Home Health Type 2 Diabetes and Fasting: What You Need to Know?

Type 2 Diabetes and Fasting: What You Need to Know?

mMost fad diets don’t live up to the hype, let alone serious scientific research. But intermittent fasting seems to be an exception. These plans involve abstaining from high-calorie foods or drinks for an extended period of time — from 16 hours to several days — and they have become increasingly popular. Research has also shown that they are effective for weight loss.

Doctors often advise people with type 2 diabetes to lose weight, which can have beneficial effects on blood glucose and insulin sensitivity, as well as disease progression. For these reasons and others, 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,” said Benjamin Horne, director of cardiovascular and genetic epidemiology at Intermountain Healthcare in Utah. “But these diets also present some of the biggest potential safety concerns because of the drugs people with diabetes typically take.”

Horne is co-author of several recent papers on the effects of intermittent fasting in people with diabetes. One of them, who appeared in the Journal of the American Medical Association in 2020 specifically looked at the risk profile of these practices. “It’s so easy to start an intermittent fasting regimen on your own, so our main focus was on the safety issues surrounding fasting if you already have a diabetes treatment plan,” he says. Based on the work of him and others, Horne says that for most people with type 2 diabetes — especially those who aren’t taking medications to control their blood sugar levels — the research indicates that intermittent fasting is both safe and likely to be beneficial. However, intermittent fasting is not for everyone. Here, Horne and other experts explain the potential risks of intermittent fasting plans, as well as the benefits and best approaches.

The Risks of Intermittent Fasting

Low blood sugar, also called hypoglycemia, can cause a rapid heartbeat, sweating, shakiness, and other symptoms. If severe, it can cause weakness, seizures, or even death. People with type 2 diabetes are at increased risk for hypoglycemia — especially if they don’t eat for a long time — and this was one of the first dangers experts looked at when assessing the safety of intermittent fasting. “If you’re taking medications that aim to reduce the amount of glucose in your blood, these, along with fasting, can cause potentially fatal hypoglycemia,” Horne says. “It’s no small security risk.”

For a 2018 study in the journal diabetic medicine, researchers in New Zealand found that the incidence of hypoglycemia did indeed increase in people with type 2 diabetes who tried intermittent fasting. However, this increase was in line with the results of other weight-loss diets, including conventional approaches that encourage people to consume fewer calories each day. Also, the people in the study were all taking medications designed to lower their blood glucose. “It was the drugs, rather than the diet itself, that caused the hypoglycemia,” said study author Brian-Corley, a diabetes specialist at New Zealand’s Capital & Coast District Health Board. Corley says people taking these drugs can reduce their risk of dangerous drops in blood sugar by working closely with a doctor, monitoring blood sugar more closely on fasting days, and teaching themselves how to manage an episode of hypoglycemia. In other words, intermittent fasting plans aren’t necessarily off the table for these patients; they just need a little more care. Meanwhile, his research also found that intermittent fasting helped with weight loss and improved measurements of blood sugar, hemoglobin A1C and overall quality of life.

For people who aren’t taking medications to lower their blood sugar, Horne says the risk of hypoglycemia appears to be very low. “People should still consult someone who treats diabetes — a physician such as an endocrinologist, or at the very least a nutritionist trained in diabetes management,” he says. Like Corley, he says even people on blood sugar medications could try intermittent fasting, as long as they work with an expert. “It’s not so much a question of whether they should or shouldn’t do it. It’s more the extent to which they need to be monitored,” he says. (That doesn’t apply to patients with type 1 diabetes; Horne says intermittent fasting is too risky for this group.)

Aside from hypoglycemia, a second major concern is dehydration. High blood glucose causes general dehydration in the body, and people with type 2 diabetes are already at increased risk. Intermittent fasting can further increase these risks if people drink or eat less than they normally would. (Food, it turns out, can provide a third or more of the water people consume each day.)

