Intermittent Fasting for Diabetes: What the Research Really Says

Intermittent Fasting and Diabetes

Diabetes Digital Podcast by Food Heaven

0:00

Welcome back to another episode of the Diabetes Digital Podcast with Wendy and Jess.

Today we’re starting a new series all about popular diets and should you try them if you have diabetes or pre diabetes.

So today specifically, we’re going to be talking about intermittent fasting and whether or not it’s effective or safe for managing diabetes.

0:22

We’re going to give you our dietitian take.

We’ve looked at a ton of research on intermittent fasting and diabetes, and we’re also going to keep in mind our values and background is providers who do focus from a health at every size and intuitive eating approach.

So we’re going to look at this from a nuanced take.

0:40

And while intermittent fasting is trendy, there are some concerns.

One of those concerns is sustainability.

Is it possible to do it long term?

Also, glycemic variability, which specifically applies to people with diabetes.

We’ll talk more about that, as well as its effects on hunger cues, which can make it a more complicated choice for people with diabetes, But we’re going to dive right in.

1:04

Welcome to the Diabetes Digital Podcast.

I’m Wendy.

And I’m Jess, and we’re best friends, registered dietitians and diabetes educators.

Through our telehealth platform, Diabetesdigital.co, we offer accessible and personalized virtual nutrition counseling for people with diabetes and pre diabetes.

1:21

Visit diabetesdigital.co.co to book your first appointment.

We accept insurance and offer affordable self pay options.

Now let’s get into today’s episode.

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3:42

Episode So let’s talk about what intermittent fasting is.

And we thought it would be very timely to cover this because it is January and I feel like now is the season where people are more drawn to these restrictive diets because they want fast results.

4:00

They want like a new year, new reset.

And so I feel like this is coming out at the perfect time with intermittent fasting.

I’ve seen different variations of it.

Some of the variations are, I don’t know, I feel like they just align with like normal eating habits where like you just maybe you have an earlier dinner and then you sleep through the night and then maybe if you’re not a morning eater, you have breakfast a little bit later.

4:26

And so you’ve had like a certain window of not eating.

And I think that for some people, they just naturally go about it that way, like me, for example.

However, there are more like rigid rules around intermittent fasting.

It just depends like what variation you’re doing.

4:42

For the most part it involves some period of not eating, like usually a a pretty long period of not eating and then you like introduce food during like a very specific eating window.

One common approach is the 16-8 method where you fast for 16 hours and then you eat all of your food within an 8 hour window.

5:05

So for example, like, let’s say that you don’t eat after 8:00 PM and then your first meal starts at 12:00 PM the next day.

So you’re eating meals between that 12:00 to 8:00 PM window.

Yeah.

5:21

I mean, it’s it’s a long time to to go without eating.

And for some people, they’ve already been doing this without it being called intermittent fasting.

They’ve already been doing this.

And so their body is just not used to eating for prologue periods of time.

5:38

Is that a good thing?

Is that a bad thing?

We’re going to get into a little bit more during this episode.

Yes.

So let’s dive into the research first and foremost, and let’s talk about one of the most common reasons people do intermittent fasting.

5:54

The truth of it is that the majority of people, especially from our experience as dietitians, are doing intermittent fasting to lose weight.

Now we talk a lot about kind of intentional weight loss on this podcast, so we’ll include some of those episodes just kind of for reference if you’re joining us for the first time.

6:12

And so we have a complicated kind of thought about intentional weight loss because there are studies that suggest that when people are trying to lose weight intentionally through a calorie restriction, they tend to gain that weight back.

6:27

And the problem with a lot of studies is that they are short term, right?

So they’re usually like two years or less, oftentimes 12 months.

And so yes, while people will lose weight within that 12 month period, majority of them tend to gain that weight back.

6:44

So let me talk about some of the studies that I found with intermittent fasting and what effects it does have on weight loss.

One in particular involved 139 participants and the study was 12 months long.

So again, a lot of people tend to regain the weight after like the three 4-5 year mark.

