The FastDay Forum

Strangely enough I just tweeted Michael suggesting he make a sophisticated forum and facilitate a substantial observational study.
Low and behold it exists. Duh.
Thank you so very much.
Additional thoughts on the study:
A friend is feeding 3 times a day at 145 cal is this less of a fasting stimulus?
Does it matter if you have 600 or 0 calories on a fast day?
Could we record fasting glucose and cholesterol etc at onset and with progress?
Many of us have the info from clinic.
I also had an MI at mile 11 of the great north run 2008. How could we document significant medical history? I continue to run half and full marathons but my most recent cholesterol was 7.2 as I' m off statins for muscle injury. Not good news but good motivation.
Are there defined outcomes?
I'm a paediatrician, I know little about this topic, but obesity is a massive issue in children.
Could we enter this area!
Best wishes, Stephen

[Tracieknits]

Welcome Stephen!

I lot of the sorts of questions you have might be better addressed down in the "Nerdy Stuff" area of the boards. There are a couple of posters who are well informed on studies and more detailed medical questions that you have. I have personally found it easier to only eat once a day in the evening - if I eat a modest breakfast, I'm much hungrier all day long. However each person is different.

We hope you enjoy it here

[carorees]

Hi Stephen, welcome to the forum!

The purpose of the forum is not really to collect data for a formal study ! However, I think the weight loss data is still interesting.

The questions you raise are very pertinent and I don't know whether we can answer them without perhaps recruiting a group willing to supply the required data. Volunteers anyone?

A friend is feeding 3 times a day at 145 cal is this less of a fasting stimulus?

Yes, I think so. We are running a poll on how often people are eating on a fast day, but at present it is not being recorded on the progress tracker. It could be added retrospectively perhaps, which could help is to see if weight loss is better with fewer meals. Probably there are too many confounding factors though.

Does it matter if you have 600 or 0 calories on a fast day?

Probably 0 is better but a 36 hour total fast twice a week is perhaps too hard for many. Some are trying it though. Of course it would be better for weight loss.

Could we record fasting glucose and cholesterol etc at onset and with progress?

Only some of us have baseline values, again we could ask people to record changes if they can. This will likely select a population with comorbidities because they have the data from clinic visits.

How could we document significant medical history?

Again retrospectively I expect. Already there is some anecdotal evidence that can be gleaned from reading the posts. For example, some people are really struggling to lose weight and many of these report thyroid dysfunction, so fasting is no different from any calorie restriction in this respect.

Are there defined outcomes?

The defined outcome for most people is to reach a healthy BMI! It's going to be a very long study before we can answer whether there are any benefits beyond those gained by losing weight!

You missed a couple of questions that also need answering:
Is keeping carbs down on fast days important for lipolysis?
Is it important to eat up to a certain percentage of TDEE on feed days (i.e. are there metabolic benefits in being more or less in energy balance 5 days a week)?
Will this up-down energy intake make weight maintenance easier?
Does long term 5:2 have any detrimental effects (questions over LVF)?

Anyway it's good to have another science-minded person on board! Please head over to the nerds corner for more technical talk!

Really helpful response thank you Caroline. I would if course volunteer.

[carorees]

What do you think of the progress tracker stats so far? I think they look interesting but we need to get to the point where we have a reasonable number who have been going for 3 months (or 6!) before we could draw any tentative conclusions.

I'm interested to see whether people experience the plateau in weight loss at around 10% of body weight loss as seen in standard diets.

Also, I forgot to answer your Q about 5:2 for child obesity. Obviously you will have some thoughts about changes in the GH/ IGF1 axis seen with fasting in children? I wonder though, whether a return to our parents' exhortations not to eat between meals would be a good first step?

One thing I can say is the paediatric MEND programme would be delighted by the current documented weight loss.
MEND struggles to get the kids not to gain weight.
It's critical to get everyone to document their weights with positive or negative change.
Presumably in evolution children were equally subject to feast and famine

[carorees]

Yes, of course, they would have been. Do you think a concomitant reduction in stature would be seen if fasting started in childhood?

I wonder though, whether a return to our parents' exhortations not to eat between meals would be a good first step?

Unfortunately Caroline, there is copious evidence that such exhortations have no impact.
It's hard to find any evidence for the impact of obesity service for children.
And cultural or societal (?word) change is similarly difficult.
As a fish and chips gourmet I have proposed a number of time in children's trusts banning them from within 1/2 mile of a school so far I've not been taken up.

Anxiety over impact upon linear growth is logical as it is over brain growth.
Protein deprived population like those in certain geographies, 50 to 100yr ago undoubtedly were stunted.
But is there a space in dietary manipulation between the continuos availability of unrestricted calories and sensible cycles of limited access and expected physical activity.
There's no logical reason (I haven't done the research) why children couldn't survive/thrive in such an environment.

