A Clinician's Experience of 15 Years of Intermittent Fasting

Orthomolecular Medicine News Service, April 9, 2024
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by Richard Z. Cheng, M.D., Ph.D.

About 15 years ago, a group of my friends I used to hang out with started playing badminton. Didn't want to be left out, so I started learning and playing badminton with them. But these people were 20-30 years younger than I. I couldn't catch up physically, not surprisingly, I might add. It was an embarrassing experience. So, I started researching how to improve my physical endurance. Having a Ph.D. in biochemistry really helped. I quickly zeroed in on boosting energy metabolism and improving mitochondrial function to help improve my exercise endurance. Diet and nutrition are two of the areas that I really focused on. Intermittent fasting and low carbohydrate/ketogenic diet are 2 dietary patterns that I concluded to be most likely mitochondrial energy metabolism friendly which I started practicing right away. I also started taking relatively high (orthomolecular) doses of vitamins and micronutrients that I felt would help my mitochondrial energy metabolism.

This practice quickly helped me to improve my badminton court performance. One of my high moments that I still remember vividly even today was in late summer of 2016. I was playing badminton as usual that evening. About 40 minutes before the courts closure, I was playing with a young post doc (who had been playing badminton longer than I had) in his early 30s. After a while, he was tired and left the court. Another young man of similar age who claimed to be a Shaolin kongfu practitioner came onto the court to play with me. About fifteen minutes into the game, he was on the floor, exhausted. I jokingly shouted to my friends on the court: anyone else wants to challenge this old man? A third post doc came to play with me until the gym closure. I still didn't feel too exhausted.

A week later, on a lecturing tour in Beijing and Shanghai with Thomas Levy (we were invited by a top-notch infectious disease expert in China for a major research project using vitamin C against HIV), I proudly shared with the audience of this interesting experience, winning rounds of applause.

I have many other such instances. Back in 2017 or 2018, I and my daughter joined a group tour of high school students and their parents to the Great Wall in Beijing. I was the only one who went to the top in one breath, leaving a busload of high school students and their parents flabbergasted.

I continue to play badminton 2-3 hours each session, 2-3 times a week with people 10-30 years younger. I often surprise badminton friends when they find out my age. My endurance is better than many of these players, not to mention ordinary people without regular exercise.

In addition to improved exercise endurance, I have seen a significant improvement in my overall health, including much improved emotional status. My insulin resistance markers (HOMA-IR, TG/HDL, and TyG) were mildly elevated about 10 years ago and now they are all within ideal ranges. My bone mineral density is on top of the normal range, better than ~80% of people in their 20s-30s. My coronary calcium score is better than most men my age.

I have also been prescribing and recommending intermittent fasting (as part of my integrative orthomolecular medicine protocol) to my patients, clients, and audience. I have seen significant improvement even complete reversal of many chronic diseases including (but not limited to) coronary heart disease and carotid plaque (atherosclerotic cardiovascular diseases) (Cheng 2022a, Cheng 2022b), type 2 diabetes and other metabolic diseases, autoimmune diseases (Cheng 2022c), cancer (Cheng 2022d), even osteoporosis.

The recent news release of a poster presentation of intermittent fasting associated with increased cardiovascular risks is irresponsible, misleading and may potentially cause harm to the public (Cheng 2024). An umbrella review of 23 meta-analyses on intermittent fasting was just published on Lancet (Sun 2024). The authors concluded that intermittent fasting may have beneficial effects on a range of health outcomes for adults with overweight or obesity. IF may decrease many metabolic health parameters such waist circumference, fat mass, LDL-C, Triglycerides, cholesterol, fasting insulin, and blood pressure, while increasing HDL-C and muscle (fat free mass). Below is a brief review of intermittent fasting studies:

Studies showing benefits of intermittent fasting on cardiovascular health:

