including men and women aged 18 to 64 years with a body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) of 27 to 43 was conducted on a custom mobile study application. Participants received a Bluetooth scale. Participants lived anywhere in the United States, with a subset of 50 participants living near San Francisco, California, who underwent in-person testing.

Main Outcomes and Measures: The primary outcome was weight loss. Secondary outcomes from the in-person cohort included changes in weight, fat mass, lean mass, fasting insulin, fasting glucose, hemoglobin A1c levels, estimated energy intake, total energy expenditure, and resting energy expenditure.

Results: Overall, 116 participants (mean [SD] age, 46.5 [10.5] years; 70 [60.3%] men) were included in the study. There was a significant decrease in weight in the TRE (−0.94 kg; 95% CI, −1.68 to −0.20; P = .01), but no significant change in the CMT group (−0.68 kg; 95% CI, -1.41 to 0.05, P = .07) or between groups (−0.26 kg; 95% CI, −1.30 to 0.78; P = .63). In the in-person cohort (n = 25 TRE, n = 25 CMT), there was a significant within-group decrease in weight in the TRE group (−1.70 kg; 95% CI, −2.56 to −0.83; P < .001). There was also a significant difference in appendicular lean mass index between groups (−0.16 kg/m2; 95% CI, −0.27 to −0.05; P = .005). There were no significant changes in any of the other secondary outcomes within or between groups. There were no differences in estimated energy intake between groups.

Conclusions and Relevance: Time-restricted eating, in the absence of other interventions, is not more effective in weight loss than eating


From the study...

On Adherence...

“Self-reported adherence to the diets was 1002 of 1088 (92.1%) in the CMT group (did not miss any meals) and 1128 of 1351 (83.50%) in the TRE group (ate only within the 8-hour win- dow) (Figure 2A).”

On Lean Mass....

“In analysis of secondary outcomes, we found a signifi- cant reduction in lean mass in the TRE group. In the in- person cohort, the average weight loss in the TRE group was 1.70 kg. Of this, 1.10 kg (approximately 65% of weight lost) was lean mass; only 0.51 kg of weight loss was fat mass. Loss of lean mass during weight loss typically accounts for 20% to 30% of total weight loss.16-22 The proportion of lean mass loss in this study (approximately 65%) far exceeds the normal range of 20% to 30%.22 In addition, there was a highly significant be- tween-group difference in ALM. Appendicular lean mass is cor- related with nutritional and physical status, and reduced ALM can lead to weakness, disability, and impaired quality of life.23-26 This serves as a caution for patient populations at risk for sarcopenia because TRE could exacerbate muscle loss.27 Finally, the extent of lean mass loss during weight loss has been positively correlated with weight regain.”


On Activity

“The Oura ring data also revealed a significant reduction in daily movement in the TRE group (−2102.14 au; 95% CI, −3162.54 au to −1041.73 au; P < .001) and between groups (−1673.44 au; 95% CI, −3211.11 au to −135.7 au; P = .03) but not in the CMT group (−428.70 au; 95% CI, −1542.25 au to 684.85 au; P = .45). There was a significant decrease in step count in the TRE group (−2498.89 steps; 95% CI, −3939.91 to −1057.88; P < .001) and between groups (−2241.41 steps; 95% CI, −4320.51 to −162.31; P = .04) but not in the CMT group (−257.48 steps; 95% CI, −1756.20 to 1241.23; P = .74). The correlation be- tween change in step count and change in TEE was 0.52 in the TRE group and 0.03 in the CMT group, but the 2 correlations did not differ significantly (eFigure 4 in Supplement 3).”
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Re: Reflecting On The 5:2 Diet & Intermittent Fasting

Postby JeffN » Fri Apr 30, 2021 6:32 am

Still not ready for prime time with little if any credible evidence for it.