“With dehydration, people with diabetes can have a variety of negative outcomes,” Horne says. Stroke, migraine headaches, and kidney damage are potential problems, especially if a person with diabetes has other health problems associated with these risks. “So if someone already has a problem with their kidneys — and oftentimes people with diabetes have some sort of kidney problem, if not full-blown kidney disease — dehydration can potentially cause damage,” he explains. While drinking water or other non-caloric fluids while fasting can reduce these risks, people who have type 2 diabetes, along with other chronic illnesses, such as heart disease or kidney disease, probably shouldn’t try fasting diets. The same goes for older, frail people with diabetes. “Fasting puts stress on the body and organs,” he says. If you’re weak or unwell, it’s probably a bad idea to go without food.

There are a few more potential health problems associated with intermittent fasting. However, these are not specific to people with type 2 diabetes. For example, nutrient deficiencies, insufficient protein intake (especially if you are older), and other forms of malnutrition are possible when you are fasting. Also, the safety profile of intermittent fasting has not been well established in pregnant or breastfeeding women, or in young children – all groups with important nutritional needs that differ from those of the general population. These groups should not fast until the risks and benefits are better understood, experts say.

While there may be hidden dangers, intermittent fasting — with expert supervision — appears to be safe for most people with type 2 diabetes.

read moreHow people with type 2 diabetes can lower their risk of health problems

The Benefits of Intermittent Fasting

While intermittent fasting may pose risks for some, it can also provide benefits over other approaches. A 2017 study in the World Journal of Diabetes found that just two weeks of intermittent fasting led to significant weight loss (over 3 pounds on average) and improvements in glucose levels. “It’s possible that intermittent fasting could lead to decreased 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. Some studies in people with diabetes have shown that intermittent fasting can increase insulin sensitivity and also lower blood insulin levels. This is a big problem. “Essentially, fasting is doing what we prescribe diabetes medications, which is improving insulin sensitivity,” Horne says. At least one small trial (using just three people) found that following an intermittent fasting diet allowed diabetic patients to stop taking their insulin medications altogether. The findings of that study have yet to be replicated in a larger group. However, these kinds of results are encouraging. Insulin resistance is associated with higher levels of inflammation and other risk factors for cardiovascular disease. “Even if people don’t lose weight on a fasting regimen, some research has shown that insulin sensitivity improves significantly,” Horne says. “This is something you don’t usually see with other calorie-restricted diets.”

How can fasting deliver these benefits? There are a handful of theories, and several of them may turn out to be true. One of the leading hypotheses — already supported by solid research — is that fasting initiates a type of cell-cleaning process that removes old or unhealthy cells and allows new cells to thrive. Based on this work, some experts argue that the human body is not designed for the modern food environment and the eating schedule of three meals a day plus snacks. They say intermittent fasting is more like the way humans ate for most of our species’ history.

More work is needed to smooth all this out. But the 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?

The condition intermittent fasting does not refer to one well-defined practice. Several approaches fall under the umbrella of intermittent fasting. The three most common and best studied are known as time-restricted eating, every other day fasting, and the 5:2 diet.

The first of these — timed eating — involves squeezing all of your day’s calories into a single “nutrition window” of six to eight hours. For example, someone on this diet might eat between noon and 6:00 p.m. each day and avoid all caloric foods and drinks for the remaining 18 hours of the day. Meanwhile, someone who fasts every other day eats normally one day, but eats few or no calories the next. Finally, the 5:2 diet means you normally eat five days a week, but fast on the other two days.

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

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

How to start intermittent fasting?

The first step is always talking to your doctor or healthcare team. They should be able to help you weigh the benefits and risks, identify nutritional approaches to avoid nutritional deficiencies and, if necessary, adjust any medications you are taking to avoid problems. “Safety must come first,” says Horne.

However, don’t be surprised if your healthcare provider isn’t enthusiastic about fasting diets. These plans are still relatively new and are generally not taught in medical school. “People may encounter pushback, or their doctor may not be very familiar with these regimens,” Horne says. If your doctor says fasting isn’t good for you, that’s one thing. But if he or she is dismissive of fasting diets in general, it may be worth seeking a second opinion from a health care provider experienced in these plans.

Intermittent fasting can be risky for some. But there is now evidence that it may be a useful or even better alternative to classic weight-loss plans for people with type 2 diabetes.

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