The Metabolic Classroom, Ep. 1: Intermittent Fasting
Summary
TLDRIn this insightful discussion, experts delve into the effects of time-restricted eating on weight loss and metabolic health. They analyze two contrasting studies: one showing no significant benefits with a surprising loss of lean mass, and another with positive outcomes across various health metrics. The conversation highlights the importance of insulin control in conjunction with fasting, the role of individual response to dietary interventions, and the significance of an early eating window for better sleep and health outcomes.
Takeaways
- 🔬 The discussion revolves around two studies on time-restricted eating and its effects on weight loss and metabolic parameters in individuals with overweight and obesity.
- 📉 One study, published in the Journal of the American Medical Association, found no significant improvements with time-restricted eating, except for a concerning amount of lean mass loss.
- 📈 The other study, smaller in scale, reported positive outcomes across various health metrics, including fat loss and improved blood lipids, insulin, and glucose levels.
- 🧬 Randomization was a strength in one of the studies, aiming to eliminate inherent differences among participants, which is a common challenge in human studies compared to controlled rodent models.
- 🤔 There was a high dropout rate in the time-restricted eating group of the larger study, suggesting participants were reluctant to adhere to the fasting protocol.
- 🕒 The timing of the eating window varied between studies, with one ending at 8 p.m. and the other averaging last meals at 6 p.m., indicating the importance of considering meal timing relative to sleep.
- 🥗 Neither study provided specific dietary advice beyond the eating window, which could be a missed opportunity to combine time-restricted eating with macronutrient management for better outcomes.
- 🏋️♂️ The degree of lean mass loss reported in the larger study was unprecedented and may be an anomaly, suggesting the need for further research to confirm these findings.
- 🛑 The control group in the negative study was also an intervention, instructed to eat three consistent meals a day, which may not reflect typical eating habits and introduces a confounding variable.
- 💉 Insulin control was emphasized as a crucial factor in managing health and weight, with time-restricted eating being one of several tools to help achieve this, rather than a standalone solution.
- 🌟 Personal experience and intuition play a significant role in nutrition and health; individuals should not be discouraged by conflicting study results but instead focus on what works best for their unique circumstances.
Q & A
What is the main topic of discussion in the provided transcript?
-The main topic of discussion is the effects of time-restricted eating on weight loss and other metabolic parameters, specifically in the context of two recently published studies with contrasting findings.
What is the difference between time-restricted eating and intermittent fasting?
-Time-restricted eating refers to changing the eating window within a 24-hour period, whereas intermittent fasting involves fasting for a full day or more, with eating allowed on alternate days or following a specific pattern like 5-2 (five days eating, two days fasting).
What was the sample size of the randomized clinical study mentioned in the transcript?
-The randomized clinical study mentioned in the transcript included well over a hundred participants.
What was the surprising finding in the study regarding weight loss and lean mass?
-The surprising finding was that 65 percent of the weight loss in the time-restricted eating group was attributed to lean mass loss, which is unusually high and not consistent with other fasting studies.
Why might the high lean mass loss in the study be considered an anomaly?
-The high lean mass loss might be considered an anomaly because it has not been observed in other studies of fasting, suggesting that it could be an artifact or due to a few individuals with an unusually high response.
What was the issue with the control group in the negative results study?
-The issue with the control group was that they were also given an intervention, being told to eat three consistent meals a day, which is not a natural eating pattern for most people and could be seen as a confounding variable.
How did the participants in the study respond to being randomized into the time-restricted eating group?
-The participants seemed reluctant to be randomized into the time-restricted eating group, as evidenced by a higher number of people being lost to follow-up in that group compared to the control group.
What is the significance of the eating window ending time in relation to sleep and health benefits?
-The eating window ending time is significant because having a longer period between the last meal and bedtime can improve sleep quality and potentially lead to better health outcomes, as suggested by the positive results study.
What is the role of insulin control in the context of fasting and time-restricted eating?
