This post is not COVID19 related. Or is it? Having been interested in what we eat for decades, the subject of how we eat is now under the microscope. In other words, let’s have a look at what is happening in the world of fasting and time restricted eating, and discover what the implications for your health are.

How we eat and how it affects our health.

You might wonder why the hell anyone would want to fast, and if its just another foodie fashion? Yet by the end of the article, I hope that you might think again about fasting as a useful way to improve health and longevity. 

As it happens, I have a personal interest in this. 

I recently decided that it might be a good idea to try Time Restricted Eating (TRE). Even in a thin person like me it has some theoretical benefits for brain health. For anyone overweight it helps shed the kilos, and for all of us all it helps get some control over eating patterns which over the time of my lifetime have become chaotic and harmful.

I wondered if it might therefore contribute to the Disease Modifying Lifestyle which I hope will keep my MS as quiet as possible.

So, about three months ago I started by eating my last meal by 6 and delaying breakfast till 11 or 12. The “16 to 18 hours of fasting and 8 to 6 of eating. This turns our engrained western habits upside down. 

It was easier than I thought. I have coffee instead of breakfast and find finishing the evening meal by 6 or 7 quite simple. The results for me have been interesting. 

I now experience less hunger, enjoy my late breakfast far more, and I lost a little weight. This was not really needed but find myself able to eat as much as I like with my three meals a day. My weight has now stabilised a few kilos lighter that before. 
Another thing I have really noticed is that I no longer feel the need for any snacks, nibbles or munchies. I never crave food! The guys in food marketing departments will be horrified!  This is a blessing in more ways than one. 

So let’s have a look at where we are right now in terms of eating patterns; how we eat. As with so much of our food culture, it’s a shocking picture. Onto the crazy world of snacking…..

Creating the snacking mindset

Anyone my age (64) has experienced a life of being blitzed by advertisements for snacks. Usually ones that hint you can “eat between meals without ruining your appetite” (see – those advertising jingles really do stick!). American children, during their 45 hours of TV viewing a week, watch about 120 fast food adverts, that’s about 6,000 a year!

Over here in the UK, Cancer research, in a survey of 3,400 children found that children who use the internet more pester their parents more for snacks. These kids watched, on average an astonishing 22 hours of TV and spent 16 hours online each week. They watch 18 junk food adverts an hour, and I’m sure the advertisers will find ways of subverting the recent 9pm watershed for junk food adverts on TV.

Simultaneously, rates of obesity have doubled in children aged 2-5 (now 12.4%) and ages 6 to 11 (17.0%). In teens ages 12 to 19, obesity has tripled to 17.6% in the US and we are catching up fast.

So, have many of us have now been convinced that we cannot go for more that a couple of hours without a snack? Have we have got used to forever imagining ourselves being hungry, craving food within hours of eating even while we are paradoxically putting on weight? Indeed, have our eating habits been designed to maximise profits instead of providing healthy nutrition?

Some good science explores this. I hope it will help you understand how we have got into this mess and how we might help change the way we eat and live longer, healthier lives. 

Industrial eating patterns

Over recent time, eating patterns have been transformed. We are now eating far more often, again with the US leading the way. 
From eating an average of three times a day in 1977, this 2006 study shows we now eat 5 or six times a day, and probably more since then. In between meals there are increasing numbers of snacks with most people now eating more that 6 times a day.

This is likely to relate to the use of fridges and microwaves, but also the the availability of packaged food available at a whim as opposed to the end of more traditional kitchen tasks.
Another more recent study sheds more light on the day to day reality of this phenomenon:

24 hour eating

A clever survey of 47 individuals in the USA used an App to record every eating or drinking event over the space of 16 weeks and gives a further insight into what is going on. This eliminated the bias that plagues dietary studies based on self completed questionnaires. What they found, in short, represents culinary chaos:
Every dot represents calories!
  • Eating patterns varied from day to day.
  • Despite reporting eating three meals a day, this patten was largely absent when food intake was analysed.
  • Only half of calories were taken in the form of meals
  • The average duration between eating was just 3 hours
  • 28% of food items were pre-packaged meals
  • More that half of adults were eating over more than 15 hours a day.
They describe this beautifully in the clock (right) in which every dot represented calories being eaten and shows eating from dawn to dusk.
Regular patterns of eating seem to have gone out the window. I also can’t help but notice the number of times people are eating at night. These are not night shift workers, they were healthy people (that is without diagnosed disease – yet). They are waking in the night feeling the need for a snack! 
Eating times
The slight peaks, shown in the graph representing the same data in a different way. Peaks at 12 and 7pm, representing the main meals, but with lots of grazing in between.
The average duration of eating was spread over 15 hours a day, a 9:15 fasting/eating pattern which takes a toll on health as I will describe below.  
They also found that when people reduced their total eating from over 15 hours daily to just 12, they lost an average of 3.3Kg, had more energy, and slept better. This weight loss persisted for the year of follow up, and tells us that that even a 12:12 pattern has health benefits.
So the reality is that many of us are eating most of the day, from an early breakfast to a late supper and sometimes waking for a nocturnal snack.
Given this, it is understandable that we take in more calories than we burn, but it goes beyond that simple paradigm. 

Why does this matter?

The graph below shows what happens to glucose and insulin levels during the traditional three meals a day. We eat food containing starch, it is slowly absorbed by the gut, and the pancreas produces insulin to keep the level of glucose in the blood within certain limits.

