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intermittent fasting


Jean Fortunet “Both the developed and developing world are currently in the midst of an obesity epidemic.  Intermittent Energy Restriction (IER) has become the subject of considerable scientific interest as a potential dietary approach for weight-loss and improving cardiometabolic health.  Current evidence from studies suggest that IER is capable of promoting weight-loss and / or favorably influencing an array of cardiometabolic health indices, with equal or greater efficacy than conventional continuous energy restrictive approaches.  Ultimately, whilst much remains to be learned about IER, including its mechanisms of action and long-term efficacy, the positive findings to date serve to highlight promising avenues for future research.”From the March 2014 issue of Research in Endocrinology (The Effects of Intermittent Energy Restriction on Indices of Cardiometabolic Health)

I love it when I see CM because she always seems to be into something new that piques my interest.  The other day she was excited that she had been able to get rid of some fat that she had been struggling to lose for years (not sure where it was because this gal is fit with a capital “F”).   Despite the fact that she is as focused and intense about her diet, workouts, and running as anyone I know (who doesn’t do it for a living — HERE), the stubborn fat wouldn’t budge — until she started Intermittent Fasting.  Although I am certainly not as hardcore as CM, I’m not opposed to pulling a “Tim Ferris” and experimenting on myself.  That being said, I have been meaning to delve into the science behind Intermittent Fasting, and fortunately she gave me the motivation to put other projects on the back burner and follow through.  Now it’s just a matter of actually implementing the plan after the coming holiday (don’t worry — NO PRE-FAST BINGE this weekend).

After talking to CM, I went to the scientific literature to see what it said; mostly because some of the claims being made seemed to be to good to be true — and frankly, went against some things I have believed to be gospel truth since; well, grade school (stick around to see what I’m talking about).  But before we get into the science of Intermittent Fasting, let’s talk for a bit about what it is because there are lots of ways that people fast.  I have been on a number of multi-day Master’s Cleanses (water, organic lemons, and cayenne pepper, sweetened with a bit of real maple syrup).  I think that the longest I ever went was a week, even though they tout 10 days as optimal.  This is not the sort of fast we are talking about today

Let me first say that I am one of those folks who still believes that BREAKFAST (all you IF’ers can roll your eyes) is the most important meal of the day.  It also happens to be, hands down, my favorite.  After all, its very name implies the “breaking” of a “fast”.   But then again, most of what I learned while working toward Exercise Physiology and Nutrition degrees at Kansas State University back in the mid and late 1980’s, has unfortunately been proven to be completely wrong (think Food Pyramid here and LIVING THE HIGH CARB LIFESTYLE).  Naturally, the first thing I did after panicking about the possibility of regularly skipping breakfast was to Google “have people always eaten three meals a day?“.  After looking through lots and lots of articles and studies on the subject, I realized I have a lot to learn.  For instance, THIS came out just this morning.  The following are bullet points concerning some of the things I discovered about Intermittent Fasting while studying.

  • WHAT IS INTERMITTENT FASTING:  I am not trying to be a smart alack when I tell you that Intermittent Fasting simply means fasting intermittently.  Which begs the question of the definition of the word “intermittent“.  Intermittent Fasting usually means that you consume all your calories of a 24 hour day during a certain window of time.  For instance, a common window would be from noon to 6 pm.  The rest of the time you can drink, but you don’t eat — anything.  There are some people who intermittently fast by eating their three meals a day, while fasting one or two complete days each week (or maybe just one or two meals). 
  • WHAT ABOUT THE SCIENCE BEHIND INTERMITTENT FASTING?  Mind you, this is not coming from someone who is heavily pushing Intermittent Fasting (at least not yet).  However, I’m already finding it impossible to ignore the abundance of peer-reviewed evidence on the subject, with exponential numbers of new studies being published each month.  Honestly, we shouldn’t be surprised in light of what we’ve recently seen concerning the benefits of CALORIC RESTRICTION IN HEALTHY INDIVIDUALS.   In a bit, I am going to cover a few of these studies.
