A Matter of Life

Fasting and Feasting

Dr Ambrish Mithal is chairman and head, Endocrinology and Diabetes Division at Medanta, The Medicity, Gurgaon
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Is it fine to keep the body stressed for so long?

There is no sincerer love than the
love of food.

—George Bernard Shaw

FOOD IS THE most basic need without which all life would be extinct. All of us have experienced hunger and the relief that comes with the intake of food. Food is, however, much more than a survival tool. It is one of the principal pleasures of the senses—for some of us, the love of food is the very purpose of existence.

Giving up food, therefore, is one of the greatest sacrifices a human can make. In the religious/spiritual context, food provides nourishment to the body, fasting nourishment to the soul. Most religions recommend intermittent abstinence from food as a form of purification or penance. In the Mahabharata, Bhishma responds to Yudhisthir’s query: ‘There is no penance that is superior to abstention from food.’ Jains don’t eat after sunset. Muslims fast for a full month every year.

Has fasting been popular for thousands of years just for spiritual reasons? Buddha, when addressing a gathering of monks in Kasi, exhorted them to give up dinner—‘Not eating a meal in the evening I, monks, am aware of good health and of being without illness.’ Fasting was thought to confer health benefits, even 2,500 years ago.

Fasting comes in many forms. It could be overnight (from sunset till sunrise) or all day (from sunrise to sunset). Intermittent religious fasting could also be periodic—weekly or monthly; or for extended periods, as during Navratras and Ramzan. During Navratra fasts, my patients end up having potato, sago and colocassia—all high carbohydrate food, which often worsens their diabetes. Those who fast during Ramzan often have heavy meals when they break their fast (iftaar) that it undoes any benefits that may have accrued from the fast.

Fasting as a weight loss tool has always attracted dieters. The principle of conventional weight loss diets is reduction in daily calorie intake by about 20-25 per cent. Realising the difficulty, frustration and high failure rates, people often look to regimens that allow intermittent fasting rather than the daily drudgery. Intermittent fasting is practiced in many forms but the most popular ones, currently a craze in the Silicon Valley, are two days a week (5:2), or alternate day fasting. This entails ‘normal’ unrestricted diets on feasting days and 75 per cent reduction in calorie intake on fasting days. In the American context, this translates to 500 calories (equal to four buttered toasts in 24 hours) on the fasting days— it would be even lower for Indians. Another approach is 25 days of ‘normal’ diet followed by five days of restrictions—in the form of a ‘fasting mimicking diet’, which has 700-1,100 calories/ day—high in unsaturated fat (chips!), low in carbohydrates.

Two studies from the USC published in February this year demonstrated benefits of the fasting mimicking diet. In one of these studies, diabetic mice were provided a fasting mimicking diet for 4/7 days every week, which reprogrammed the non- insulin producing cells in the pancreas into insulin producing cells. Even in late-stage diabetes—both type 1 and type 2— there was a reversal of disease. In the second study, conducted on humans, people followed their normal diets for 25 days a month followed by fasting mimicking diet for five consecutive days. Seventy-one individuals who followed the diet lost 2.3 kg over three months. Intermittent fasting also seemed to benefit BP, body fat content and blood cholesterol. Impressive results, but three months is a short time and subjects were fairly healthy to begin with.

Earlier this month, a study from UIC, published in JAMA, compared conventional and alternate day fasting diets among 100 individuals and found similar weight loss (5-6 per cent) in both fasting groups. The dieters found it difficult to adhere to 500-600 calories on fasting days and ended up eating more than allowed. Overall dropout rates were higher in the intermittent fasting group. This study is a setback for proponents of intermittent fasting. It is possible that some individuals may be more suited to intermittent fasting diets. The long-term effects of intermittent fasting are still not fully understood. Is it fine to keep the body stressed on days of fasting, for months or years?

There are no shortcuts to losing weight. If you decide to follow a fasting regimen, ensure healthy food—adequate proteins, fruits and vegetables. Don’t forget to exercise; it’s important to prevent concomitant muscle loss. Talk to your nutritionist, and choose a diet that you are comfortable with. If you can’t follow a diet, it won’t work.

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