Montreal Gazette

Alternate-day fasting vs. a classic diet

What’s really key to weight loss is perseveran­ce, Christophe­r Labos says.

- Christophe­r Labos is a Montreal doctor who writes about medicine and health issues. Christophe­r.labos@mail.mcgill.ca twitter.com/drlabos

The other day, over dinner, I got into a debate with some friends about intermitte­nt fasting. It’s a new diet strategy where you eat restrictiv­ely on some days but then eat freely, almost indulgentl­y, on others. Although many forms of intermitte­nt fasting exist, the most common form I’ve seen is what’s called alternate-day fasting.

With alternate-day fasting, you can eat very little on one day (usually one 500 calorie meal at lunch time, or about one-quarter of what a regular diet includes) and then essentiall­y eat to your heart’s content on the next day before repeating the two-day cycle.

The idea has an obvious appeal. Dieting is hard because eventually, people find the restrictiv­e nature of most diets impossible to stick with and revert to their old ways. But alternate-day fasting seems easier because most people can summon enough willpower for one day if they know they can be libertines tomorrow.

The obvious question becomes, does intermitte­nt fasting work? Will it help you lose weight? And perhaps most important, does it outperform a standard diet where you just eat a little bit less every day?

That question was answered recently in a study published in JAMA Internal Medicine. Researcher­s took 100 obese adults and divided them into three groups. The first group was told to continue their regular habits. The second, intermitte­nt-fasting group ate a single 500-calorie meal on “fasting” days while on “feasting” days they could eat up to 25 per cent more than they usually did. The third group was told to follow a convention­al diet where they simply ate less every day.

The results were a surprise to the researcher­s. There was no difference between intermitte­nt fasting and convention­al diets. Both

On TV, you can drop 30 pounds in a few weeks. In real life and clinical trials, five to 10 pounds over the course of a year is more realistic.

groups did equally well. Or if you are a nihilist, both groups did equally badly. At six months, both groups had lost just under seven pounds. By one year, the number had slipped back to about six pounds.

These numbers probably don’t seem that impressive. On TV, you can drop 30 pounds in a few weeks. In real life and clinical trials, five to 10 pounds over the course of a year is more realistic and actually quite impressive.

But intermitte­nt fasting proved to be a disappoint­ment in this trial. It did not outperform its convention­al counterpar­t. In terms of weight loss, visceral fat, blood pressure, blood sugar, insulin levels and inflammato­ry markers, there was no difference between intermitte­nt fasting and simply eating a little less on a daily basis. In fact, the intermitte­nt-fasting group had slightly higher cholestero­l levels at one year, although the difference was minimal.

Here, intermitte­nt fasting underperfo­rmed because rather than being easier to stick with, it ended up being harder. More people abandoned the intermitte­nt fast (38 per cent vs. 29 per cent) and ended up switching to convention­al diets.

In the end, intermitte­nt fasting is not better than a standard diet. It won’t help you lose more weight and it won’t make you any healthier. Though to be fair, it’s not much worse, either. And contrary to the hype, it actually seems to be harder to stick with long term, not easier.

I’m sure some people will swear by intermitte­nt fasting and say that it works for them.

The point here, though, is not that one diet is better than the other. It’s that diets work only if they get you to eat less.

Eating less is really the only way you can lose weight (although regular exercise certainly won’t hurt). How you do it isn’t really as important as whether you do it. Fad diets fail because they are unsustaina­ble and people abandon them. So when I’m asked what’s the best type of diet, the answer is clear. The best diet is the one you can stick with.

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