  • BUT WHAT ABOUT THE SCIENCE BEHIND EATING THREE MEALS A DAY?   Numerous studies have concluded that one’s weight or ability to lose weight has virtually no bearing on whether one eats two meals a day or a handful of meals a day.  Furthermore, it seems that there is little or no science backing the, I-have-to-have-my-three-squares-a-day attitude that most Americans (self included) tend to have.   This sort of follows something I have noticed about myself over the years.  The more active and busy I am, the less hungry I find myself (unless I am swimming — particularly in THE CURRENT RIVER).  I will frequently skip or combine meals if I am busy with something or physically working hard. Likewise, if I am sitting around doing nothing, I find myself thinking about food and feeling hungry.  In a moment I’ll show you why.
  • WHAT SHOULD MY BASE DIET BE FOR INTERMITTENT FASTING BE?   WHAT ABOUT PALEO? The biggest piece of advice I can give you here is that your health and what you eat is far more important than your weight (HERE).  In other words, you can be MONW and completely fool yourself into thinking you are healthy.  Likewise, obese people are fooling themselves each every day (HERE) that they are healthy as well.  Because I deal with patients who struggle with CHRONIC PAIN, rampant AUTOIMMUNITY, and a whole host of CHRONIC INFLAMMATORY DEGENERATIVE DISEASES (including OBESITY), I want to recommend something to them that addresses all of these.  It’s why I have been high on the PALEO DIET for quite some time. Not only is there plenty of empirical evidence for Paleo as a way of life, but most of those touting Intermittent Fasting on the web seem to be proponents of it or something similar.
  • INTERMITTENT FASTING FOR WEIGHT LOSS:  The truth is, there are so many studies on Intermittent Fasting for WEIGHT LOSS that I am not going to do much with this bullet point.  I will, however, leave you with the conclusions of a couple studies.  Back in January, the medical journal PLoS One published a study called Intermittent Moderate Energy Restriction Improves Weight Loss Efficiency….  This study’s conclusions were that, “Intermittent moderate energy restriction may offer an advantage over continuous moderate energy restriction, because it induces significantly greater weight loss relative to energy deficit.”  Essentially what they are saying is that there are lots of ways to restrict calories and create an “energy deficit” leading to weight loss.  Intermittent Fasting proved better than all of them.  At the very worst, Intermittent Fasting is proving to be every bit as good as calorie restriction for losing weight.  Case in point, the study that was published in the March issue of the European Journal of Clinical Nutrition (Intermittent Energy Restriction and Weight Loss: A Systematic Review) that concluded, “All studies reported significant weight loss for Intermittent Energy Restriction (IER) groups. Average weight loss was approximately .2 – .8 kg per week.  Intermittent Energy Restriction resulted in comparable weight loss to Daily Energy Restriction (DER) when overall energy restriction remained similar between diets. The majority of studies that reported body composition outcomes have shown equal efficacy for fat mass, fat-free mass and waist circumference.  IER may be an effective alternative strategy for health practitioners to promote weight loss for selected overweight and obese people.”  None of this should come as a surprise in light of what you are going to see concerning Intermittent Fasting and Blood Sugar.
  • WON’T I GET CRAZY HUNGRY AND FEEL LIKE I HAVE NO ENERGY?  As I searched for the answer to this question, I came across mountains of anecdotal evidence (people’s testimonies and experiences) saying that just the opposite was true.  Part of this may be due to the effects of the hunger hormone Ghrelin.  John Romaniello of Roman Fit Systems says, “ghrelin controls hunger; the production of ghrelin is dependent on when you eat.  Producing ghrelin makes you want to eat, and eating produces ghrelin…which makes you want to eat more.”  As crazy as it sounds, many people (certainly not all) actually had more energy and were less hungry while intermittently fasting.  This can be verified by a study from last June’s issue of the Journal of Health and Psychology (Distraction, Not Hunger, is Associated with Lower Mood and Lower Perceived Work Performance on Fast Compared to Non-Fast Days During Intermittent Fasting).  “Low positive mood was associated with higher distraction, and lower perceived work performance was associated with higher distraction and lower positive mood. No associations were found with hunger. Associations between mood, perceived work performance and distraction but not hunger mirror those found in traditional dieting…”  In other words, it’s not so much hunger that causes people to blow their diets and pig out, it’s things like distraction, mood, and the feeling that one is not accomplishing what needs to be accomplished (not to mention ADDICTION).  If you want to avoid this, one of the best pieces of advice I can give you is stay active.  Keeping your body and mind active will help you — especially initially — keep your mind off of food.
