Welcome to Dr. Paz’s Newsletter #7

This newsletter will focus on timely topics that can have a direct impact on your health. If you are interested in sending a question, you can send it to drpaz@drpaz.com.  Please remember,  your questions should be of general medical interest and should not include any patient-specific information since this is not a HIPAA compliant email.

Intermittent Fasting for Weight Management and Health

Intermittent Fasting(IF) is an eating plan that switches between fasting and eating on a regular schedule. A close cousin to this concept is Time-Restricted Eating (TRE) which is a dietary approach that consolidates all calorie intake into 6 to 8 hour periods during the active phase of the day, without necessarily altering diet quality and quantity. Research shows that both are ways to manage your weight and prevent — or even reverse — some forms of disease. But how do you do it? Which approach is best?   

Obesity is a Common, Serious, and Costly Disease

According to the Center for Disease Control(CDC) 42% of all Americans are now obese. This is up from 30% in 1999. Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer. These are among the leading causes of preventable, premature death.

The estimated annual medical cost of diseases caused by obesity in the United States was $260.6 billion in 2016. The medical costs for people who have obesity were $1,429/year higher than medical costs for people with healthy weight.

https://www.cdc.gov/obesity/data/adult.html

Are You Obese? 

BMI or Body Mass Index and waist circumference are the two most widely accepted methods to decide if you are obese.

Body Mass Index(BMI). BMI compares your height to your weight.  A BMI greater than 30 is considered to be obese and places you at increased risk for medical complications related directly to your weight.  You can check your BMI using the following calculator. https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm

BMI can be falsely elevated especially in younger people with a lot of muscle mass. However for 99.9% of people over 40, it will be accurate.

Waist Circumference. Measuring waist circumference helps screen for possible health risks that come with overweight and obesity. If most of your fat is around your waist rather than at your hips, you’re at a higher risk for heart disease and type 2 diabetes. This risk goes up with a waist size that is greater than 35 inches for women or greater than 40 inches for men. To correctly measure your waist, stand and place a tape measure around THE LARGEST PART of your middle, just above your hipbones. 

The Three Pillars of Health and Weight Management:  Quality/Quantity/Timing

Quality. All calories are not created equal.  We know that the rate at which calories are turned into sugar and absorbed through your bloodstream can make a significant difference in how they are processed.  Generally speaking, real food, such as fruits, vegetables, beans, seeds and nuts are broken down more slowly and in the most beneficial way,  while processed foods will tend to generate high spike's in INSULIN which will cause fat deposition, especially around your  abdomen.  I have often said that you should "eat the way God made it".  And in his wisdom, God did not make bread trees.

When humans alter our food supply, its usually not for the better. I have yet to meet a patient who became obese eating too much broccoli, carrots or spinach!   I generally believe that a lower carbohydrate diet is the way to go, with emphasis on restricting added sugars. Try to restrict your total Carbohydate intake to 60-80 grams/day.

NOTE :Food quality will be the focus of a future newsletter. 

Quantity. It is generally accepted that you need to ingest 3500 cal over and above your daily requirements to gain one pound of fat.  Based on the math, it would take a 500-calorie deficit every day to lose 1 pound per week.  I am generally not a fan of calorie counting, however it can be helpful for some people.  There are a number of free calorie counting apps that you can obtain for your phone.  I think doing periodic "spot checks" on your total calorie intake can be quite worthwhile. 

Take a look at Apps such as:

• Lifesum.
• Spark People Calorie Tracker
• MyFitnessPal
• Calorie Counter by Fat Secret

Timing. We have known for quite some time that when you eat can play a significant role in determining how many calories you absorb, burn and process.  Since we originated as a hunter/gatherer species, our genetics are designed for intermittent periods of fasting, when no food was readily available.  Having short periods of fasting may actually be genetically preferred.

The Potential Benefits of Intermittent Fasting

Research suggests that there are numerous potential benefits for intermittent fasting aside from weight reduction. These include the following:

. 

1. Changes the function of hormones, cells, and genes

Insulin levels. Insulin is a STORAGE hormone. When you fast, insulin levels drop significantly and fat storage is reduced.

Cellular repair. Fasting induces important cellular repair processes, such as removing waste material from cells.  https://www.sciencedirect.com/science/article/pii/S1568163718301478

Gene expression. There are beneficial changes in several genes and molecules related to longevity and protection against disease.  https://www.annualreviews.org/doi/full/10.1146/annurev-nutr-071816-064634

2.  Reduced insulin resistance, lowering your risk for type 2 diabetes

Anything that reduces insulin resistance should help lower blood sugar levels and protect against type 2 diabetes. Intermittent fasting has been shown to have major benefits for insulin resistance and to lead to an impressive reduction in blood sugar levels. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7856758/

3. Reduced oxidative stress and inflammation in the body

Oxidative stress is one of the steps toward aging and many chronic diseases. It involves unstable molecules called free radicals. Free radicals react with other important molecules, such as protein and DNA, and damage them. Several studies show that intermittent fasting may enhance the body’s resistance to oxidative stress. Studies also show that intermittent fasting can help fight inflammation and may benefit any inflammatory body process, such as autoimmune diseases, arthritis, etc.