Intermittent fasting (IF) has been shown to have a range of potential benefits for cardiovascular health. It can improve cardiac energetics and activate survival signaling pathways, leading to a longer lifespan (Abdellatif 2020). This dietary pattern can also reduce blood pressure, insulin resistance, and oxidative stress, and improve appetite regulation and gut microbiome diversity (Varady 2021). Furthermore, intermittent fasting may improve body composition, ectopic fat, and classic cardiometabolic risk factors, and increase protein and fat oxidation (Dote-Montero 2022). It has been suggested that intermittent fasting could reduce the risk of cardiovascular disease by improving weight control, hypertension, dyslipidemia, and diabetes (Dong 2020). However, further research is needed to fully understand the potential benefits of intermittent fasting for cardiovascular health (Hamer 2023).

Intermittent fasting for metabolic diseases

Intermittent fasting has been shown to have a range of potential benefits for metabolic health. It can improve metabolic and inflammatory parameters, particularly when combined with regular physical exercise (Zhang 2023). Different intermittent fasting approaches, such as alternate day fasting and time-restricted eating, have been found to be effective in weight loss and improving cardiometabolic risk factors (Zhu 2020). Aligning food habits with the circadian clock through early time-restricted feeding can also improve metabolic health (Charlot 2021). Intermittent fasting regimens, including time-restricted feeding, have been linked to improvements in dyslipidemia and blood pressure (Vasim 2022). These regimens can also improve the lipid profile, decrease inflammatory responses, and change the expression of genes related to inflammatory response and other factors (Azevedo 2013). Furthermore, intermittent fasting may optimize intestinal microbiota, adipocyte status, and metabolic health (Matías-Pérez 2022).

Intermittent fasting's impact on longevity

Intermittent fasting has been linked to longevity and improved healthspan, with potential benefits for various diseases. Longo (2021) and Hu (2020) both highlight the role of IF in activating cellular repair and rejuvenation pathways, as well as its impact on gut microbiota and circadian rhythm. IF has been shown to have disease-modifying effects, particularly in metabolic disorders, cancer, and neurodegenerative diseases (Mishra 2020; Longo 2014). It may also improve metabolic health and insulin sensitivity (Hoddy 2020). The neurobiological mechanisms of IF, including its effects on brain-derived neurotrophic factor, have been explored (Mattson 2005). Furthermore, a diet that mimics fasting has been found to promote multi-system regeneration and enhanced cognitive performance (Brandhorst 2015).

Intermittent fasting has also been shown to be beneficial for brain health.

Intermittent fasting has been shown to have potential benefits for brain health, particularly in the context of aging and neurodegenerative diseases (Francis 2020, Seidler 2022). It can upregulate brain-derived neurotrophic factor (BDNF), which is crucial for cognitive function (Seidler 2022). However, the evidence for short-term cognitive benefits in healthy individuals is inconclusive (Gudden 2021). IF may also have positive effects on mental health, including affective and cognitive disorders (Currenti 2020). The metabolic switch induced by IF, which leads to the production of ketones, can enhance brain function and resilience (Mattson 2018). However, the specific effects of IF on brain health and cognitive function may vary depending on factors such as age, obesity, and fasting patterns (Gudden 2021).

Intermittent fasting for cancer prevention and treatment:

Intermittent fasting has shown potential in cancer prevention and treatment, with studies suggesting its ability to limit cancer cell adaptability, survival, and growth (Tiwari 2022). However, the safety and feasibility of IF during chemotherapy are still being explored (Lutes 2020). IF, particularly time-restricted eating, has been found to synchronize circadian rhythms and upregulate autophagy, potentially preventing tumorigenesis and slowing tumor progression (Fang 2023). Despite these promising findings, the need for high-quality randomized clinical trials to further investigate the effects of IF on cancer incidence and prognosis is emphasized (Clifton 2021). Furthermore, the potential anticancer effect of IF in animal experiments warrants further exploration in well-designed clinical trials (Giannakou 2020).