Metabolic response to meals
I cannot find a similar graph to illustrate the metabolic chaos that eating many times over most of the day will bring, but you can imaging the multiple peaks of insulin and the yo-yoing of blood glucose levels throughout the day. 
This is not what our digestive or endocrine systems are designed for at all and will lead to problems with glucose tolerance, insulin insensitivity and progress to diabetes in so many together with feelings of fatigue, lack of energy and poor sleep. It too is associated with greater risk of the biggest killer, heart disease.

A metabolic metaphor

Imagine that lots of calories arriving at mealtimes and snacks. There is no let up in between with continual snacking and nibbles from breakfast to that last supper and nocturnal nibble. A full day of eating. How and where does our body store those calories? 

Imagine calories are like cars driving into town. The town centre has short and long term car parks filling as more cars arrive than they can cope with. The short term car parks, akin to the livers stores of glycogen soon fill up and the overspill has to go somewhere – the long stay car parks which are located in the belly, which soon expand with stores of energy from the flood of unneeded calories for ever arriving with no time to empty the short term stores.

The stored fat is not consumed as the short term storage in the liver is always full and so more and more yet more fat is stored in the belly, around the liver and organs like the heart. Like a town centre surrounded, and indeed being consumed by ever expanding long term car parks. This leads to what we term central obesity. (As well as city centre blight)

Metaphors only go so far, remember though, there are a few overweight people who eat too much good food, who stay healthy, and thin people who don’t eat too many calories, but exist on a diet made of junk snacks and whose health, though lean, is a ticking time bomb.

Simple steps to create your own eating culture

One of the many disadvantages of Brexit is their capture of the concept of “Taking Back Control”, yet this is precisely what we need to do when it comes to our food and our health. So many of my patients felt so much better when they realised that they were able to do this, to control their weight by knowing what to do with food and eating. 
These simple daily steps represent giant leaps forward in terms of how we eat:
  • It helps to eat meals – three times a day.
  • Snacking is not needed, so keep eating in between meals to a minimum.
  • Restricting eating to a 12 hour window is a good start
  • Extending the daily time without food is beneficial for anyone trying to lose weight.

Fasting – The last supper

5:2 diet
The most common way of fasting is to restrict eating on one or two days a week to a decent 500Kcal breakfast and nothing for the rest of the day. 
To follow the car park metaphor, the city centre parks empty, and the cars from the over-expanded long stay parks have space to be moved in and then leave. The fat in your belly and around your organs is mobilised and converted to energy in the form of ketones which are said to be particularly good for the brain. Empty spaces appear and are removed; we lose weight, feel better, sleep better, live longer. 
You need to build up to this slowly over a month or two as the metabolic changes from forever trying to store calories to using them up can tale a little getting used to. You develop what is called “ketosis” as the body burns up the unwanted fat, but this can leave you feeling tired if done too quickly. 
Yet is is so well worth the effort and time getting there. If you want to lose weight, its a great way to  achieve it, its wonderful not to be craving food all day – it helps us get back in control of our diet and our health.

Time Restricted Feeding

This for me was simple. Delay breakfast until 11 or 12, eat at lunch time, and dinner about 6. No snacks, indeed, little desire for them. Insulin peaks with meals and does its job properly, you have much more stable blood glucose, a bit of ketosis every day. The system is back to normal, the pancreas which produces Insulin at the right times and doesn’t get exhausted.
Again, this can be done gradually. Some people have breakfast and end the eating day in the afternoon. Whatever fits in with your routine. 

Whatever you choose to do, those suppers taken at exactly the time the body least needs them, come to a welcome end. The last supper indeed!

Exceptions to the rule:

In population terms, fasting is most beneficial for the two thirds of us who are overweight, that is where this advice is most helpful. It has potentially has benefits for people with type 2 diabetes, or those multitudes with pre-diabetes who need to take action to control metabolic damage. Also for those with MS, there are potential benefits which have been described as beneficial “biohacking

There are exceptions to every rule. Occasionally people need to keep weight up in the face of illness, or surgery – and of course, pregnancy with its increased need for calories and extra nutrition. In these situations, eating will need to be spread over a longer period of time to take in all the extra nutrition required for maternal and foetal health. Nevertheless, it is important to eat real food and resist the temptation to snack on ultra-processed junk food. 

Children too may be rather different as skipping meals and breakfast for youngsters is more often a marker of a poverty and want than conscious choice, and regular meals are of benefit given the extra calories needed for (hopefully) extra activity and the nutrition needed for brain and body growth. 

Reduction in snacking on the usual culprits of biscuits, buns, cakes and confectionary, with their high content of sugar, industrial fats and salt, is however beneficial for anyone.

The bottom line:

This goes way beyond personal choice. People don’t choose to be overweight or develop diabetes, it is a mirror held up against the way we create, transport, subsidise, advertise and sell food.
We don’t choose to watch tens of thousands of health damaging adverts in our young lives, and we don’t choose the resultant culture.
Yet, given the weakness of political leadership, the ascendance of global agri-business and ongoing aggressive junk food marketing, the way out of this trap does involve making decisions to release ourselves from our habits and make create our own food future.
The governments drive to reduce obesity will, Im afraid, not be enough to tackle this. Exercise for example, is a good for health and wellbeing in so many ways, but on its own is not and effective way to lose weight. You can run a marathon and lose just 1 pound!
Further, the food, and sugar lobbies are not going away and still have far more power and influence than the health lobby, such as it is.
These cultural habits play a significant part in that epidemic of unwanted stored calories appearing so clearly in the COVID19 death statistics. 
Make no mistake, losing those excess calories, stored away as inflammation-generating fat in the belly and around vital organs, brings big health benefits and in the current situation, reduces your risk of a whole host of illnesses, excess deaths from COVID19 being just the latest. 
I wish you happy eating, and contented healthy fasting in between!

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