Can this discussion be transferred to NERD corner.
Mind you I give talks to schools on the apparent end of the enlightenment.
Such discussion is really helpful and everyone can understand it if the language is clear.
I discussed the issue of 3x 150 with 2 friends yesterday they were well able to understand the possible difference on the bodies response.
For me my compliance and actions are much higher when I understand and respect the science.

[carorees]

I think the science aspect is what has attracted a lot of us here!

Quite a lot of our members are finding that splitting the calorie allowance over 2 or 3 mini meals leaves them hungrier than having one bigger meal (in the evening usually). There is good science behind this too when you look at the satiety mechanisms. So rather than prescribe 150 x 3 it would be better to allow flexibility, regardless of whether there is any metabolic benefit!

I guess the issue in children is choosing the right degree of caloric restriction? The diet as Dr M created it gives an approx 20% restriction averaged over the week provided that you don't go over your TDEE on feed days. Most people are assuming they are near enough to the average man or woman to use the standard daily allowance for feed days and that eating normally on feed days is achieving this without calorie counting and for most the appetite loss after fasting is enough to ensure they don't eat more than TDEE. It does not work for everyone though...probably due to known/undiagnosed metabolic derangements (thyroid, history of previous weight loss etc). Would that approach work in children? The fast day calorie allowance is 25% of TDEE, so would you need to know TDEE for each child or could you create a standard formula?

Just thinking aloud here...

At the moment Dr M is playing safe and saying children should not fast and the NHS as a whole is sticking with the (failed) advice of low fat, more exercise. However, more and more doctors are trying it (you are not even the first on this forum!), so perhaps if we can get good data in adults, suggesting fasting for children might not be considered outrageous!

[carorees]

Moved to Nerdy stuff!

Hi Stephen
I am one of the people who has been doing this since 3 August. I have type 2 diabetes, and have experienced huge improvements in my sugar levels - HBA1C dropped from 89% in July to 48% in January. I have lost 3 stone so far and am still following this WOE as I have another 6 and a half stone to lose to reach healthy BMI of 25 (ish). I thought I would introduce myself as I have been obese most of my life and was encouraged to diet as a child. I can tell you that I was actively fighting my parents over compliance with dieting by 7 years of age to my certain recollection. I had motivation to diet, I was bullied for being fat, and at times I did try - but always in the past I gave up. For me, this way of eating turned up when I really needed it, and I can do it, and feel that I can stick to it to achieve my objective. If you would like a patient's perspective, I will give you any answers I can remember - I am 53, so memory is a bit dim on some things!
Liz

Thank you for your message.
Compliance with therapy, we have used the word concordance and a number of others!
Anyway helping a young patient (as a paediatrician) to change behaviours is massively challenging for everyone involved.
My interest is whether a 5:2 or similar fasting based regime is any easier to stick to?
Does knowing it only lasts a day and tomorrow will be near normal, does that make a difference?
Is it similarly effective?
Is it safe? This last question is difficult to answer with evidence but millions of children go hungry without overt detriment. A healthy child in my experience should be as tolerant as an adult.
How do you feel you would have responded?

Certainly as an adult I find 5:2 much easier to stick to - it is only one day, and the next day holds the possibility of alternatives in terms of food. If this were presented to a child over 10, say, I would expect that they would find it easier than sticking to the same level of diet every day. I think boredom is much harder to handle when you are younger.
Going without food over a period of time does seem to help to reset appetite.
I know it is probably next to impossible to achieve, but I have eliminated as much sugar as possible from my diet - my eating habits with sugary foods were completely insane, and felt like an addiction - the more I ate, the more I wanted to eat, and it was a vicious circle which for me was broken by stopping it completely - I could not do 'just a taste' I would always eat everything that was available and then go looking for more - it started when I was quite young.
It took about 8 weeks, but now I can walk past the displays in supermarkets without being tempted. I dish out icecream for my husband and son without even licking the spoon.
If you could frame the fasting in the form of a game, or a challenge, I think I might have responded positively to the idea. At times, I call this 'the bloody-minded stubborness programme' and I definitely remember having quite a strong 'I won't' response as a child. the trick being to get the response to be positive to the diet, and not 'I won't' to any suggestion of changing eating habits.
Unfortunately, I think today's children live in a much more challenging environment in terms of easily available temptation where food is concerned - the modern habit of grazing constantly and never being hungry do not help. I grew up with 'don't eat between meals' - it didn't stop me, but at least it wasn't the norm.
I hope some of that is helpful.