Does Intermittent Fasting help with Diabetes Management?

Intermittent fasting is the vogue diet plan of this century; shedding weight like a snake's skin. But from a medical point of view, how good is it really?

Can a diabetic patient try IF safely? What are the risks associated with fasting causing the sugar levels to go too low?

Let's debunk all of it. 

Introduction: Demystifying Intermittent Fasting (IF)

Intermittent fasting is an eating plan that switches between fasting and eating on a regular schedule. So, you basically give your body a rhythm to work with, instead of eating throughout the waking hours constantly.

This helps burn intra- myocellular fats- the type of fat cells that keep you in a diabetic state. You will learn about them later in this article.

You can pick a daily approach, which restricts daily eating to one six- to eight-hour period each day. 

For instance, you may choose to try 16/8 fasting: eating for eight hours and fasting for 16.

You can go with another intermittent fasting plan, known as the 5:2 approach. It involves eating regularly five days a week. For the other two days, you limit yourself to one single 500–600 calorie meal. 

One point of intermittent fasting is to put the body in a state of ketosis, where it burns its stored fats to survive instead of using instant glucose coming from meals and snacks all the time.

Intermittent fasting, in its various forms, including time-restricted feeding and alternate-day fasting, has become the most popular method of weight loss. Its benefits can be effectively, if employed properly for diabetes management. We have used IF for many of our clients with very promising results. Here is one of our client's story:

Research further shows that intermittent fasting helps:

• reduce weight,
• fat mass,
• blood pressure, and,
• improves insulin sensitivity in both type 1 and type 2 diabetes mellitus.

That is why endocrinologists and nutritionists have been increasingly recommending personalized intermittent fasting plans for sustainable diabetes management.  

Some types of intermittent fasting plans include:

1. Alternate day fasting: You eat your regular diet one day, and then eat fewer than 600 calories the next day, repeating this pattern throughout the week. I do not recommend this type of fast to my clients, specifically if they have diabetes. 
   
   
2. 5:2 Style Fasting: The popular 5:2 plan is related, in which you eat a regular healthy diet 5 days a week and cut down to about 500 to 800 calories on the other 2 days. Once again, I would not recommend this to my clients.
   
   
3. Time-restricted eating: This is when you get all your calories for the day during a specific number of hours. For instance, on an 8-hour plan, you might eat from 10 a.m. to 6 p.m. and then not again until the next day at 10 a.m. This is different from IF itself as you are really eating the same number of total calories and not missing any meals. I highly recommend this to all my clients.

Dr. Satchin Panda has authored various books based on his research on circadian rhythm, eating habits, and metabolic diseases. In his podcast with Simon Hill, Dr. Satchin Panda talks about how eating habits have resulted in increased incidence of metabolic diseases, and how remarkable results can be achieved by fixing them.

"With the increasing incidence of metabolic syndrome, diabetes mellitus, and cardiovascular deaths, there is definitely something wrong with this generation's lifestyle, and that might be the random eating habits.

Instead of eating all day, and specifically increasing intake at bedtime, we need to stick to the circadian rhythm of our body, as our ancestors during hunting times used to do.

The pancreas is much better at responding to carbs in the first six hours of the day after waking than at any other part of the day. So, the first meal of the day should be filling and hearty.

The body prepares to put itself to sleep by secreting melatonin two to three hours before the daily bedtime. Melatonin inhibits the pancreas from releasing insulin. Not eating in those hours is a fantastic idea to control blood sugar levels, especially for diabetics."- Dr. Panda

Should I Skip Breakfast or Dinner While Fasting?

As a diabetic, you want to consume a bigger chuck of your overall calories in the first half of the day VS the second. Your body is better at optimizing caloric bur in the first half VS the second. Watch this to understand more:

By this logic, having a hearty breakfast and fasting for a few hours before you sleep is the best approach.

Interestingly, according to this one concept of ego depletion, individuals tend to lose control and indulge themselves after a single act of self-control. So, if a person eats less in the morning, they are more likely to give themselves the liberty to eat more at a later time in the day, as compared to a person who had a heavier meal in the morning.

To summarize, what I am suggesting here is:

• Avoid eating immediately after waking up. Your pancreas is not in its prime at that time. Eating your first meal 90- 120 minutes post waking up is ideal.
• Avoid eating too close to bedtime. Finish your dinner 2-3 hours before bedtime.
• Let your breakfast be heavier and dinner lighter.

NOTE: It is very important to work with your doctor and tweak your medication dosage before any form of fasting. All my clients work with our in- house doctors along with our nutrition coaches to help reduce their medication dosage as their body heals. Fasting can be a very powerful tool in healing from diabetes. You want to be extra cautious to tweak your medication to avoid hypoglycemia. 

What Should You Eat After Fasting?

The prevalence of diabetes type 2 has been the highest among non-vegetarians, standing at 7.6%, and the lowest among vegans, which is only 2.9%. By merely eating more plants than animal products, can you see a difference in your fasting glucose in as little as 2-3 weeks!

Dr. Neal Barnard and his research team received a grant to investigate the optimum nutritional approach to diabetes. They compared a conventional diet with a plant-based diet and their effects on diabetes management. 

• The conventional diet approach focused on reducing calories, controlling the carbs intake, and limiting the bad fats. 
• The plant-based diet, on the other hand, avoided animal products completely and focused on plant-based foods.