-Insulin control is considered a crucial factor in managing metabolism and weight. Combining time-restricted eating with strategies that lower insulin levels, such as controlling carbohydrates and prioritizing protein and fat, can enhance the benefits of fasting.
What advice do the experts give to individuals who are considering intermittent fasting?
-The experts advise individuals to consider intermittent fasting as a tool and to apply it in a way that fits their lifestyle and intuition around hunger. They emphasize the importance of not suffering or being miserable with the approach and to prioritize insulin control.
What is the 'n equals one' concept mentioned by the participants?
-The 'n equals one' concept refers to the idea that each individual's experience and response to a treatment or intervention is unique, making them their own study with a sample size of one, highlighting the importance of personal anecdotes and experiences.
Outlines
🔬 Controversy Over Time-Restricted Eating Study
The first paragraph introduces a discussion on a recent study about time-restricted eating, which is a form of fasting within a 24-hour window. The study, published in the Journal of the American Medical Association, is controversial due to its findings of no significant improvements in weight loss or other metabolic parameters for overweight and obese individuals. The study's randomized clinical trial design is highlighted as a strength, but concerns are raised about the high percentage of lean mass loss observed, which is unusual compared to other fasting studies. The paragraph also notes a high dropout rate in the time-restricted eating group, suggesting reluctance among participants.
📊 Contrasting Results in Time-Restricted Eating Research
The second paragraph compares the controversial study with another study published earlier in the year that reported positive outcomes for time-restricted eating, including improvements in fat loss, blood pressure, blood lipids, insulin, and glucose levels. This study was smaller and involved self-selected participants, suggesting a possible bias towards those already motivated for time-restricted eating. The discussion points out the lack of specific dietary advice in both studies, emphasizing the potential benefits of combining time-restricted eating with macronutrient management to lower insulin levels. The paragraph also notes the different eating windows in the studies and speculates on the impact of eating closer to bedtime.
🤔 Critique of Study Design and Control Groups
In the third paragraph, the critique of the negative study's design is expanded upon, with concerns about forcing participants into time-restricted eating and the artificial nature of the control group's instructions to eat three consistent meals a day. The discussion suggests that this control group setup could be a confounding variable, as it represents an intervention in itself. The paragraph also addresses the importance of an earlier eating window and the potential benefits of going to bed on an empty stomach, citing a study where an early 3 pm eating window ended positively.
🛠️ Intermittent Fasting as a Tool for Insulin Control
The fourth paragraph wraps up the discussion by emphasizing intermittent fasting as a tool for insulin control, rather than a one-size-fits-all solution. It highlights the importance of individual intuition and behavior around food, and the significance of controlling insulin levels for overall health. The speakers encourage not being discouraged by conflicting science and to focus on what works best for the individual, underscoring the 'n of one' concept, where personal experience is the most relevant study for oneself.
Mindmap
Keywords
💡Time-Restricted Eating
💡Randomized Clinical Study
💡Lean Mass
💡Insulin Resistance
💡Intermittent Fasting
💡Lost to Follow-Up
💡Macronutrients
💡Eating Window
💡Insulin IQ
💡N of 1
Highlights
Discussion of a recent study on time-restricted eating and its effects on weight loss and metabolic parameters in overweight and obese individuals.
The study was a randomized clinical trial, which adds strength due to the elimination of inherent human variability.
The study found no significant improvements with time-restricted eating, contrary to expectations.
A significant reduction in weight was observed, but it was attributed to a loss of lean mass, not fat.
The degree of lean mass loss was unusually high at 65% of total weight lost, which is not consistent with other fasting studies.
Some individuals on social media are using this finding as a reason to avoid time-restricted eating due to concerns about muscle mass.
The study had a high dropout rate in the time-restricted eating group, with seven participants lost to follow-up.
Comparison with an earlier study that found numerous benefits from time-restricted eating, suggesting a possible selection bias in participant motivation.
Neither study provided specific dietary advice, only a time window for eating, which could be a common strength or weakness.
