Type 2 diabetes and fasting: What you need to know

USAThe fad diet doesn’t fit the hype, let alone serious scientific research. But intermittent fasting seems to be an exception. These plans involve not consuming calorie-dense foods or drinks for an extended period of time — anywhere from 16 hours to a few days — and they’re becoming increasingly popular. Research has also shown them to be effective in weight loss.

Doctors often recommend that people with Type 2 diabetes lose weight, which can have beneficial effects on blood glucose and insulin sensitivity, as well as disease progression. For this and other reasons, experts are actively looking at the effects of intermittent fasting in people with Type 2 diabetes. However, there are some safety concerns. “People with diabetes should be the ones who benefit most from intermittent fasting,” says Benjamin Horne, director of cardiovascular and genetic epidemiology at Intermountain Healthcare in Utah. “But these diets also have some of the biggest potential safety issues due to the medications commonly used by people with diabetes.”

Horne is a co-author of several recent papers on the effects of intermittent fasting in people with diabetes. One of them, appearing in Journal of the American Medical Association in 2020, specifically reviewed the risk profiles of these activities. “It’s easy to start an intermittent fasting regimen, so our main focus is on the safety issues around fasting once you have a diabetes treatment plan in place,” he says. “. Building on her and others’ research, Horne says that for most people with Type 2 diabetes — especially those who don’t take medication to control blood sugar — research shows that fasting Intermittent eating is both safe and possibly beneficial. However, intermittent fasting is not suitable for everyone. Here, Horne and other experts explain the possible risks of an intermittent fasting plan, as well as the benefits and best approaches.

The risks of intermittent fasting

Low blood sugar, aka hypoglycemia, can cause a rapid heartbeat, sweating, tremors, and other symptoms. If severe, it can cause weakness, seizures, or even death. People with Type 2 diabetes are more at risk for low blood sugar — especially if they fast for long periods of time — and this was one of the first dangers experts looked at when assessing blood sugar levels. safety of intermittent fasting. “If you’re taking medications aimed at lowering blood glucose levels, along with fasting, they can cause hypoglycemia which can be fatal,” says Horne. “It’s not a small safety risk.”

For a 2018 study in the journal diabetes medicine, Researchers in New Zealand found that rates of hypoglycemia were increased in people with Type 2 diabetes who tried intermittent fasting. However, this increase is consistent with the results of other weight loss diets, including conventional methods that encourage people to consume fewer calories daily. In addition, the people in the study were all taking medications designed to lower their blood sugar. Study author Brian-Corley, a diabetes specialist at the Capital & Coast District Health Board in New Zealand, said: “It was the medication, not the diet, that caused the hypoglycemia. Corley says people who are taking these medications can reduce their risk of dangerously low blood sugar by working closely with their doctor, monitoring their blood sugar more carefully on fast days, and learning to control it themselves. hypoglycemia. In other words, an intermittent fasting plan is not necessary for these patients; they just need a little more care. Meanwhile, his research also shows that intermittent fasting helps weight loss and improved measures of fasting blood sugar, hemoglobin A1C, and overall quality of life.

For people who don’t take medication to lower their blood sugar, Horne says the risk of hypoglycemia appears to be very low. “People should still consult with someone who treats diabetes – a doctor like an endocrinologist, or at least a dietitian trained in treating diabetes,” he said. . Like Corley, he says that even people on blood sugar-lowering medication can try intermittent fasting as long as they’re working with a professional. “They should or should not. That is the extent to which they should be monitored,” he said. (That doesn’t affect Type 1 diabetics; Horne says that for this group, intermittent fasting is too risky.)

Aside from hypoglycemia, the second biggest concern is dehydration. High blood sugar causes general dehydration in the body and people with Type 2 diabetes are already at increased risk. Intermittent fasting may further increase these risks if people drink or eat less than usual. (Food turns out to provide a third or more of the water people consume each day.)

“With dehydration, people with diabetes can have many negative outcomes,” says Horne. Stroke, migraines, and kidney damage are potential problems, especially if a person with diabetes has other health conditions associated with these risks. “So if someone already has problems with their kidneys – and it is common for people with diabetes to have some sort of kidney problem, if not full-blown kidney disease – then dehydration can be a problem,” he explains. may cause harm. While drinking water or other non-alcoholic liquids while fasting may reduce these risks, people with Type 2 diabetes along with other chronic conditions — such as heart disease or kidney disease — perhaps not trying the diet. The same goes for frail elderly people with diabetes. “Fasting puts a strain on the body and organs,” he says. If you are weak or unwell, going without food is probably a bad idea.

