A study published open access in JAMA suggests that an intermittent fasting dieting technique was associated with significant benefits for patients with obesity and Type 2 Diabetes. The “5:2 meal replacement diet” involves consuming limited calories — in the form of meal replacement shakes — for two nonconsecutive days each week. On the other days, the person then eats a normal breakfast and lunch, followed by a meal replacement for dinner.
More than 400 overweight or obese Chinese adults with type 2 diabetes were randomized to one of three treatment strategies for 16 weeks: the 5:2 meal replacement diet, metformin twice per day, or empagliflozin once per day. The group’s mean age was 45.5 years old, 65% were men and the mean hemoglobin A1C (HbA1C) was 7.9%. Overall, after 16 weeks, the most significant mean reduction in HbA1C level (1.9%) was seen in patients who followed the 5:2 meal replacement diet. This was 0.3% greater than the reduction seen with metformin and 0.4% greater than the reduction seen with empagliflozin. The same trend was seen when focused specifically on the study’s oldest patients, who were 60 years old and older. Weight loss was also the most significant among participants following the 5:2 meal replacement diet.
One of the patients I most enjoyed seeing (because of her positive attitude and kindness) weighed over 400 lbs. She was recovering from a Fournier’s gangrene that left her with a massive open abdominal and groin wound. One day she came in to the wound center very excited because she had managed to lose more than 30 lbs over a relatively short period of time. She told me that she was using an intermittent fasting technique recommended by her primary care doctor. The “fasting” technique suggested to her was that she not eat after 6 pm. To this woman, going more than 12 hours without eating was “fasting.” That may seem almost humorous to those of us who go longer than that accidentally, simply because we are too busy to stop to eat! However, that simple change was working for her (and may provide a hint as to the time of day during which she tended to eat the most calories).
I understand that there are purported benefits to going some period of hours (or even days) without eating. However, to food addicts and to patients who for various reasons may not be able to go long periods of time without food, the lesson may be that any change which reduces calorie intake will likely result in weight loss. (The Chinese study may also tell us that medication without lifestyle changes, is not going to work.)
–Caroline
Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos
The opinions, comments, and content expressed or implied in my statements are solely my own and do not necessarily reflect the position or views of Intellicure or any of the boards on which I serve.