The importance of combining time-restricted eating with macronutrient management for potential synergistic effects.
The timing of the last meal in the studies may have affected results, with earlier meals potentially leading to better outcomes.
The control group in the negative study was also an intervention, which could have influenced the study's outcomes.
The potential impact of going to bed on an empty stomach on sleep quality and overall well-being.
The role of insulin control in the success of time-restricted eating and the importance of individualizing dietary approaches.
Intermittent fasting as a tool for insulin control, with case studies showing its effectiveness in type 2 diabetes management.
The significance of individual behavior and intuition in dietary practices and the importance of not suffering for the sake of a dietary protocol.
The value of understanding and applying the science of fasting and time-restricted eating in a practical, individualized manner.
Transcripts
we have a little bit of ben's science
corner yeah
what's with the big voice last time it
was then
we don't know what the call is the
classroom
the reason we want to take a few minutes
is because this week
dr sher brett sher
of diet doc referencing another
article that was published this past
week
and it started a conversation here at
insulin iq
and so ben thought that he might just
get with steve and rich
and spend a little time just talk about
this particular
article and dr shore's uh
comments on it yeah probably take a few
minutes to do that so i'll turn the time
over to ben
yeah yeah thanks thanks jack so you guys
this is something i thought might be fun
to do from time to time where we
i can pull out some relevant science
in the actual manuscripts that have been
published and just sort of give you guys
a bit of a primer on some of these
findings from time to time
so as jack highlighted this study came
out very recently about
fasting or time restricted eating that
form of fasting where
it's fasting within a 24-hour window so
i use the term time-restricted eating
to refer to that when you when you're
changing the eating window within a
24-hour window
rather than like alternate day or or you
know because
people can do a one-on-one fasting where
they eat one day fast another day or
they do a 5-2
let's call that intermittent fasting
where it's a full day
or so and then time-restricted eating
when it's within one day
journal the journal of the american
medical association one of the
preeminent biomedical journals
um the you'll see the link uh the boys
are gonna
i think post that that a picture of it
but the title
of this one that was just published the
effects of time restricted eating on
weight loss and other metabolic
parameters
in women and men with overweight and
obesity one of the strengths of this
study and they are they are
right to highlight this is that it was a
randomized
clinical study so that there's a power
there
because in randomizing it you're you're
hopefully
eliminating uh or accounting for some of
the inherent differences that people may
well that that we all have we're that's
the problem with studying humans why so
many of us rely on
on rodent models i can have a whole
colony of mice that are basically
genetically identical and are going to
respond to the diets and everything we
do identically
in humans of course we have such a
variety so it was a randomized
trial and and it was fairly big where
they were
they had well over a hundred people
included in the study that's
really good for a human study
one concern i had from the get-go with
the so so briefly this study finds
basically no
significant improvements with the
time-restricted eating just to kind of
cut to the
cut to the um outcomes or the results
they found
that there was a significant reduction
in weight
in the time-restricted eating group but
also a significant reduction in lean
mass
in fact it was a shocking amount i think
65 percent of the weight lost
was considered from lean mass and that i
say
shocking because it is a very high
degree of lean mass
loss it also is a lean mass loss that is
not seen in any other study of
of fasting to my knowledge so that was a
bit of an
a shocking finding and a bit of an
anomaly
now some people i've seen in social
media are citing that one finding as
reason
to avoid time-restricted eating because
they want to
get big with muscle mass gains or they
want to maintain muscle mass gains
i would simply try to alleviate that
concern by saying
that is not a finding seen in other
studies
so the degree to which that is is real
and i'm not accusing this
the authors of this manuscript in any
way of dishonesty no
it could just be an artifact it's
something that's come up and it's just
an anomaly
or there were a couple people that had a
very high response
and the rest didn't at all so whether
that's a real worry or not
i don't think it is just because it's
not been shown in other studies but
that's one of the key takeaways
from this sort of negative study if we
want to call it that
there was a significant body mass
reduction but it was not because of fat