7:02

So it’s really hard to tell from a 12 month trial what’s really happening long term.

But did these people who only ate between 8:00 AM and 4:00 PM by way of intermittent fasting actually lose weight?

Yes, they did.

And they compared this weight loss to a calorie restriction.

7:18

So what they found is there were two groups, one group who did intermittent fasting and one group who did just a calorie restriction where they ate, you know, whatever they wanted throughout the day.

And what they found was that both groups had similar changes in BMI, body fat, visceral fat, blood pressure, glucose levels and lipid profiles with no added benefits observed from time restrictive eating, which is another way of saying intermittent fasting.

7:46

So what does this mean?

Basically, that while you may lose weight from intermittent fasting, and like I said, these studies don’t show the big picture of whether or not you gained that weight back And also some of the negatives which we’re going to talk about, when they compare it to just a traditional calorie restriction, there’s not really a difference.

8:06

So when people are losing weight from intermittent fasting, they’re losing weight because they’re eating less, right?

Like Wendy said, a lot of folks doing IF will skip breakfast.

So when you’re skipping breakfast, you’re eating less presumably, right?

8:22

You’re eating, you know, you’re not having those calories from breakfast.

So therefore it’s a form of calorie restriction research.

Aside, I think the hardest part of a diet like intermittent fasting that I’ve seen as a clinician is that it’s really hard to stick to.

8:37

Just like any diet, it’s really hard to stick with that long term.

It’s not very sustainable, especially when you’re socializing, you know, if you’re just like, oh, I can only eat within a certain window.

Like, that can become really tough when they’re travelling on weekends, if you have friends or family that want to hang out or if they’re doing some kind of food gathering.

8:58

I’ve been in those gatherings where someone shows up and they’re like, oh, you know, I can’t eat.

Or they just keep talking about how guilty they feel that they’re eating outside of, like, their window.

And so, yeah, I think that it definitely sucks the joy out of eating when you have these very rigid rules that you feel like you have to stick to.

9:18

And ultimately, like everyone is so different, like I mentioned earlier, like there are some people where maybe they don’t have the strongest appetite during the morning hours, but for many people, they do enjoy breakfast and they may start feeling really fatigued or with hunger headaches, for example, by going so many hours without eating.

9:37

And if you have diabetes, you’re already prone to like those fluctuations with your glucose if you’re not eating for like a long period of time.

And so it can definitely deregulate your glucose.

It can start swinging your A1C as well.

9:54

For women, since we have hormone changes throughout the month, that can also be something to consider because when you’re fasting, especially when you are leading up to menstruation, your body has more caloric needs.

10:11

And so if you are forcing yourself into a fast when your body is actually craving more food, that can add more stress to the body.

And so, you know, I have seen, yeah, just from the patients that I’ve worked with who do intermittent fasting, like, it might be something that they do for a few months.

10:28

But for the most part, like I haven’t really, I’ve come across maybe one person where intermittent fasting has worked like over the one year period.

And for this one person, I was actually talking to her yesterday, it works for her more so because she has all these gut issues and it’s like there’s underlying issues there where she doesn’t even really have a strong appetite that have to be addressed.

10:51

It’s not necessarily because she’s like choosing to do this, if that makes sense.

So it’s very individual.

I would say you definitely want to prioritize how your body is feeling and also like what are the effects that this is having on your glucose?

11:07

If you have like a glucometer or a CGM, it might be good to look at those trends to just see like what is the correlation there?

Yeah.

And just back to like the point about women in particular, I do think intermittent fasting is more challenging for us just because especially like when he said during your cycle or women who are going through midlife changes like perimenopause and menopause, like your body’s already going through a lot of stress with the hormonal changes and fasting can actually add more stress to the body.

11:39

So there are many researchers that say that intermittent fasting is not a great idea for women at all because again, it adds that stress and raises cortisol.

And we know that when your cortisol is raised like that can have impacts on your blood glucose levels, which brings me to my next point, which is glucose variability.

11:59

So I want to point to another study in diabetes care that looked at glycemic variation and cardiovascular risk in the Veteran Affairs Diabetes Trial.