Intermittent Energy Restriction, Weight Loss and Cardiometabolic Risk: A Critical Appraisal of Evidence in Humans
Healthcare 2021, 9(5), 495; https://doi.org/10.3390/healthcare9050495
Received: 26 March 2021 / Revised: 16 April 2021 / Accepted: 20 April 2021 / Published: 22 April 2021

https://www.mdpi.com/2227-9032/9/5/495

Abstract

Dietary patterns with intermittent energy restriction (IER) have been proposed as an attractive alternative to continuous energy restriction (CER) for the management of obesity and its associated comorbidities. The most widely studied regimens of IER comprise energy restriction on two days per week (5:2), alternate-day energy restriction by 60–70% (ADF), and timely restriction of energy intake during a specific time window within the day (TRF; time-restricted feeding). Although there is some evidence to suggest that IER can exert beneficial effects on human cardiometabolic health, yet is apparently not superior compared to CER, there are still some critical issues/questions that warrant further investigation: (i) high-quality robust scientific evidence regarding the long-term effects of IER (safety, efficacy, compliance) is limited since the vast majority of intervention studies had a duration of less than 6 months; (ii) whether the positive effects of IER are independent of or actually mediated by weight loss remains elusive; (iii) it remains unknown whether IER protocols are a safe recommendation for the general population; (iv) data concerning the impact of IER on ectopic fat stores, fat-free mass, insulin resistance and metabolic flexibility are inconclusive; (v) the cost-effectiveness of IER dietary regimens has not been adequately addressed; (vi) direct head-to-head studies comparing different IER patterns with variable macronutrient composition in terms of safety and efficacy are scarce; and (vii) evidence is limited with regard to the efficacy of IER in specific populations, including males, the elderly and patients with morbid obesity and diabetes mellitus. Until more solid evidence is available, individualization and critical perspective are definitely warranted to determine which patients might benefit the most from an IER intervention, depending on their personality traits and most importantly comorbid health conditions.

11. Conclusions

IER is an interesting subject in the research field of body weight regulation, CVD prevention and overall health promotion. However, given the relative paucity of long-term data, it is yet not clear whether IER provides a safe recommendation for the general population. Regarding body weight loss, parameters such as long-term adherence and compliance, personalization, efficacy, high-quality foods and balanced diet, negative energy balance, realistic goal setting and safety should be underlined.
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Re: Reflecting On The 5:2 Diet & Intermittent Fasting

Postby JeffN » Wed Jun 16, 2021 7:00 pm

Less effective

A randomized controlled trial to isolate the effects of fasting and energy restriction on weight loss and metabolic health in lean adults

Science Translational Medicine
16 Jun 2021:Vol. 13, Issue 598, eabd8034
DOI: 10.1126/scitranslmed.abd8034

Not so fast
Intermittent fasting is increasingly popular, but whether fasting itself offers specific nutritional benefits in lean individuals compared to traditional daily calorie restriction is unknown. In a small clinical trial of healthy individuals, Templeman et al. found that alternate-day fasting without energy restriction was ineffective at reducing body mass. Even with net energy intake restricted to that of daily dieters, alternate-day fasting less effectively reduced body fat content and offered no additional short-term improvements in metabolic or cardiovascular health compared to daily energy restriction.

Abstract
Intermittent fasting may impart metabolic benefits independent of energy balance by initiating fasting-mediated mechanisms. This randomized controlled trial examined 24-hour fasting with 150% energy intake on alternate days for 3 weeks in lean, healthy individuals (0:150; n = 12). Control groups involved a matched degree of energy restriction applied continuously without fasting (75% energy intake daily; 75:75; n = 12) or a matched pattern of fasting without net energy restriction (200% energy intake on alternate days; 0:200; n = 12). Primary outcomes were body composition, components of energy balance, and postprandial metabolism. Daily energy restriction (75:75) reduced body mass (−1.91 ± 0.99 kilograms) almost entirely due to fat loss (−1.75 ± 0.79 kilograms). Restricting energy intake via fasting (0:150) also decreased body mass (−1.60 ± 1.06 kilograms; P = 0.46 versus 75:75) but with attenuated reductions in body fat (−0.74 ± 1.32 kilograms; P = 0.01 versus 75:75), whereas fasting without energy restriction (0:200) did not significantly reduce either body mass (−0.52 ± 1.09 kilograms; P ≤ 0.04 versus 75:75 and 0:150) or fat mass (−0.12 ± 0.68 kilograms; P ≤ 0.05 versus 75:75 and 0:150). Postprandial indices of cardiometabolic health and gut hormones, along with the expression of key genes in subcutaneous adipose tissue, were not statistically different between groups (P > 0.05). Alternate-day fasting less effectively reduces body fat mass than a matched degree of daily energy restriction and without evidence of fasting-specific effects on metabolic regulation or cardiovascular health.
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Re: Reflecting On The 5:2 Diet & Intermittent Fasting

Postby JeffN » Thu Apr 21, 2022 6:39 am

Once again, not better

Calorie Restriction with or without Time-Restricted Eating in Weight Loss

Abstract

BACKGROUND
The long-term efficacy and safety of time-restricted eating for weight loss are not clear.