loss based on how they measured this it
was because of a lean
a lean mass loss now one other problem
with this
recently published study this randomized
trial
people were reluctant it seems to be
randomized into the time restricted
eating group
into that fasting group and i say that
they were reluctant to get into that
group
because in the results they report
something called lost
to follow-up so people who committed to
study
and once they were randomized into the
two groups
and we'll emphasize another problem with
those two groups in a moment
the people that were randomized in the
time restricted eating group
they uh seven of them were lost to
follow up so they
were put into the group and then they
didn't want to do anything to do with it
and they then the researchers couldn't
contact them again seven people were
lost
from the fasting group only one was lost
from the control group so there's
something i think about people very
reluctantly being put into the fasting
group and they didn't want to
now with that point in mind i'll
emphasize the second study that was
published earlier this year
that found a legion of benefits every
outcome they looked at
with time-restricted eating they got
better
whether it was fat loss blood pressure
loss
blood lipid improvements insulin
improvements glucose improvements
and the boys will show that other study
here uh but here's the other one
here's the other one that i'm
emphasizing um and i'm just i think it's
interesting to compare these two
one both published this year um and have
very different findings
now this study which found significant
improvements across the board
it was much much smaller i think was it
19
people steve do you remember i think it
was 19 subjects
but they all were they all self-selected
in so this is basically a case study
where they had 19 patients
who wanted to engage in time-restricted
eating i think there's something
powerful to that
where this group of people in the
positive results study
they wanted to do time-restricted eating
they self-selected they volunteered they
wanted to do it
as opposed to the group that i believe
apparently were very reluctant
in so far as the loss to follow-up was
seven times higher
and ben weren't they just showing they
were not on a specific
dietary response they were just eating
whatever they wanted to eat right they
weren't eating an insulin controlled
diet or a ketogenic diet of any kind and
the time window
was like 10 hours wasn't it yes so
that's the next important that's another
point yeah
so what these studies both have in
common is that
neither gave specific dietary advice
beyond
here's your eating window stick to it so
that's a strength
that they both have in common but
it's a weakness that we would all agree
to if you're going to encourage someone
to time restricted eat to time
restricted eating or fasting
i think you really ought to be playing
with that other lever
which is arguably at least as relevant
which is manipulate
manage your macronutrients in a way that
if much of the power of time restricted
eating and fasting is that you lower
your insulin imagine if you can couple
the insulin lowering effective fasting
or time-restricted eating
with the insulin lowering effect of
controlling carbohydrates prioritizing
protein and filled with fat
so i do think there's a lot of synergy i
hate to use that word
because it's so cliche but there's a lot
of power in combining
time-restricted eating with manager
macronutrients
which they didn't do but that that's
okay because it allows us to compare
these two studies head to head
now rich you'd mentioned the eating
window i think that's another point to
mention
in the negative results study finding
nothing really beneficial about the
time-restricted eating
the the time of ending your diet the
food for the day was 8 p.m
as opposed to the positive finding their
at last meals
on average were at 6 p.m and they
actually measured that on average the
average subject
was eating their last calories four
hours before they were going to bed
and that wasn't they didn't report on
that in the negative results study and i
can't help but wonder
to what degree were the benefits
the positive study was the benefit
partly because they were sleeping better
which they did indicate as opposed to no
improvements in sleeping in the time
restricted eating study no longer window
after they finish eating
before that yeah more time for the food
to digest i worry if
these people in the negative results
study or anything like me they had to
fight the temptation to just binge all
evening
you know when suddenly they're home they
they are
they are you know that's quiet time the
day has slowed down they're ready to sit
down and
binge watch netflix and they're ready to
binge eat something they shouldn't
and they feel okay about it because it's
in their eating window and they weren't
told to restrict calories and that's
another point
in the negative results study there was
no difference in calories they were
eating the exact same amount of calories
as they were before the study started
that shouldn't be viewed as a weakness
because we don't tell people to control