There are a few potential health concerns associated with intermittent fasting. However, these are not exclusive to people with Type 2 diabetes. For example, nutrient deficiencies, not eating enough protein (especially if you are older) and other forms of malnutrition can occur. if you are fasting. In addition, the safety profile of intermittent fasting is not clearly mapped among pregnant or breastfeeding women, or in young children – all other groups with important nutritional needs. with the general population. Experts say these groups should not fast until the risks and benefits are better understood.

Despite the potential risks that may arise, intermittent fasting – with expert supervision – appears to be safe for most people with Type 2 diabetes.

Read more: How people with type 2 diabetes can reduce their risk of health problems

Benefits of intermittent fasting

While intermittent fasting can be risky for some people, it can also be more and more beneficial than other approaches. A 2017 study in World Journal of Diabetes found that just two weeks of intermittent fasting led to significant weight loss (more than 3 lb. on average) as well as improvements in blood glucose levels. “It’s possible that intermittent fasting could lead to a reduction in insulin resistance,” said Kerry Mansell, co-author of that study and a professor in the College of Pharmacy and Nutrition at the University of Saskatchewan in Canada.

Research supports this hypothesis. Several studies on people with diabetes have found that intermittent fasting can increase insulin sensitivity and also decrease blood insulin levels. This is a big broblem. “Basically, fasting is doing what we prescribe for diabetes, which is improving insulin sensitivity,” says Horne. At least one small trial (just three people) showed that intermittent fasting allowed diabetics to stop taking insulin altogether. The findings of that study still need to be replicated in a larger group. However, these results are very encouraging. Insulin resistance is associated with higher levels of inflammation and other risk factors for cardiovascular disease. “Even when people don’t lose weight on a fasting diet, some studies have found that insulin sensitivity is markedly improved,” says Horne. “This is something you don’t usually see with other calorie-restricted diets.”

How can fasting produce these benefits? There are several theories, and some of them may come true. One of the leading theories — strongly supported by research — is that fasting kicks off a kind of cellular cleansing process, removing old or unhealthy cells and allowing new cells to grow. develop. Based on the results of this study, some experts argue that the human body is not designed for the modern food environment and eating schedule of three meals a day plus snacks. They say that intermittent fasting may closely resemble the way humans ate for most of our human history.

More work is required to iron all of these. But research to date indicates that intermittent fasting can provide unique and meaningful health improvements for people with Type 2 diabetes.

Which fasting plan is best?

Duration intermittent fasting does not refer to a well-defined practice. Several different approaches fall within the scope of intermittent fasting. The three most popular and well-researched ways are known to be time-restricted eating, alternate-day fasting, and the 5:2 diet.

The first of these – time-restricted eating – involves squeezing all of your day’s calories into a single “feeding time” of six to eight hours. For example, a person following this diet could eat between noon and 6 p.m. each day and avoid all high-calorie foods and drinks for the other 18 hours of the day. Meanwhile, a person following an alternate day diet eats normally for one day, but consumes little or no calories the next day. Final, diet 5: 2 consists of eating normally five days a week but fasting the other two days.

There are many variations of each of these plans. At this point, it’s still unclear which of these, if any, is optimal for people with Type 2 diabetes. “I think time-restricted eating is probably commonplace,” says Horne. first, followed by fasting two days a week. “But for now, I would say that there is not one plan that stands out as the best option.” The “right” plan is one that the patient will stick with, he added. Even if more intense fasting programs turn out to be the most beneficial, it doesn’t really matter if people can’t stick to it.

Read more: The link between type 2 diabetes and mental disorders

How to start intermittent fasting?

The first step, always, is to talk to your doctor or care team. They will be able to help you weigh the benefits and risks, identify dietary methods to avoid nutritional deficiencies, and, if necessary, adjust any medications you’re taking to avoid problems. “Safety has to come first,” says Horne.

However, don’t be surprised if your healthcare provider isn’t enthusiastic about the diet. These plans are still relatively new and they are not usually taught in medical school. “People may experience adverse reactions, or their doctors may not be familiar with these regimens,” says Horne. If your doctor says fasting isn’t right for you, that’s one thing. But if she or he doesn’t seem to approve of the diets in general, it may be a good idea to seek a second opinion from an experienced provider about these plans.

Some people with intermittent fasting may be at risk. But now there’s evidence that it could be a helpful, or even superior, alternative to classic weight loss plans for people with type 2 diabetes.

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