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KAŹMIERCZAK, Anna, PERKOWSKA, Klaudia, KIEŁB, Anna, BORKOWSKA, Agata, IZDEBSKA, Wiktoria, STANEK, Jakub,
SORNEK, Patrycja, PAWLAK, Igor, MICH, Anna and CIESIELSKI, Radosław. Effects of Intermittent Fasting on Weight Loss and
Metabolic Health. Quality in Sport. 2024;22:54618 eISSN 2450-3118.
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1
Effects of Intermittent Fasting on Weight Loss and Metabolic Health
Anna Kaźmierczak
a.kazmierczak.1998@o2.pl
ORCID: https://orcid.org/0009-0000-8435-6685
4th Military Clinical Hospital in Wroclaw, Weigla 5, 53-114, Wroclaw, PL
Klaudia Perkowska
dr.kperkowska@gmail.com
ORCID: https://orcid.org/0009-0001-7362-4995
Military Medical Institute, Szaserów 128, 04-349 Warsaw, PL
Anna Kiełb
akielb97@gmail.com
ORCID: https://orcid.org/0009-0005-3152-5429
5th Military Clinical Hospital in Krakow, ul. Wrocławska 1-3, 30-901 Krakow, Poland
2
Agata Borkowska
agata.borkowska.ab@wp.pl
Orcid: https://orcid.org/0009-0008-7347-7762
Military Institute of Aviation Medicine, ul. Zygmunta Krasińskiego 54/56, 01-755 Warsaw,
PL
Wiktoria Izdebska
wiktoriaxizdebska@gmail.com
ORCID: https://orcid.org/0009-0005-0242-141X
J. Gromkowski Regional Specialist Hospital in Wrocław, Koszarowa 5, 51-149 Wrocław, PL
Jakub Stanek
E-mail: jakubstanek22@gmail.com
ORCID: https://orcid.org/0000-0002-9450-7261
Medical University of Lodz, al. Tadeusza Kościuszki 4, 90-419 Łódź
Patrycja Sornek
sornekpatrycja5@gmail.com
ORCID: https://orcid.org/0009-0003-9630-055X
Military Medical Academy Memorial Teaching Hospital- Central Veteran Hospital ul. Stefana
Żeromskiego 113, 90-549 Lodz, Poland
Igor Pawlak
igor.a.pawlak@gmail.com
ORCID: https://orcid.org/0009-0003-1942-9296
Independent Public Hospital in Mińsk Mazowiecki, ul. Szpitalna 37, 05-300 Mińsk
Mazowiecki
Anna Mich
aniamich97@icloud.com
ORCID: https://orcid.org/0009-0004-6299-5506
Independent Public Hospital in Mińsk Mazowiecki, ul. Szpitalna 37, 05-300 Mińsk
Mazowiecki
3
Radosław Ciesielski
radoslaw.ciesielski@yahoo.com
ORCID: https://orcid.org/0000-0002-3458-2024
Independent Public Hospital in Mińsk Mazowiecki, ul. Szpitalna 37, 05-300 Mińsk
Mazowiecki
Abstract
Introduction and Purpose: Intermittent fasting (IF) has become a popular strategy for
combating obesity and improving metabolic health. This dietary regimen alternates between
periods of fasting and eating, aiming to enhance cellular health and increase longevity. With
obesity rates doubling globally since 1990 and metabolic diseases on the rise, IF offers
a potential solution by promoting metabolic benefits and reducing obesity-related conditions.
Material and Method: This review examines various IF methods, including alternate-day
fasting, the 5:2 diet, and time-restricted eating. The analysis focuses on the impact of these
fasting methods on body weight, insulin sensitivity, and lipid profiles, based on a compilation
of studies that explore the physiological effects and health outcomes associated with IF.
Results: IF has shown to be effective in reducing body weight and improving metabolic
parameters. Studies indicate significant benefits in insulin sensitivity and lipid profiles, with
some variations across different IF protocols. Physiological insights reveal that IF leads to
a metabolic switch from glucose-based to ketone-based energy, which plays a critical role in
its effectiveness.
Conclusions: Intermittent fasting appears to be a viable alternative to continuous calorie
restriction for weight loss and metabolic enhancement. It not only aids in weight management
but also offers additional health benefits such as improved insulin sensitivity and better lipid
profiles. However, more long-term studies are needed to fully understand its benefits and
potential risks. Future research should focus on optimizing fasting protocols and exploring
their long-term effects on health and disease.