The results showed that while the diabetics and pre-diabetics on the conventional diets exhibited reduced HbA1c levels, those on the plant-based diet showed a much more remarkable decrease. Besides this, participants were more likely to continue following the plant- based diet even after the program ended. 

All clients on my program follow a plant- based diet without restrictions on portion control, carb counting or carb- restriction. We have a 98% improvement ratio! Meaning 98 out of 100 clients who join our program see an improvement in their health. Here is why our program works so well (if you understand hindi, watch the below video):

The blood sugar levels and insulin sensitivity in those patients who followed a plant- based diet showed better and more sustainable results in the long term, which tells us the optimum way of managing diabetes: combining intermittent fasting with a plant-based lifestyle. 

Several studies have investigated the effects of phytonutrients (compounds produced by plants that provide health benefits to the body) on glycemic and weight management in diabetes patients. It turns out that phytochemicals such as cinnamaldehyde and curcumin double the effects of insulin. Meaning, you will need much lesser insulin to do the same job. 

When insulin administration is accompanied by the intake of these phytonutrients, glucose uptake is improved by 70% as compared to giving insulin alone

Does Research Support Intermittent Fasting?

Both intermittent fasting (when done right) and plant-based diets have been shown to:

1. Reduce blood cholesterol levels
2. Reduce weight
3. Bring HbA1c levels down
4. Improve insulin sensitivity
5. Reduce blood pressure
6. Protect against glucose spikes
7. Improve the body's capacity to take up glucose

When intermittent fasting is coupled with a plant-based diet, these effects become additive. For a diabetic patient to find a balance between their diabetic medication, plant-based nutrition, and intermittent fasting, strict monitoring as well as expert nutritionist advice is required. 

Studies show improved outcomes in diabetic patients but also an increased risk of hypoglycemic events despite the reduction in the dosage of insulin sometimes. For my clients, we insist they do a home prick test a few times per week to avoid episodes of hypoglycemia.  

The patient should have a thorough understanding of the signs and symptoms of hypoglycemia and acute management of the condition because hypoglycemia can be life-endangering.

Addressing Concerns.

Intermittent fasting can present challenges for those managing diabetes, such as feelings of hunger, fatigue, and other discomforts. It is vital to listen to your body's cues and adjust your fasting routine accordingly. If you're new to intermittent fasting, make sure you start gradually and increase fasting periods over time.

“People with diabetes should be those who benefit most from intermittent fasting. But these diets also present some of the greatest potential safety issues because of the medications that people with diabetes are typically taking.”-  Benjamin Horne, director of cardiovascular and genetic epidemiology at Intermountain Healthcare in Utah. 

People with Type 2 diabetes are at increased risk for hypoglycemia—especially if they go long periods without eating—and this was one of the first dangers experts looked at when assessing the safety of intermittent fasting. 

“If you are taking medications that are aimed at reducing the amount of glucose in your blood, together with fasting these can cause potentially fatal hypoglycemia,” Horne says. “It’s not a minor safety risk.”

While intermittent fasting has numerous health benefits, it is important to remember that it is not a standalone solution. We use this technique with clients but with caution. We use a huge number of lifestyle modification techniques with clients to help them manage diabetes. IF is simply one of them. 

Intermittent fasting should be part of a comprehensive approach to health, including a balanced nutrition, regular exercise, and expert medical advice regarding the dosage and timing of insulin.

How Should An Average Day Of Eating Look Like?

With my clients, we do a time- restricted eating type of fasting. Meaning, the eat all three meals (plus a snack), but within a 6- 8 hour window. Here is an average day of eating for a client:

Additional Tips to Follow:

1. As long as you are eating the right foods and avoid fats, you will not have to worry about the portion sizes of meals. 
2. Include plenty of vegetables in each meal to increase fiber intake and promote satiety.
3. Opt for whole grains like brown rice, quinoa, and whole wheat over refined grains.
4. Limit added sugars and processed foods, opting for whole, unprocessed plant-based foods instead.

Tips for Success.

As we have already discussed, intermittent fasting can get a bit tricky for diabetics if they do not pay attention. Coupling it with a plant-based diet can further make your plan more sustainable and easy to follow.

1. Stay hydrated during the fasting windows. Dehydration and diabetes are a lethal combination.
2. Avoid sugar-containing fruit juices. Smoothies with the fiber are ok to consume. 
3. Always choose whole foods, even among the plant-derived options. Processed foods such as white pasta, white flour, and additive sugars will harm your glycemic control even if they do not exceed your caloric target.
4. Stick to the circadian rhythm as closely as possible. Wake up with the sunrise and sleep a few hours post sunset. 
5. Avoid eating close to bedtime, no matter what your choice of fasting window is. 
6. Inculcate healthy stress management techniques to your routine such as meditation, breathwork etc. 
7. Diversify your plant-based diet plan. Pay special attention to protein sources such as lentils, seeds, quinoa, and chickpeas. Eat enough fruits and vegetables to get your daily intake of minerals and vitamins. 

Conclusion.

It is a great sign that you are researching long-term, sustainable lifestyle modifications for managing diabetes; I cannot emphasize enough how important that is. Plant-based approaches and intermittent fasting can help you manage blood sugar levels and insulin sensitivity, thereby protecting your body against the long-term complications of type 2 diabetes.

If you are curious how much team can plan a role in diabetes reversal, fill in the free consultation form below and let us get on a call to further help you.