4. Beneficial for heart health

Intermittent fasting has been shown to improve numerous different risk factors, including:

• blood sugar levels
• blood pressure
• blood triglycerides
• total and LDL (bad) cholesterol
• inflammatory markers

5. May help prevent cancer

Promising evidence from animal studies indicates that intermittent fasting or diets that mimic fasting may help prevent cancer. Research in humans has led to similar findings, although more studies are needed.

6. May help prevent Alzheimer’s disease

Alzheimer’s Disease is the world’s most common neurodegenerative disease. There’s no cure currently available for Alzheimer’s, so preventing it from showing up in the first place is critical.

Studies in rats and mice show that intermittent fasting may delay the onset of Alzheimer’s or reduce its severity.

https://www.sciencedirect.com/science/article/abs/pii/S0969996106003251

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6022926/

In a series of case reports, a lifestyle intervention that included daily short-term fasts was able to significantly improve Alzheimer’s symptoms in 9 out of 10 people

https://www.aging-us.com/article/100690/text#fulltext).

7. May extend your lifespan, helping you live longer

One of the most exciting applications of intermittent fasting may be its ability to extend lifespan.

Studies in rodents have shown that intermittent fasting extends lifespan in a similar way as continuous calorie restriction https://www.sciencedirect.com/science/article/pii/S1550413118305126

In some of these studies, the effects were quite dramatic. In an older study, rats that were fasted every other day lived 83% longer than rats who weren’t fasted. https://www.karger.com/Article/Abstract/212538

Common  Fasting Regimens

Here are some common approaches to intermittent fasting, with my recommendations.

Alternate-day fasting. Eat a normal diet one day and either completely fast or have one small meal (less than 500 calories) the next day. This can be a challenging approach requiring a great deal of self-discipline. It may be too restrictive for many.

Daily time-restricted fasting(16-8 or 18-6). Eat normally but only within a six to eight hour window each day. For example, skip breakfast but eat lunch around noon and dinner by 8 p.m. Remember the “eating clock” starts ticking with your very first bite of food, so if you decide to eat breakfast at 8am, you will need to stop eating by 4pm. This approach can be very successful if you are very obese(BMI >40) or for weight maintenance. It does not seem to work as well if you need to lose only 15-20 pounds.

Intermittent Fasting 5:2. I have found this approach to be effective and one of the easier ones to follow.  With 5:2 fasting, you will eat a normal, healthy diet 5 days a week.  Then on two non-consecutive days, you will limit your total calorie intake to 500 cal.  These 500 cal should be primarily fat and protein with no added sugars.  The 500 calories can be eaten as a single meal or divided throughout the day. 

Click on these links for some ideas on 500-calorie meals:

https://www.livestrong.com/article/323616-sample-500-calorie-diet-plan/ 

https://ohsofoodie.com/500-calorie-keto-meals/

https://www.simplemost.com/low-carb-dinners-under-500-calories/

You have flexibility in picking your fasting days. For example, if your normal fasting days are Tuesdays and Thursdays, but you have a party to attend on Thursday you could simply move your fast-day to Friday for that week.

Dr Paz’s Recommendation- Intermittent Fasting 5:2-3

I think the 5:2 approach is a great place to start.  However, my real preference is for the 5:2-3 approach.  This incorporates no eating within 3 hours of bedtime.  This three-hour restriction is 7 days a week.  There is good evidence that late-night eating, especially within 3 hours of bedtime, has the potential to cause significant weight gain.  It is also well known to interrupt normal sleep patterns.

https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1467-789X.2011.00975.x

https://jcsm.aasm.org/doi/full/10.5664/jcsm.7658

So give it a try! For many it can have life-changing benefits if done consistently. Good Luck!

What about exercise?

While the benefits of exercise are extensive, including reducing the risk of heart disease, diabetes, Alzheimer’s disease, arthritis and cancer, it does tend to fall short when it comes to weight loss.  However, because of its other benefits, I strongly encourage at least 150 minutes a week of vigorous exercise.  This will  be helpful with weight maintenance but probably will not be enough to promote significant weight loss.

Why do I say this? Lets do the math. In order to lose one pound you will need to expend 3500 calories while exercising.

Here are some examples of how long you would need to exercise to lose one pound(3500 calories):

Aerobics, low impact                     10 hours                                               

Aerobics, water                               9 hours                                                          

Bicycling, < 10 mph                       12 hours                                         

Dancing                                         16 hours                                                                

Elliptical trainer, moderate effort    10 hours                                

Running, 5 mph                               6 hours                                             

 Swimming laps, later moderate      8 hours                                 

Walking, 3.5 mph                           11 hours                                               

I'm often reminded of the old body-building adage: "Biceps are made in the gym, but Abs are made in the kitchen!"

IT’S JUST MY OPINION. The opinions in my newsletter are based on my interpretation of the literature and my personal experience from tens of thousands of medical visits over the last 37 years. 

TALK TO YOUR DOCTOR. The information I share in this newsletter is meant for general medical information purposes and is not specific to your medical care. Before you initiate any therapy you should discuss it with your doctor.  If your doctor is not open to discussing nutritional therapies, maybe it is time to find a new doctor…..