4
KEYWORDS: intermittent fasting; intermittent fasting and metabolic health
INTRODUCTION
Intermittent fasting (IF) has garnered considerable attention as a method for weight
management. It involves alternating between periods of eating and fasting, emphasizing both
timing and overall food intake.[1] Latest research indicates that in 2022, 1 in 8 people in the
world were living with obesity. In addition, since 1990, the global adult obesity rate has more
than doubled. There were 2.5 billion adults over the age of 18 who were overweight, with
890 millions of them classified as obese.[2] Additionally, IF may enhance metabolic health
and decrease the likelihood of obesity, as well as related conditions like nonalcoholic fatty
liver disease, diabetes, and cancer.[3] This dietary approach promotes metabolic and cellular
health, potentially delaying the onset of age-related diseases and enhancing longevity.[4,5]
However, there is limited data from human studies regarding the beneficial effects of time-
restricted heating.
PURPOSE OF STUDY
This review aims to thoroughly analyze the effects of intermittent fasting (IF) on body
weight, insulin sensitivity, and lipid profiles by evaluating a variety of studies that have
explored the efficacy of different IF methods, such as alternate-day fasting, the 5:2 diet, and
time-restricted eating. The primary objective is to systematically assess the impact of IF not
only on weight loss but also on enhancing metabolic functions, potentially mitigating obesity-
related conditions, and improving overall health outcomes. This review also seeks to explain
the physiological mechanisms through which IF exerts its effects, considering its potential to
delay the onset of age-related diseases and enhance cellular health. By integrating findings
from diverse clinical trials and observational studies, this review addresses the growing need
for effective dietary strategies against the backdrop of a global obesity epidemic and
associated metabolic diseases. This is particularly important at a time when obesity rates are
at historic highs and the medical community is urgently seeking sustainable, effective
interventions.
METHODS OF INTERMITTENT FASTING
5
Intermittent fasting methods generally fall into three main categories: alternate-day
fasting (ADF), the 5:2 diet, and time-restricted eating (TRE).[6] ADF consists of a cycle
between days of no food intake at all and days where eating is allowed without restrictions.
The 5:2 approach limits calorie intake to approximately 500 for women and 600 for men on
two non-sequential days of the week, permitting normal eating on the other days. TRE differs
by establishing a consistent daily schedule, restricting food intake to a specific timeframe
each day, such as the 16:8 method, which confines eating to an 8-hour period and fasting for
the remaining 16 hours.[7] This is the most popular model of time-restricted diet, however,
the hours can be adjusted according to individual preferences, work, etc. The methods are
presented in Table 1. [6,7]
Main Intermittent fasting schemes
DIET
FEED DAY
Energy Allowance
FAST DAY
Energy Allowance
Weekly Fast Days
Feeding
Window
ADF
Alternate-
Day
Fasting
normal eating
0%
¾
Open
5:2
normal eating
25%
women 500kcal
men 600kcal
2
Open
TRF
Time-
Restricted
Feeding
normal eating
normal eating
7
<10h
Table 1
6
Weight reduction through IF is generally comparable to that achieved through daily
calorie restrictions. IF may offer additional advantages like increased insulin sensitivity,
independent of weight loss. Given the variability in individual responses to different IF
regimens, no singular approach is deemed universally effective.[8] Other analyses indicated
that IFD notably reduces BMI, fasting glucose levels, and insulin resistance measures
compared to control diets. Also, notable biochemical changes included increased adiponectin
levels and reduced leptin levels, suggesting potential metabolic benefits. This evidence
suggests that intermittent fasting may offer considerable advantages for glycemic control and
weight management in adults.[9]
Physiology of intermittent fasting
The main source of energy on which IF is based are ketones. The shift from glucose-
based energy to ketones, which are derived from fatty acids, acts as a pivotal moment that
transitions metabolism from synthesizing lipids and cholesterol and storing fat to activating
fat breakdown through fatty acid oxidation. [10] Glucose falling approximately 6 hours post-
meal, then decrease and remain low until the following day. [11] However, for this reaction to
occur, decreasing glucose is not enough. The metabolic switch occurs only after 10-14 hours
after the glycogen stores in their liver are empty. Some research even claims up to 36 hours
after stopping food intake. This timing varies based on the amount of food consumed, the
initial level of liver glycogen and exercise during the fasting period. After liver's glycogen
reserves are used up, fats stored in adipocytes are broken down into free fatty acids (FFAs)
through lipolysis. These FFAs are subsequently released into the bloodstream. The FFAs are