  • WON’T I LOSE LEAN BODY MASS (OR AT LEAST NOT BE ABLE TO GAIN LEAN BODY MASS) WHILE INTERMITTENTLY FASTING?  This is a huge concern of many people — particularly athletes and weightlifters (sometimes these two groups overlap).  A study from the February issue of Endocrinology (Intermittent Fasting Promotes Fat Loss With Lean Mass Retention….) helps us answer a portion of this question.   Remember what I’ve previously shown you about the Hypothalamus and weight loss (HERE)?  This study concluded that, “Body fat was lower (40%-52%) in all diet interventions. Lean mass was increased in the intermittent fasting group (12%-13%) compared with the high fat diet and low fat diet groups.” 
  • WHAT IF IT REALLY DOES WORK AS TOUTED AND I END UP DROPPING A LOT OF WEIGHT QUICKLY: ISN’T THAT UNHEALTHY?  In two words, not necessarily.  Although one can get quite stupid with fad diets and weight loss, studies have actually shown that losing weight faster is better, more effective, and longer-lasting than losing it slowly (HERE).
  • WHAT ABOUT INTERMITTENT FASTING IF I HAVE BLOOD SUGAR ISSUES?  Although everyone is different (and as always, make sure to get the express written consent of your doctor before trying anything new or potentially effective), research has shown that BLOOD SUGAR levels do not plummet while IF, as some of you might imagine it might.  Although there are some studies that show IF does not help to regulate Blood Sugar and Insulin levels, there are any number of studies that show they do.  Insulin and HGH (Human Growth Hormone — the focus of most “anti-aging” clinics and treatments) have an inverse relationship to each other.  Intermittent Fasting lowers Insulin levels, which in turn helps to raise HGH levels.  Among other things, HGH promotes lean body mass, which burns something like fifty times more calories than does equal amounts of adipose tissue (fat).  The venerable Mark Sisson of Mark’s Daily Apple put it this way when answering someone who raised the question of blood sugar regulation.  “Let me hammer this point home: Once you become a fat-burning and keto-adapted beast, most of your energy demands will be met by stored fat and ketones, so you won’t need to eat protein to spare muscle. If you are fat-adapted and keto-adapted, intermittent fasting is protein sparing.”   In other words, you don’t really need dietary carbohydrate (and the insulin load that often comes with it) to keep yourself from burning muscle.  In fact, a current trend is for people to do their workouts without eating immediately afterward in an attempt to increase their endogenous levels of HGH.  It would not be difficult to argue that the relationship between insulin and HGH is a chief factor in why this dietary approach works.
  • INTERMITTENT FASTING AND A REDUCTION OF CHRONIC PAIN:  A couple months ago, the March issue of the Journal of Pain carried a fascinating study called Increasing Neuroplasticity to Bolster Chronic Pain Treatment: A Role for Intermittent Fasting and Glucose Administration?  Firstly, we know that sugar is one of the most inflammatory things you can put in your body (HERE).  Secondly, inflammation is intimately related to both pain (HERE) and Scar Tissue / Fibrosis (HERE).  Here is the very cherry-picked abstract of this study.  “Neuroplastic changes in brain structure and function are not only a consequence of chronic pain but are involved in the maintenance of pain symptoms. Strategies to maximize neuroplastic responsiveness to chronic pain treatment could enhance treatment gains by optimization of learning and positive central nervous system adaptation. Intermittent fasting and glucose administration are two propitious strategies, that are noninvasive, inexpensive to administer.”  In other words, there is evidence that LOW CARB diets of similar ilk actually change the brain in beneficial ways that low fat or high carb diets can’t (an all too common example of this is ALZHEIMER’S).   One last thing to mention is that when I fast (or just cut way back on how much I eat), I have much less discomfort from several old sports injuries.
