From indianexpress.com
While a calorie-restricted diet is good for adolescents keen on weight loss, intermittent fasting ensures that calories don’t pile up in the body and is good for those at risk of diabetes, says Dr Atul Luthra, Director and HOD, Fortis C-DOC, Centre of Excellence for Diabetes and Metabolic Diseases, Fortis Memorial Research Institute, Gurugram
Is time-restricted eating or intermittent fasting better at controlling Type 2 diabetes than following a low calorie diet? A recent study published in the ‘Nature Medicine Journal’ seems to indicate that time-restricted eating had a modest effect on post-prandial glycemia after six months than calorie restriction in adults at a higher risk of Type 2 diabetes.
Explaining the study, Dr Atul Luthra, Director and HOD, Fortis C-DOC, Centre of Excellence for Diabetes and Metabolic Diseases, at the Fortis Memorial Research Institute, Gurugram, says that the process of fasting has always been known to flush toxins out of the body. However, early time-restricted eating along with intermittent fasting is better than total caloric restriction because the former compresses the meal timing and prevents a late evening binge.
Early time-restricted eating or calorie restriction, which is better for reducing the risk of diabetes?
I would like to share two historical facts. Religious fasting has been practised over centuries for body cleansing and ridding it of toxins. Our forefathers followed the circadian rhythms for eating, prioritising heavier food intake in the early part of the day and finishing all meals by sunset. Now we talk of similar concepts and call them either intermittent fasting, time-restricted eating or calorie restriction.
Time-restricted eating means eating or energy intake within a specific time window or compressed meal timings. On the other hand, we have a continuous caloric restriction known as CR, where you restrict the total number of calories you consume in the day, bringing it down to 70 per cent of your normal allowance without any restricted timing.
Which diet is good for whom?
Both are good strategies but we have to understand what is good for whom. Caloric restriction is basically a method of reducing the intake of calories and burning them more through physical activity and exercise. The purpose could be weight management, changing the body composition or reducing the fat mass. So caloric restriction can be used for weight management, fat burning and change in body composition.
Intermittent fasting is for a subset of people who have a high risk of diabetes in the future, either due to genetic factors or because of certain clinical parameters. Why does this work? That’s because our basal metabolic rate drops in the evening and we tend to burn lesser calories. As our activity level decreases during this time of the day and our unspent calories get stored, insulin resistance goes up. Also, we have more cravings in the evening because of a change in our nutrient-signalling pathways. So leptin, the satiety hormone, goes down and ghrelin, the appetite-stimulating hormone, goes up. With metabolic rate and exercise levels dipping, nutrient cravings increase and insulin resistance becomes higher, factors not conducive for diabetics. So if you compress the meal timings within a specific window of eight hours or so, having your first meal at 10 am and your last meal at 6 pm, commonly known as time-restricted eating, you can avoid a late evening calorie load from building up.
The other method is alternate day fasting where one day you have ad libitum food and the other day you just take 30 per cent of your normal calories, that too in a four-hour window.
Which diet is better for diabetic patients?
As far as diabetes prevention or glucose metabolism is concerned, definitely time-restricted eating is better than total caloric restriction in suppressing insulin resistance factors. So, diabetes patients should avoid eating late in the evening. This not only applies to people who have diabetes but also people who are predisposed to developing diabetes later or are pre-diabetic.
What about those who want to reduce weight? Which diet should they follow?
For someone who is an adolescent, has no diabetes or cholesterol issue but just wants to lose weight, they must focus on total caloric restriction. The caloric intake is determined by your body weight and your activity level. Once you figure that out, you have to take only 70 per cent of your required calorie count. This will help in weight management, body composition and fat mass as well as inch loss. Caloric restriction is basically to create a positive balance towards expenditure rather than intake of calories.
Which age group needs caloric restriction the most?
I would advise it for adolescents because they have very bad dietary habits, are into high fat, low-fibre fast and processed foods. They should have more protein, complex carbohydrates and less of simple sugars and saturated fats.
Middle-aged people are prone to diabetes and should go for time-restricted eating. For older people, the caloric restriction works because they tend to gain weight.
What about those who have no option but to stay up late at night, eat late but want to lose weight and not develop diabetes?
Then you follow that old principle: Eat breakfast like a king, have lunch like a commoner and dinner like a beggar.
What are the negative impacts of these diets?
When we talk of intermittent fasting that involves restricting meals between 10 am and 6 pm, then the practitioner can feel fatigued late in the evening. One might also report sleep disturbances, develop constipation and midnight cravings for food. For diabetics, managing medication, which has to be taken twice a day at a gap of 12 hours, can become a problem.
Suppose a diabetic takes a tablet at 6 pm but without any meal after that, the person’s sugar levels can drop. So, matching the intake of medication with meal patterns is a tough discipline to follow.
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