Intermittent fasting vs calorie restriction: Which diet reduces the risk of Type 2 diabetes more?

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.

https://indianexpress.com/article/health-wellness/intermittent-fasting-vs-calorie-restriction-type-2-diabetes-8555512/

Simple Type-2 Diabetes Treatment With Low Calorie Diet is So Effective

From goodnewsnetwork.org

A “breakthrough” treatment plan for type-2 diabetes has the British National Health Service (NHS) bustling as they position themselves to adopt a new standard of treatment.
The course of treatment consists of a liquid diet of 800 calories to be taken as a soup or shake daily for a set amount of months depending on the time since the patient developed type-2 diabetes.

The breakthrough research arose out of Newcastle University which seems to have stuck a pin in many of our assumptions about type-2 diabetes—as well as proven almost beyond a shadow of a doubt that type-2 diabetes is actually reversible, especially in newer patients.

The treatment is basically a prescription for a reduction in calorie intake—a potential intervention that has shown incredible results for many different conditions.

The Diabetes Remission Clinical Trial, (DiRECT) recently published these findings as a means of demonstrating the massive potential of DiRECT as a general treatment plan.
One-third of all people taking part in the trial were free of diabetes at 2 years. Around three quarters of everyone who was in remission at 1 year stayed in remission at 2 years. Furthermore, the group who embarked on rapid weight loss had fewer serious medical problems in the second year of DiRECT.

The Nature of the Beast

Official statistics from the NHS place the number of Brits with type-2 diabetes at 4 million, and rising. Meanwhile, in the United States, the CDC reports that 1 in 10 Americans—roughly 30 million people—have diabetes, 90% of which is type-2. Many people also go undiagnosed for years.

Recent studies carried out by Professors Mike Lean and Roy Taylor of Newcastle University showed that type-2 diabetes is triggered by fat spills. These fat spills, which came from the liver, travelled to the nearby pancreas where it wreaked havoc in the efficiency of the organ to produce insulin.
Insulin is needed to command your cells to absorb excess carbohydrates circulating in your body after a carb or sugar-dense meal.

“The liver fat, astonishingly high in type 2 diabetes, falls to normal,” explains Dr. Taylor in an interview with Medscape. “The pancreas fat comes down gradually, gradually, and the pancreas recovers gradually, gradually. And that’s amazing because we always thought that the pancreas had to go downhill inevitably in type 2 diabetes.”

In April 2020, the NHS will begin trials with a liquid diet as per the DiRECT research with 5,000 participants helping to test whether the program can benefit the public. If the trials are successful, the breakthrough diet will become the new standard of care in a remarkably rapid frame of time for the chronic ailment that’s been causing amputations, blindness, and heart complications for decades.

The widely-taken drug Metformin has been the standard of care for the treatment of diabetes in France since 1957 and in Canada since 1972. Illustrative of how long it can take to approve a treatment in the U.S., Metformin didn’t receive approval by the FDA until 1994, even though 5.8 million Americans were diagnosed with diabetes in 1980.

Like all professional men and women of science, Taylor feels more research is needed before the liquid diet intervention is widely prescribed.

“We need to follow up this group,” said Taylor. “We follow them up for a total of 2 years in the proper randomized controlled trial.”
“We have funding to follow up the intervention group participants for a total of 3 years. And we’ve applied for further funding because we need to see what happens to these people as time goes on.”

But, he admits it is “heart-warming” hearing all the stories about remissions. “It’s all about the individual and all about helping people back to this state of relative health and happiness. And that does seem to be happening in quite large numbers of people who are able to do it.”

https://www.goodnewsnetwork.org/simple-new-type-2-diabetes-treatment-may-be-new-standard-of-care/

Cutting only 300 calories a day can cut your risk of diabetes and heart disease, study finds

From abcnews.go.com

It’s no secret -- watching what you eat can help keep your heart healthy.

But new research published in The Lancet Diabetes & Endocrinology has reached a surprising conclusion: even those of us with a healthy weight might benefit from cutting out a relatively small number calories from our daily diet.

“We wanted to investigate the effect of calorie restriction on disease markers in healthy, young humans,” Dr. William Kraus, preventative cardiologist and lead author of the study, told ABC News. “We found that a small calorie reduction -- around 300 -- appears to be beneficial to the heart.”

Researchers studied two groups of healthy people, all under 50 years old, over a period of two years. One group of 71 people continued a normal, unrestricted diet. The other group of 188 people underwent calorie restriction. In the beginning, the second group was asked to cut 25% of their daily calories.

“We didn’t alter the proportion of carbohydrate, fat or protein -- we just reduced the calorie content,” Kraus told ABC News. This was done by teaching study participants the essentials of calorie restriction, such as calorie counting and portion size.

People were asked to maintain the diet over two years, but the average person in the calorie restricted group managed to cut down only 12% of their calories, equivalent to roughly 300 calories per day.

That’s a modest decrease -- just a fraction of the 1,600 to 2,400 recommended daily calories for women, and 2,000 to 3,000 recommended calories for men.

Three hundred calories is equivalent to a slice of apple pie, 30 potato chips or “cutting out a snack after dinner,” Kraus told ABC News.

Even with this limited reduction, there were striking benefits: people lost over 11 pounds of fat and had reduced levels of bad cholesterol (LDL), increased levels of good cholesterol (HDL) and lower blood pressure. They were also more sensitive to insulin, a key blood sugar hormone, potentially reducing the risk of diabetes.

“Clearly what surprised us was the magnitude of response in people that already have normal parameters, are young and have a normal weight,” Kraus told ABC News.

Researchers found that even in young, healthy adults, a moderate calorie restriction can improve cardiovascular risk factors with a potential long-term benefit for heart health.

The next step is exploring why the benefit is so big.

“We expected some improvement in their biological parameters because they were losing weight,” Kraus said to ABC News, “but the weight loss only explained 25% of the improvement.”

Dr. Kraus has some theories about where the remaining 75% comes from.

“The effects of calorie restriction on DNA methylation is something we want to study in the future,” Kraus said. Methylation is a type of chemical modification made to DNA in response to environmental changes -- including nutrition -- which alters how genes are expressed.

Dr. Frank Hu a professor of nutrition and epidemiology at Harvard, called the study “ground-breaking in several respects,” but remained cautious.

“One practical challenge of translating calorie restriction is reliably counting daily calories and establishing optimal levels of calorie restriction,” said Hu.

He added that calorie counting alone is “unlikely to curb the global obesity epidemic.”

“Creating a healthy food environment and changing social norms…can make it easier for individuals to achieve and maintain a healthy weight,” Hu said.

Nevertheless, inexpensive and effective methods like calorie restriction could be invaluable in addressing some of issues surrounding the obesity epidemic.

The bottom line according to Kraus: when it comes to cutting down on calories, “anything is better than nothing.”

https://abcnews.go.com/GMA/Wellness/cutting-300-calories-day-cut-risk-diabetes-heart/story?id=64281135