  • INTERMITTENT FASTING AS AN IMMUNE SYSTEM REGULATOR / MODULATOR:  What do we know about the Immune System?  We know that 80% of it resides in your Gut, largely in the form of bacteria (HERE).  Furthermore, we know that sugar feeds infection (HERE), including DYSBIOSIS — the abnormal ratios of bacteria that occur as the result of things like antibiotics (or for that matter, NON-ANTIBIOTICS).  As you begin to understand GUT HEALTH, you will realize how critical this issue is.    A study published in the February issue of the Dutch journal Age (Intermittent Fasting Favored the Resolution of Salmonella Typhimurium Infection……) had some rather fascinating results.  After comparing mice purposely infected with a common bacteria and then feeding some as much as they wanted, and others on an “intermittent” schedule, the authors determined that Intermittent Fasting significantly aided Immune System function.
  • INTERMITTENT FASTING AND STRESS:   Stress causes some people to lose weight via the simple fact they can’t eat.  But others (women more so than men) tend to “stress eat,” which can be extremely problematic in light of what we know about the vicious cycle leading to ADRENAL FATIGUE / FIBROMYALGIA.   In a study from last August’s Journal of Neuroimmunology (Intermittent Fasting Modulates IgA Levels in the Small Intestine Under Intense Stress) we see some of this phenomenon in action.  Mice were fed for 12 weeks on either an ad libitum diet (as much as they cared to eat) or via Intermittent Fasting.  Stress was then created by making these mice go on an intense “forced swim“.  Upon autopsy, researchers looked at any number of hormones, INFLAMMATORY MARKERS, cortisol, etc.  They concluded that Intermittent Fasting had a significant effect on, “intestinal homeostasis” compared to the eat-all-you-want group — an extremely important finding considering what we know about the Small Intestine and the Immune System (see previous bullet).
  • INTERMITTENT FASTING AND OXIDATION / INFLAMMATION:  Most people have heard of antioxidants and realize they are mostly a good thing (as the name would imply, they work against oxidation).  Naturally, this would indicate that oxidation is not something we want happening in our bodies (HERE).  A study from Brazil’s University of São Paulo was published in last May’s issue of Neurobiology of Aging (Effects of Intermittent Fasting on Age-Related Changes on Na,K-ATPase Activity and Oxidative Status…..).  This study concluded that, “Chronic neuroinflammation is a common characteristic of neurodegenerative diseases…  Intermittent fasting (IF) induces adaptive responses in the brain that can suppress inflammation.   Intermittent Fasting induced adaptative cellular stress-response signaling pathways reverting LPS effects in rat hippocampus of young and older rats. The results suggest that Intermittent Fasting in both ages would reduce the risk for deficits on brain function and neurodegenerative disorders linked to inflammatory response in the Central Nervous System.”  As I have shown you time and time again, if you want to solve your health problems, you can’t do it without dealing with your levels of INFLAMMATION — particularly critical once you realize how intimately increased Blood Sugar levels are being linked to the vast majority of sickness and disease.
  • INTERMITTENT FASTING AND INFLAMMATION PART II:  As I showed you the other day (HERE), the “Inflammasome” is essentially ‘pre-inflammation’.   In a study that was a joining of scientists from universities in the US, South Korea, Singapore, and Australia (Intermittent Fasting Attenuates Inflammasome Activity in Ischemic Stroke from a 2014 issue of the Journal of Experimental Neurology), we learned that, “Recent findings have revealed a novel inflammatory mechanism that contributes to tissue injury in cerebral ischemia mediated by multi-protein complexes termed inflammasomes.  Intermittent fasting (IF) can decrease the levels of pro-inflammatory cytokines in the periphery and brain…..  These findings demonstrate that Intermittent Fasting can attenuate the inflammatory response and tissue damage following ischemic stroke by a mechanism involving suppression of inflammasome activity.”  How cool is it that simply eating less often can help people recover from a stroke!