So this study was published in 2018.

And basically what it suggested was that when there are big swings in your blood glucose levels, those fluctuations may cause harm by stressing blood vessels, triggering inflammation and worsening overall heart health.

12:27

So I thought that was really interesting because I think while some people maybe intermittent fasting works for them and works for their diabetes, I’m sure there’s a whole host of other people where it does ’cause that glucose variability, right?

Because let’s say you’re going so long without eating and you then you’re eating in such a small window, it’s like your blood glucose may not be as stable as if you were to eat, you know, three meals and snacks throughout the day.

12:54

So that’s another thing to consider.

There is no direct link.

I’m just kind of saying what the study said and also what could happen for people who are in intermittent fasting because the study is not about intermittent fasting, it’s just about glucose variability.

But I think it’s worth mentioning and you know, something like Wendy said to consider and use your continuous glucose monitor to kind of see how intermittent fasting is, is affecting your blood glucose if this is something that you choose to do.

13:23

Now I want to talk about the risks of intermittent fasting for people with diabetes because there’s always a risk for many things, right?

And one of those risks can be hypoglycemia.

Hypoglycemia is when you have low blood sugar.

13:39

And this is especially challenging for people who have diabetes and are on certain medications like insulin.

Fasting for long periods of time can result in dangerously low blood sugar, particularly for those on insulin or glucose lowering medications.

13:57

So again, if you are taking these meds, let’s say you have type 1 diabetes or again, insulin dependent, you want to talk with your doctor and make sure this is safe for you to even try because hypoglycemia is a real risk and can be life threatening.

14:15

So when I throw out that consideration, and I kind of already talked about this, but will reiterate just the blood sugar fluctuations, it may cause you to feel like you’re on a glucose roller coaster with highs during eating windows and lows during fasting windows.

And not only may that have negative implications on your health overall, but it also just doesn’t make you feel good to be on that glucose roller coaster.

14:38

So pay attention to how you feel and how your body is reacting more than anything. 100% And in thinking about like how you feel and how your body is reacting, I think it’s important to also talk about hunger and satiety because that does get thrown off of intermittent fasting.

14:56

Our goal as dietitians is to help people tune back into their internal hunger and satiety cues.

And it’s hard to do that when you’re following this very rigid eating window.

You’re not necessarily reacting to being hungry or even being full, because if you’re not reacting to being hungry, that affects your ability to realize if you are completely satiated or not.

15:22

And so it just kind of throws off that whole cycle because you’re eating on this window.

And so, I don’t know, let’s say 12:00 rolls around and it’s time to eat and you’re not necessarily hungry because everything is thrown off.

You’re like, OK, well, I have to eat anyway.

15:37

And that can have long term impacts and just developing a healthy relationship to food and being attuned to what your body needs, it can definitely result in overeating.

If you’re not attuned with those cues, you’re like, wait, am I, am I full?

15:57

Is this like, am I eating from a place of deprivation?

And so that is something that I have seen as well.

Yeah.

Another thing to consider are the mental health implications.

Wendy kind of talked about this a little bit, but I’ve definitely been out with people where we can’t even go out for a meal because they’re intermittent fasting and they don’t eat before this time or they don’t eat after this time.

16:24

And then it just kind of is a killjoy.

Yeah.

Of course, you know, you want to respect people’s bodily autonomy, but if it means that like you can never break bread with that person because their window is so short or they don’t eat on certain days, which is another thing that I’m finding to be very popular where people literally just don’t eat, I would never recommend that.

16:47

I think this can disrupt your mental well-being.

And I even wrote an article about this for Self magazine, how we really need to consider the social and mental health aspects of our eating and if we are dieting, what impact that has.

17:02

I can also see it leading to stress and anxiety.

Maybe the meals are feeling not sustainable for you because again, you’re in that smaller window as well as you having anxiety about eating outside of that window, right?

17:18

So there’s so many different ways it can impact us.

The other thing is like, what happens if you get hungry before or after the window?