calories with insulin iq education and i
don't think we ever should
but one of the things that just tends to
happen
is people just tend to start controlling
their calories a little better
that was evidenced in the positive
results study
they were eating just by self their own
will their own choice just by nature of
the eating window changing they were
eating about 10
10 fewer calories per day just of their
own volition i think there's
something meaningful there well and ben
involving people into a insulin
controlled protocol where they're eating
a little more fat protein and and the
windows a little more
like an 18-6 kind of window not i mean a
10-hour window of eating
that's big is that really fasting that's
big i know i mean i know
who eats more than 10 hours a day yeah
that's a small step i don't know how
they call that fasting
right yeah i think these are two that's
a day that ends with why
i think these are two completely
different studies and i think they
were set up completely differently uh
and you know
the uh the larger study the smaller
study was 19 people and they didn't
really have a control group
the larger study the control group was
told to eat three meals a day yeah
yeah i don't know many people that in a
in a measured period of time
actually get three separate meals a day
every day
and that may uh i think that's an
artificial uh element
involved in this study as well that they
are asked to eat three meals a day i
don't know how that
that came through an excellent point
yeah i'm glad you i meant to i wanted to
bring that up
so when they split these two groups in a
negative study they split them into two
groups the people randomized
um one was the time-restricted eating
the other one was
i believe just as much an intervention
where they were told you eat three
meals per day people don't do that
that alone is an intervention which i
think creates a bit of a confounding
variable
that if they had been told eat whatever
you want
you're the control group don't change
anything you eat what you're doing
and then maybe try to attempt um to
in the time restricted eating group kind
of try to calorie match them
which isn't some that's not easy to do
it is admittedly kind of next level
difficulty but
but in a rodent study when we do this
kinds of things in the perfectly
controlled environment of rodent work
we we will pair feed them we will say
okay the control group ate this much
we're going to try to help these other
animals eat this much same calorie
maybe it's a ketogenic diet or maybe
it's a narrowed eating window
or time-restricted eating but again one
of the problems with the negative
results study
is that the control group was just as
much of an intervention
they were told i believe in just as much
a way to
change their diet than the time
restricted eating group
because going to the average person and
telling them you need to eat three
what did they call them consistent meal
timing
so that was the group that was the
control group consistent meal timing
that's not how much that's not a
controller
that is a confounding variable that i
think was a bit of a problem
so those are some of the main concerns
with the negative results study
i think there's a problem in forcing
people to time restricted eat when they
don't want to
also i think the control group was a bit
problematic insofar as it
was as much an intervention as the
intervention group the fasting group
and in the time the eating window
actually ended up going pretty late into
the day
and i think it probably was pushing up
till bedtime a little too closely
and that would offset some of the
benefits now
another thing else in fact to emphasize
that point into these authors credit in
the negative study
they cite a study they cite one of the
concerns
in their negative findings could be that
the eating window was too late
that maybe if they pushed it into the
earlier in the day there could have been
a benefit and they cite a study
where the eating window ended at 3 pm
and
you know that's a wonderfully long
period of time before you go to bed and
i
the more the older i get and the more i
kind of manipulate my own
lifestyle the more power i see in my
life
of going to bed on a relatively empty
stomach i'm not going to bed hungry
but i'm not going to bed full that tim
that
in my as i'm in my mid 40s now is the
single greatest variable
on how well i sleep and how well i feel
the next day how energetic i am
don't go to bed full anyway there's some
thoughts
so what am i missing what else anything
to add on that steve well
i would just like to say what do you see
well physician
i agree a lot with with uh what you've
said dr bickman i
i just have to say in my practice i
don't
have any of my patients in this negative
finding study
follow this at all because as we
emphasize here it's about controlling
insulin and intermittent fasting
is one of the many tools that we have in
insulin control
is by far the most important factor to
focus on
and my patients that focus on insulin
control have tremendous success the ones
that combine
time restricted eating the having a six
or eight hour period a day