METHODS
We randomly assigned 139 patients with obesity to time-restricted eating (eating only between 8:00 a.m. and 4:00 p.m.) with calorie restriction or daily calorie restriction alone. For 12 months, all the participants were instructed to follow a calorie-restricted diet that consisted of 1500 to 1800 kcal per day for men and 1200 to 1500 kcal per day for women. The primary outcome was the difference between the two groups in the change from baseline in body weight; secondary outcomes included changes in waist circumference, body-mass index (BMI), amount of body fat, and measures of metabolic risk factors.

RESULTS
Of the total 139 participants who underwent randomization, 118 (84.9%) completed the 12-month follow-up visit. The mean weight loss from baseline at 12 months was −8.0 kg (95% confidence interval [CI], −9.6 to −6.4) in the time-restriction group and −6.3 kg (95% CI, −7.8 to −4.7) in the daily-calorie-restriction group. Changes in weight were not significantly different in the two groups at the 12-month assessment (net difference, −1.8 kg; 95% CI, −4.0 to 0.4; P=0.11). Results of analyses of waist circumferences, BMI, body fat, body lean mass, blood pressure, and metabolic risk factors were consistent with the results of the primary outcome. In addition, there were no substantial differences between the groups in the numbers of adverse events.

CONCLUSIONS
Among patients with obesity, a regimen of time-restricted eating was not more beneficial with regard to reduction in body weight, body fat, or metabolic risk factors than daily calorie restriction.
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Re: Reflecting On The 5:2 Diet & Intermittent Fasting

Postby JeffN » Sun Jul 03, 2022 4:19 pm

No advantage, At best, no better

Intermittent Energy Restriction for Weight Loss:
A Systematic Review of Cardiometabolic, Inflammatory and Appetite Outcomes
Biol Res Nurs
2022 Jul;24(3):410-428. doi: 10.1177/10998004221078079. Epub 2022 May 8.

PMID: 35531785 DOI: 10.1177/10998004221078079
Abstract

Current guidelines for obesity treatment recommend reducing daily caloric intake for weight loss. However, long-term weight loss continues to be an issue in obesity management. Alternative weight loss strategies have increased in popularity, such as intermittent energy restriction (IER), a type of eating pattern with periods of fasting alternating with unrestricted eating. The effects of IER on weight loss, cardiovascular risk factors, inflammation, and appetite are not clear. The purpose of this systematic review was to analyze short- (<24 weeks) and long-term (≥24 weeks) effects of IER on anthropometric, cardiometabolic, inflammatory, and appetite outcomes in adults with overweight/obesity. PubMed, CINAHL, Embase, and PsycInfo were searched from inception to July 2020. Human randomized controlled trials (RCTs) on IER with participants with a body mass index ≥25 kg/m2 were included in this review. A total of 42 articles (reporting on 27 different RCTs) were included. In short-term studies, IER showed pre-to-post treatment improvements in eight of nine studies that assessed weight. Weight outcomes were sustained in the long-term. However, no significant long-term between group differences were observed in fat mass, other anthropometric, cardiometabolic, inflammatory, or appetite outcomes. Compared to continuous energy restriction (CER), IER showed no significant long-term differences in anthropometric, cardiometabolic, inflammatory, or appetite outcomes in included studies. More long-term studies are needed to assess the benefits of IER on health outcomes.
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Re: Reflecting On The 5:2 Diet & Intermittent Fasting

Postby JeffN » Tue May 16, 2023 6:19 am

To be fair, this study found an excellent outcome using intermittent fasting. :)

To be fair, the benefit is from the weight loss, which as we know (see above), with or without IF, has been shown to rapidly reverse diabetes. The intervention group lost 13 lbs while the control group lost .6 lbs :)



Effect of an Intermittent Calorie-restricted Diet on Type 2 Diabetes Remission: A Randomized Controlled Trial
The Journal of Clinical Endocrinology & Metabolism, dgac661, https://doi.org/10.1210/clinem/dgac661
Published: 14 December 2022

Abstract

Context
The 2021 consensus report on the definition and interpretation of remission of type 2 diabetes (T2D) has been released. Although intermittent fasting diets (IF) are becoming very popular, no studies have investigated their benefit in diabetes remission.