transported to liver to produce the ketones acetone. Gene called SIRT1 which is activated
during the shift from glycogenolysis to ketone production play an important role in the
process. It contributes to decreasing glucose production, prevents liver fat accumulation, and
regulates energy expenditure. [4] As a result, ketones are produced and therefore able to
encourage the growth of new mitochondria, enhance synaptic flexibility and boost cellular
resilience against stress by stimulating producing of BDNF (brain-derived neurotrophic
factor). The products of metabolic switch also stimulate realising GLP-1 (glucagon-like
7
peptide 1) into blood. Hormone which improves glucose removal from the bloodstream as
well as enhances insulin sensitivity in cells.[12] Additionally, adenosine triphosphate (ATP) is
another product ketones are metabolized into. This process is conducted in cells with elevated
metabolic rates, such as muscle cells and neurons. This mechanism allows ketones to act as
a vital energy source, sustaining the function of both muscle and brain cells during fasting and
prolonged physical activity. Increasing evidence indicates that certain organ systems
demonstrate comparable cellular and molecular reactions to aerobic exercise and intermittent
fasting (IF), such as the inhibition of mTOR, activation of autophagy, and promotion of
mitochondrial biogenesis.[4] Research also outlining the function of autophagy in cancer and
its prospective use as a therapeutic target. [13]
Effects of intermittent fasting on bodyweight
Chronic overeating results in the accumulation of excess fat tissue, termed obesity, and
is associated with various metabolic alterations, including insulin resistance and type 2
diabetes mellitus.[14] Regulating caloric consumption can potentially reverse these metabolic
shifts. Intermittent fasting is an effective strategy for facilitating weight loss. Studies indicate
that this approach aids in reducing body weight. [1,5,9,15,16,17,18,19] However, there are
differences in the findings of various studies. Some research indicates no significant change in
weight with lean mass largely preserved.[9] In contrast, other studies report a considerable
decrease in body weight, approximately 8 kg, after eight weeks of alternate day fasting (ADF).
Unfortunately, these studies do not offer details on changes in body composition.[20]
According to another research, presented results are more specific and include information
regarding alterations in body composition such as an approximate reduction of 4 kg in body
weight, including 3 kg of fat mass and 1 kg of lean mass.[15]. Other studies have shown a
decrease in both body weight and fat mass, with lean mass remaining stable [17,18]. These
findings relate to obese individuals, but similar outcomes are observed in non-obese groups.
For instance, after a four-week ADF regimen, there was a 4.5% decrease in body weight
along with an improvement in the fat-to-lean mass ratio [5]. When comparing the
effectiveness of intermittent energy restriction (IER) with continuous energy restriction
(CER), both methods show similar effectiveness in promoting short-term weight loss and
8
metabolic improvements. However, more long-term research is needed to provide definitive
conclusions. [21,22,23]
Effects of intermittent fasting on glucose metabolism and insulin sensitivity
Excessive calorie consumption has become increasingly prevalent in modern diets,
contributing to a rise in obesity and related health issues. This trend towards higher calorie
intake often stems from easily accessible processed foods high in sugar and fat, exacerbating
lifestyle diseases.[10] This phenomenon leads to glucotoxicity. Nonphysiologically,
potentially irreversible harm within pancreatic beta-cells caused by prolonged exposure to
excessively high glucose levels, resulting in impaired insulin secretion and deteriorating
glucose control.[24] Intermittent fasting has been found to offer benefits for managing blood
sugar levels in individuals with metabolic syndrome, significantly enhancing insulin
sensitivity. It can serve as a supportive treatment strategy to mitigate the consequences of
abnormal glucose levels and therefore the risk and progression of chronic illnesses such as
atherosclerotic and cardiovascular diseases, along with insulin resistance and diabetes, which
can lead to various vascular and neurological issues, including strokes.[25] While there may
be some varying findings, the majority of research suggests that intermittent fasting leads to a
reduction in insulin levels and improves insulin sensitivity.[15,16,26] Definitely, may
enhance insulin resistance conditions better than not following any specific, structured eating
plan.[27] Some research presents the superiority of IF in lowering insulin levels over calorie-
restricted diets.[21,22] However, no significant or clinically meaningful differences in insulin
sensitivity was found between those practicing long-term Alternate Day Fasting (ADF) and
the control group of non-obese people.[5] That presents a pattern that IF may affect
differently based on level of insulin resistance.