Because I know that would probably happen to me where it’s like, I’m hungry in the morning and I’m hungry at night.

So is that wrong?

Like I, I just, I don’t agree with the general philosophy of like having to micromanage your eating so much.

17:40

And of course, yeah, maintaining diet quality as well, I think can be a challenge just because when you are restricting your eating, it oftentimes means that it’s harder to have that variety and to get in all the nutrients that you need throughout the day if you only are eating in a certain window.

17:59

So there’s definitely some challenges and that’s.

Where intuitive eating comes in, which we always talk about, we think it’s definitely a more sustainable approach.

With intuitive eating, if you’re not familiar, you prioritize responding to your body’s natural hunger and fullness cues.

18:16

And we definitely think that this aligns better with long term diabetes management.

You’re eating balanced meals regularly throughout the day, which helps to balance out those blood sugar fluctuations.

It reduces the risk of hypoglycemia.

There’s a lot of room for flexibility.

18:33

There’s a lot of misinformation about intuitive eating.

I think people think it’s like a permission slip to eat, you know, whatever it is that you want.

And there’s definitely a place for nutrition and balance.

If you have a chronic condition, even more important.

18:49

And so it really takes all of that into account.

Like what are your preferences?

What is your culture?

What are the foods that you enjoy?

Also, are we adding things like fiber, protein, healthy fats to help stabilize blood sugar levels?

Like these are all things that are part of intuitive eating.

19:07

And I think the flexibility is one of the most important things because life is always throwing things at you, you know, like your situation is always going to be changing, whether it’s work responsibilities, time commitments.

And so I feel like with food, it’s you don’t want like another thing to add to your list to have to stress out about.

19:29

In my opinion, the goal is to approach it with some type of ease, like once you have a good flow going where it’s just like another thing that you do and it’s not something that you overthink or that you’re constantly stressing about.

Yeah.

So now some practical advice.

19:45

If you’ve made it this far, you can probably tell we’re not the biggest fans of intermittent fasting.

However, if you listen and you’re like, hey, I still want to try it, I think it’s for me.

We would highly recommend that you consult with your healthcare team just to evaluate potential risks, especially if you are on medications for diabetes.

20:04

Our recommendation would be to consider alternatives that focus more on consistency and regular meal timing and nutrient dense foods.

So a couple of practical strategies to try would be instead of fasting, you can eat balanced meals every three to four hours.

20:23

And a balanced meal would include a carbohydrate, protein, some kind of non starter tea, vegetable and a fat.

Amazing if you can get all those on the plate.

But even if you can only get two or three, that’s great too.

Also including fiber rich foods like whole grains, legumes and vegetables and staying active and hydrated.

20:44

Those things are going to support your health and your blood sugar stability, which is probably going to make you feel better mentally and physically long term.

Yeah.

So final thoughts, You can tell we’re not the biggest fans.

We don’t consider intermittent fasting to be sustainable or safe for many people with diabetes just based on our clinical experience.

21:06

However, I am all about experimentation and doing what you feel might be best for you.

So if you are interested in doing intermittent fasting, it’s you definitely want to let your provider know, but also work with one of our dietitians.

21:22

You can go to diabetesdigital.co slash quiz to get started and that way you have additional support and resources and you have someone that you can consult with as concerns or questions come up.

Yeah, I would just recommend focusing on approaches that are prioritizing your overall well-being, your body’s natural cues.

21:44

If you’re interested in intuitive eating or dietitians, do take on that focus and can also support you in that as well.

Yeah.

Thank you so much for tuning in and we hope to work with you.

Bye.

Thanks for joining us for today’s episode.

22:00

If you’re interested in nutrition counseling with one of our expert dietitians to help improve your pre diabetes or diabetes, visit us at diabetesdigital.co.

Also, if you found our conversation helpful, do us a favor and rate and review this podcast on iTunes, plus share with someone who might find this helpful.

22:19

You can also connect with us on Instagram at Diabetes Digital.Co and Tune In every Wednesday for practical, inclusive, and culturally humble Diabetes insights.

We’ll catch you later.