  • INTERMITTENT FASTING AND BREAST CANCER:  A dutch study at Amsterdam’s University, De Boelelaan provided some fascinating information concerning BREAST CANCER and Intermittent Fasting.  I’ve shown you on many occasions that SUGAR FEEDS CANCER.  I’ve also explained the phenomenon of OVERDIAGNOSIS & OVERTREATMENT to you as it pertains not only to Breast Cancer, but to CANCER in general.  Listen to the conclusions of Dr. Lankelma’s team in a study that was published in December’s issue of Biosystems (A Reason for Intermittent Fasting to Suppress the Awakening of Dormant Breast Tumors).  “For their growth, dormant tumors, which lack angiogenesis may critically depend on gradients of nutrients and oxygen from the nearest blood vessel. Because for oxygen depletion the distance from the nearest blood vessel to depletion will generally be shorter than for glucose depletion, such tumors will contain anoxic living tumor cells. These cells are dangerous, because they are capable of inducing angiogenesis, which will “wake up” the tumor. Anoxic cells are dependent on anaerobic glucose breakdown for ATP generation. The local extracellular glucose concentration gradient is determined by the blood glucose concentration and by consumption by cells closer to the nearest blood vessel. The blood glucose concentration can be lowered by 20-40% during fasting. We calculated that glucose supply to the potentially hazardous anoxic cells can thereby be reduced significantly, resulting in cell death specifically of the anoxic tumor cells. We hypothesize that intermittent fasting will help to reduce the incidence of tumor relapse via reducing the number of anoxic tumor cells and tumor awakening.”  This is an almost identical scenario to what we saw with both Calorie Restriction (see earlier link) and the KETOGENIC DIET. Need I mention Blood Sugar again?
  • THE LARGE BODY OF RESEARCH ON INTERMITTENT FASTING CONCERNING RAMADAN:  Muslims observe their ninth month by fasting from sun up to sun down, and also refraining from drinking any fluids, smoking, or having sex during these hours (the first time I ever heard of Ramadan was when the Houston Rocket’s Hakeem Olajuwon was playing in the NBA finals — they won back to back in 94 and 95 — while neither eating or drinking during the daytime).  The Muslim community has a large body of work on Intermittent Fasting.   This research is picking up steam as Intermittent Fasting gains traction in the non-Muslim world.  A good overview of some of this research can be found in the July 2014 issue of the International Journal of Health Sciences (Role of Intermittent Fasting on Improving Health and Reducing Diseases).
  • INTERMITTENT FASTING AND GENETIC / EPIGENETIC FACTORS:  Prior to his work as a biochemist and professor of both Physiology and Exercise & Sports Science at East Carolina University, Dr. Darrell Neufer worked as a researcher and professor for several institutions of higher learning, including Yale.  He was also the common denominator on the research teams that published two groundbreaking studies back in the early 2000’s (Effect of Short-Term Fasting and Refeeding on Transcriptional Regulation of Metabolic Genes in Human Skeletal Muscle in the journal Diabetes, and Exercise Attenuates the Fasting-Induced Transcriptional Activation of Metabolic Genes in Skeletal Muscle in the American Journal of Physiology, Endocrinology, and Metabolism).  “During short-term fasting, substrate utilization in skeletal muscle shifts from predominantly carbohydrate to fat as a means of conserving glucose.  Fasting elicits a progressive increase in lipid metabolism within skeletal muscle.  The present findings demonstrate that short-term fasting/refeeding in humans alters the transcription of several genes in skeletal muscle related to lipid metabolism.  These data demonstrate that fasting elicits a fiber type-specific coordinate increase in the transcription rate of several genes involved in and/or required for lipid metabolism and indicate that exercise may attenuate the fasting-induced transcriptional activation of specific metabolic genes.”  What’s truly amazing in this study that is essentially about EPIGENETICS is that the rates of transcription for some of the genes that regulate the body’s production of enzymes that control fat metabolism, increased by as much as 100 times.
  • WHAT ABOUT INTERMITTENT FASTING FOR FEMALES?  Firstly, there are tons of articles online about Intermittent Fasting for females.  Many are actually authored by females who have done it themselves.  One of those is mother of four (and grandmother of one), Josie, over at YumYucky.com.  There are also numerous excellent science-based articles on the subject by men.  Research has shown that while most men will typically knock it out of the park with Intermittent Fasting, women are less inclined to do so.   As is always the case, do your own research (my site is only a primer).  Start slow with any fasting or dietary changes you might make, and to reiterate, be sure to consult your physician before trying any of this.  Just be aware that they might know way less than you do concerning the subject (HERE).

I’m excited about getting started.  I was so unexpectedly busy this morning that other than a handful of pecans, I didn’t eat until I had my usual salad trough at lunch time.  It not only looks doable, but the science behind it looks promising as well.  One way or another, I will let you know by the end of the summer / first part of the fall how it goes.  In the meantime, have a blessed day.


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