Effects of intermittent fasting on lipid profiles and cardiovascular disease
Increased triglycerides (TG) in the blood, and reduced levels of high-density
lipoprotein (HDL) in the blood are two of five factors indicating metabolic syndrome [28] and
both concern lipid profile. In addition, the condition contributes to the proliferation of
illnesses such as type 2 diabetes, heart diseases, strokes, and various other health
complications. What contributes to developing diseases mentioned above is sedentary lifestyle
9
and consuming
a high-calorie-low fibre diet.[29] Modifying one's diet could offer protection against
developing DM2 and heart-related conditions. This process often co-occurs with not only
affecting lipid profile but also weight body reduction. [1,17,30] Compared to individuals who
do not follow any diet, those who adhere to intermittent fasting (IF) and energy-restricted
diets (ERD) see notable improvements in their levels of lipid profile.[31] Whereas, comparing
IF and ERD the findings are still nonconclusive. Both diets have similar potential to improve
the physical measurements, body composition, and lipid profile of overweight or obese adults.
[21, 23] Research on specific lipid classes presents a decrease in total cholesterol (TC), low-
density lipoprotein cholesterol (LDL-C), and triglycerides (TG). However, not significant
change in high-density lipoprotein cholesterol (HDL-C) levels is observed. [18,31] Whereas,
the others demonstrate a positive impact of IF on HDL-C levels.[19,32,33] IF has been
demonstrated to effectively decrease the risk of cardiovascular disease (CVD) not only in
overweight or obese individuals but also in metabolically healthy, non-obese patients.
Significant improvements in blood lipid levels were observed after more than six months of
ADF intervention.[5]
Conclusions
This comprehensive review on the effects of intermittent fasting (IF) on weight loss
and metabolic health reveals a multifaceted impact. IF, encompassing methods like alternate-
day fasting (ADF), the 5:2 diet, and time-restricted eating (TRE), offers a promising
alternative to traditional calorie restriction diets. The evidence consistently shows that IF can
lead to weight loss, with some studies highlighting its superiority in improving insulin
sensitivity and lipid profiles. Intermittent fasting's physiological impacts, particularly its
ability to switch metabolism from glucose-based to ketone-based energy, play a crucial role in
its health benefits. This metabolic switch not only supports weight loss but also stimulates the
breakdown of fats, reduces inflammation, and enhances cellular health. Notably, the shift to
ketone production and utilization promotes improvements in cellular resilience, which may
delay aging and mitigate age-related diseases. In terms of weight management, IF has shown
comparable or even superior results to continuous energy restriction, especially in the context
of significant body weight reduction and metabolic improvements. The variability in
10
individual responses suggests that personalization of IF regimens could enhance their
effectiveness and sustainability. For metabolic health, IF has been shown to improve glucose
control and insulin sensitivity, making it a viable intervention for individuals with metabolic
syndrome and type 2 diabetes. Additionally, intermittent fasting positively influences lipid
profiles, reducing the risk of cardiovascular diseases. While the current body of research
provides substantial evidence supporting the benefits of IF, long-term studies are necessary to
fully understand its impact on health, sustainability, and potential risks. Future research
should focus on the mechanisms underlying the health benefits of IF, the optimal fasting
protocols for different populations, and the long-term effects of IF on health and disease. In
conclusion, intermittent fasting emerges as a beneficial strategy for weight loss and metabolic
health improvement, offering a feasible alternative to traditional dieting methods. Its potential
for widespread application in public health and individual wellness needs further exploration
to optimize its implementation and understand its full scope of benefits and limitations.
Declarations:
Funding: This research received no external funding
Author contributions:
Conceptualization, Methodology, Formal analysis, Investigation, Writing: [ZC]
Data availability: Not applicable
Ethics approval: Not applicable
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