Objective
The present study examined the effectiveness of IF in diabetes remission and potential remission durability.

Methods
Participants between ages 38 and 72 years with a duration of T2D of 1 to 11 years, a body mass index (BMI) of 19.1 to 30.4, 66.7% male, and antidiabetic agent use and/or insulin injection were randomly allocated at a ratio of 1:1 to the Chinese Medical Nutrition Therapy (CMNT) or control group. The primary outcome was diabetes remission, defined as a stable glycated hemoglobin A1c (HbA1c) level of less than 48 mmol/mol (< 6.5%) for at least 3 months after discontinuing all antidiabetic medications. The secondary outcomes included HbA1c level, fasting blood glucose level, blood pressure, weight, quality of life, and medication costs. We conducted a 12-month follow-up to assess the continuation of remission.

Results
On completing the 3-month intervention plus 3-month follow-up, 47.2% (17/36) of participants achieved diabetes remission in the CMNT group, whereas only 2.8% (1/36) of individuals achieved remission in the control group (odds ratio 31.32; 95% CI, 2.39-121.07; P < 0.0001). The mean body weight of participants in the CMNT group was reduced by 5.93 kg (SD 2.47) compared to 0.27 kg (1.43) in the control group. After the 12-month follow-up, 44.4% (16/36) of the participants achieved sustained remission, with an HbA1c level of 6.33% (SD 0.87). The medication costs of the CMNT group were 77.22% lower than those of the control group (60.4/month vs 265.1/month).

Conclusion
This study demonstrated the clinical efficacy of CMNT in achieving diabetes remission for at least 1 year.
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Re: Reflecting On The 5:2 Diet & Intermittent Fasting

Postby JeffN » Tue Jun 13, 2023 7:17 pm

"This review suggests that intermittent fasting interventions are not associated with a reduction in hunger, fullness, desire to eat, or prospective food consumption, when compared to continuous energy restriction interventions."


Nutrients. 2023 Jun; 15(11): 2604.
Published online 2023 Jun 1. doi: 10.3390/nu15112604
PMCID: PMC10255792PMID: 37299567

The Effect of Intermittent Fasting on Appetite: A Systematic Review and Meta-Analysis

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10255792/

Abstract
Previously, narrative reviews have considered the effects of intermittent fasting on appetite. One suggestion is that intermittent fasting attenuates an increase in appetite that typically accompanies weight loss. Here, we conducted the first systematic review and meta-analysis to quantify the effects of intermittent fasting on appetite, when compared to a continuous energy restriction intervention. Five electronic databases and trial registers were searched in February 2021 and February 2022. Abstracts (N = 2800) were screened and 17 randomized controlled trials (RCTs), consisting of a variety of intermittent fasting regimes, met our inclusion criteria. The total number of participants allocated to interventions was 1111 and all RCTs were judged as having either some concerns or a high risk of bias (Cochrane RoB 2.0 tool). Random effects meta-analyses were conducted on change-from-baseline appetite ratings. There was no clear evidence that intermittent fasting affected hunger (WMD = −3.03; 95% CI [−8.13, 2.08]; p = 0.25; N = 13), fullness (WMD = 3.11; 95% CI [−1.46, 7.69]; p = 0.18; N = 10), desire to eat (WMD = −3.89; 95% CI [−12.62, 4.83]; p = 0.38; N = 6), or prospective food consumption (WMD = −2.82; 95% CI [−3.87, 9.03]; p = 0.43; N = 5), differently to continuous energy restriction interventions. Our results suggest that intermittent fasting does not mitigate an increase in our drive to eat that is often associated with continuous energy restriction.

Conclusions

"This review suggests that intermittent fasting interventions are not associated with a reduction in hunger, fullness, desire to eat, or prospective food consumption, when compared to continuous energy restriction interventions."
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