where they're focusing on controlling
insulin keeping it low
during that window combining those two
variables have tremendous success so
this is a very interesting study
that did not at all focus on insulin
control
and i think that's as far as i'm
concerned is the greatest variable that
didn't play out in this study it may
explain why they had a negative result
because that wasn't their that wasn't
their focus and controlling insulin
is the most important focus when you
look at your your nutrition
in fact speaking of controlling insulin
what i ought to have done is also bring
in the case studies that
dr jason fung has reported where they
find they take
profoundly insulin resistant type 2
diabetics that are on insulin therapy
they're that insulin resistant that they
need
more insulin to control their glucose
which is lots of patients which is
which is terrible but they find that
within just a couple weeks
the intermittent fasting is so effective
that they're able to get off all
insulin i find that as well with my type
2 diabetics insulin controlled
yeah within two weeks 20 years on
insulin they're off that's cs crazy
the power and benefit we're also talking
about behavior
here where where if somebody has the
will and
the ability to fast it's just that
they're so much more intuitive
around their eating patterns when
they're fasting they can feel when
they're hungry they're not
saying hey i gotta eat you know eight
and at 10 and at 12 and
they're starting to be way more
intuitive around their behavior around
food i just don't want him to get
discouraged if you have just discovered
this intermittent fasting tool remember
it's a tool
and you have to apply it to your
lifestyle and what works best for you i
think it's more important
that you're intuitive about your
nutrition and that you don't make
yourself
suffer because you're much more likely
to to not be consistent and not be
successful if you are
miserable with what you're doing i enjoy
the window of opportunity to eat and i
feel so much better going to bed on an
emptier stomach but boy let me tell you
there are times once in a while after if
i've worked out real hard i'm still
hungry
and i will still satisfy my hunger even
though it's a little outside the window
with my focus being insulin control
and that by far gives me the greater
benefit and for all my patients
i tell them that is your first focus is
keeping your insulin low the second one
is being intuitive about your hunger
so don't get discouraged by this study
it's an interesting study but
it no way reflects how i teach my
patients intermittent fasting is a tool
but it's not by any means the most
effective way to achieve
health by avoiding the plagues of
insulin resistance
great yeah yeah you guys let us know
what you think if this sort of
metabolic classroom um manuscript
discussion is
uh helpful uh then we'll keep doing them
because there are a lot of cool studies
we can get to in the future
yeah and studies can be very confusing
you need several of them to understand
what a real outcome is this other study
the positive one only had 19
participants
and they were very well controlled and
that's much more similar to how i wrote
my practice
so i see that this positive result study
is much more like
i see day in and day out in my practice
because
it's very controlled there's a specific
purpose the patients are well screened
they're motivated
and they're motivated and uh and
that's what we're here to do is to help
you see the motivation
thank you thanks for discussing that
it's important that our audience know
we know our audience at insulin iq we
have
very very science-focused folks
in the community that follow every
single bit of research that dr pickman
does
and then we have folks watching today
that are on the total
other end of the scale they're just
coming to this whole space
and and some of the things are just far
too deep and too technical
our mission is to try to take the
science and
dissect it and work it and we bash it
around
and spend a lot of time but then we try
to
condense it down and hone it in so that
we have
actionable things that insulin iq uh
clients and and students can do so steve
i appreciate that you
kind of brought that home with and you
too uh rich as far as behavior
and don't be discouraged about
intermittent fasting
don't think that because there is
conflicting science that
it we don't see a huge amount of
of patients and and students that we
help
and ultimately jack it's n equals one i
mean
how it affects you n equals one yeah
you're the study
you are the study you are the study yeah
so n in fact to be scientific
n refers to a sample size so this study
you know was an n of 19 or an n of 116
and this refers to the sample size so
rich's point
is that anecdotes matter that if you
yourself are seeing a benefit you are
conducting your own study in n of you
you're
your own sample size great so i said
something smart it was brilliant
brilliant tell your kids i know i hope
my kids are watching
i hope my wife's watching we're going to
transition to a few questions
and
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