Intermittent fasting for weight loss and bone health

Intermittent fasting has been shown to have potential benefits for weight loss and metabolic health (Clayton 2023, Tinsley 2015a, Gerboğa 2023). However, its effects on bone health are less clear. Some studies suggest that IF may not have a significant impact on bone metabolism (Clayton 2020), while others indicate that it could potentially compromise bone health, particularly when combined with other dietary restrictions (Clayton 2023, Hisatomi 2019).

The impact of intermittent fasting on muscular health and exercise endurance

Intermittent fasting combined with resistance training can improve body composition and muscular performance (Tinsley 2015b). It may also enhance endurance by engaging metabolic and cellular signaling pathways (Marosi 2018).

Intermittent fasting for mental and emotional health

Intermittent fasting has been shown to have a positive impact on mental and emotional health. It can improve brain health, including signaling, neurogenesis, and synaptic plasticity (Currenti 2020, Francis 2020). The practice has also been linked to enhanced cognitive performance, particularly in athletes (Cherif 2015). Fasting can lead to increased vigilance, mood improvement, and a sense of well-being (Fond 2013). It has been associated with a reduction in β-amyloid accumulation, a marker of Alzheimer's disease, and has been proposed as a potential preventive intervention for dementia (Elias 2023). Furthermore, intermittent fasting has been found to be safe and well-tolerated, leading to improvements in emotional and physical well-being (Wilhelmi de Toledo 2019).

Intermittent fasting for autoimmune diseases

Intermittent fasting has shown promising results in the treatment of autoimmune diseases. Studies have demonstrated its ability to ameliorate symptoms and promote recovery in mouse models of multiple sclerosis (Bai 2020, Cignarella 2018, Razeghi 2016). Medically supervised water-only fasting has also been associated with remission of autoimmune diseases (Fuhrman 2002). The immunomodulatory effects of intermittent fasting, including its ability to strengthen circadian rhythms, lower inflammatory factors, and enrich microbials, have been highlighted in a systematic review (He 2023). Furthermore, a diet mimicking fasting has been shown to promote regeneration and reduce autoimmunity and multiple sclerosis symptoms in mouse models (Choi 2016).

Evolutionary perspective on intermittent fasting

Human ancestors were hunters-gatherers and evolved in environments with sporadic food availability, leading to periods of fasting and feasting, relying mostly on fatty animal meats for millions of years until ~10,000 years ago when agriculture appeared (Pattillo 2019, Mattson 2019, Ben-Dor 2021). This evolutionary pressure favored individuals with cognitive capabilities and metabolic adaptations that could thrive during food scarcity (Pattillo 2019). The wide range of cognitive abilities like spatial navigation, decision-making, and creativity evolved to enable success in food acquisition (Pattillo 2019). Metabolic switching between glucose and ketone body utilization was a key adaptation to intermittent food deprivation (Pattillo 2019, Hoddy 2020). Intermittent fasting patterns that incorporate periods of fasting may enhance neuroplasticity and cognition by stimulating the same neural signaling pathways that evolved to cope with food scarcity (Pattillo 2019, Hoddy 2020).

Impact of intermittent fasting on energy and mitochondrial function

Intermittent fasting has been shown to enhance energy metabolism and mitochondrial function in various studies. Real-Hohn (2018) found that a combination of IF and high-intensity intermittent exercise (HIIE) improved physical endurance and metabolic pathways, while Pak (2022) demonstrated that prolonged IF increased mitochondrial activity in neurons. IF has also been linked to improved health and disease resistance (Cabo, 2020), and to changes in liver mitochondrial function (Menezes-Filho, 2019). The metabolic switch induced by IF and exercise can enhance endurance capacity (Marosi, 2018), and improve metabolic flexibility in short-term high-fat diet-fed mice (Dedual, 2019). Carlson (1994) found that fasting increased fat oxidation and protein oxidation, contributing to energy homeostasis. These findings collectively suggest that IF can boost energy metabolism and mitochondrial function, potentially through a variety of mechanisms.

Summary

As part of an integrative approach, intermittent fasting, when practiced properly under the supervision of a qualified and experienced healthcare provider, can offer tremendous benefit to one's health and well-being.

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