Does It Work? - IntermountainPhysician · 2 Intermittent Fasting Studies 7 Alternate Day Fasting Studies 3-6% reduction in fasting glucose after 8-12 weeks treatment 10 Continuous

Does It Work for Weight Loss or Cancer Prevention? Intermittent Fasting, Alkaline Diet and Functional Food Sarah Gunnell Bellini, PhD, RDN, CD

Intermountain Nutrition Update 2016

Objectives Evaluate quality of research related to intermittent

fasting, alkaline diet, and functional food Provide evidence-based nutrition interventions

Intermittent Energy Restriction/Fasting

Fast Diet Eat normal 5 days a week and calorie restrict 2 days per week

Fast days can’t be back-to-back

Fast days around 500 to 600 calories

Eat lean protein, vegetables, and fruit on fasting days

Eat anything on 5 “off” days

5:2 diet

Benefits

Improve biomarkers of disease

Reduce oxidative stress

Preserve learning and memory functioning

Cardiovascular protection

Why it works

Cells under mild stress during fasting period Enhance ability to cope with stress and maybe resist disease

Ketones Protect memory and learning functionality

Slow disease process in the brain

Overall weight reduction

Animal Models

Adaptive Stress Response Prevent age-related decrements in antioxidant enzymes in livers cells of rats

Increased levels of antioxidant enzymes in muscle cells of mice

Protect neurons against oxidative, metabolic, and proteotoxic stress in animal models of neurodegenerative disorders

Stimulates neuroprotective proteins

Harvie MN and Howell T. Could intermittent energy restriction and intermittent fasting reduce rates of cancer in obese, overweight, and normal-weight subjects? A summary of evidence Adv Nutr 2016; 7:690-705.

Intermittent Fasting and Tumors in Rodents Mammary tumor rates reduced by 40-80%

Antitumor effect proportional to degree of overall energy restriction and reduced body weight

Intermittent fasting had no antitumor effects when mice were allowed to overeat on unrestricted days


Intermittent Fasting and Tumors in Rodents Four studies in estrogen-responsive mouse mammary tumor virus found

intermittent fasting superior to ad libitum

Prostrate rates not influenced by 2 week 50% energy restriction and 2 week ad libitum


Are animal cancer models the same as human cancers? No direct data on the effects of intermittent energy restriction/fasting on

cancer rates in humans

Adverse effects of hyperphagia seen in animal models not in human studies

Reduction in IGF-I in rodents good but does not relate to bioactivity within tissues in humans


Barnosky AR, Hoddy KK, Unterman TG, Varady KA. Intermittent fasting vs daily calorie restriction for type 2 diabetes prevention: a review of human findings. Translational Research 2014;164:302-311.

Body Weight Changes 2 Intermittent Fasting Studies 7 Alternate Day Fasting Studies

3-8% reduction in body weight after 3-24 weeks Providing food to subjects on fast day key factor

6-8% weight loss

10 Continuous Restriction Studies 4-14% reduction in body weight after 6-24 weeks


Visceral Fat Changes 2 Intermittent Fasting Studies 5 Alternating Day Fasting Studies

4-7% reduction in visceral fat after 6-24 weeks of treatment Assessed indirectly using waist circumference Paralleled weight reduction

8 Continuous Restriction

2 -38% reduction in visceral fat 38% was in 50% energy reduction for 24 weeks

Paralleled weight reduction


Fasting Glucose Levels in Prediabetes

2 Intermittent Fasting Studies

7 Alternate Day Fasting Studies 3-6% reduction in fasting glucose after 8-12 weeks treatment

10 Continuous Restriction (25-30%) Studies No effect on fasting glucose concentrations


Insulin Sensitivity

2 Intermittent Fasting Studies 4 Alternate Day Fasting Studies

Consistent improvement in normoglycemic and prediabetes after 3-24 weeks Best improvement found with greatest weight loss

23% decreases seen in one IF after 8 weeks of fasting 1 day/week

9 Continuous Restriction Studies Substantial improvements after 6-24 weeks


Limitations

Heterogeneous study protocols and interventions

Limited number of studies with intermittent and alternate day fasting

Weight loss not quantified per week


Conclusion

Difficult to determine if overall calorie reduction is the cause of improved biomarkers and decrease inflammatory markers or the intermittent fasting makes a difference

More randomized controlled studies in humans are needed

What if a patient/client wants to do it?

Recommend around 300 to 500 calories on the restriction days

Not recommended for patients with diabetes taking insulin or medication

Choose healthy foods on the non-restricted days

Discuss the social implications

Alkaline Diet

Alkaline Diet

Fenton TR and Huang T. Systematic review of the association between dietary acid load, alkaline water and cancer. BMJ Open 2016;6:e010438.

Alkaline Diet

Based on the concept that mineral components of food make the body acidic, alkaline or neutral

Acid-ash hypothesis suggests one must consume more fruits and vegetables and moderate amounts of meat to raise pH of blood

Some evidence cancer cells and tumors grow in acidic environment

Results

8278 citations identified and 252 abstracts reviewed

No randomized trials

1 study met inclusion criteria

Prospective cohort study (27,096 male smokers) Relative risk of bladder cancer

Diet estimated renal NAE compared to urinary organic acid secretion

No significant difference in risk factor

Conclusion

There is no evidence following an alkaline diet changes the pH of blood and prevents cancer or other diseases

Functional Foods

Functional Foods

“Foods defined as whole foods along with fortified, enriched, or enhanced foods that have a potentially beneficial effect on health when consumed as part of a varied diet on a regular basis at effective levels.” Academy of Nutrition and Dietetics Position Paper 2013

Health Functional Foods

Foods or food components that provide benefits beyond basic nutrition

Developed in Japan in 1980s

Nutraceuticals

87% of Americans believe certain foods have health benefits beyond basic nutrition

2011 Functional Foods/Foods for Health Consumer Trending Survey

Categories of Functional Foods

Conventional foods containing natural bioactive food compounds Vegetables, fruits, grains, dairy, fish, and meats

Isoflavones in soy-based foods

Modified foods containing bioactive food compounds Fortified margarine spreads with omega-3 fatty acids

Food ingredients that are synthesized Indigestible carbohydrates

Functional Foods

Omega 3 fatty acids EPA and DHA

Prebiotics

Probiotics

Oat soluble fiber

Psyllium seed soluble fiber

Soy protein

Sterol-and stanol fortified

Cranberries

Garlic

Nuts

Grapes

Chocolate

Green tea

Tomatoes

Qualified Claims About Cancer Risk

Tomatoes and tomato-based foods ½ to 1 cup of tomatoes and/or tomato sauce per week may reduce the risk of

prostrate cancer

Consumption of tomato sauce 2 times per week may reduce the risk of ovarian cancer

Limited scientific evidence

Wang Y, Jacobs EJ, Newton CC, McCullough. Lycopene, tomato products and prostate cancer-specific mortality among men diagnosed with nonmetastatic prostate cancer in the Cancer Prevention Study II Nutrition Cohort. Int. J Cancer 2016; 138 (12):2846-2855.

5,643 men with nonmetastatic prostrate cancer

Prediagnosis and postdiagnosis dietary intake of lycopene and tomato products was not associated with prostrate-cancer specific mortality

Qualified Claims About Cancer Risk

Antioxidant Vitamins and Cancer Vitamin E and Vitamin C

Limited and non-conclusive research antioxidant vitamins reduce risk of certain times of cancer

Selenium May produce anticarcinogenic effects in the body

Conclusion

Scientific substantiation Establish bioavailability and efficacy of compounds that are physiologically

achievable

Human studies needed- most in vitro models

Interactive effects of compounds

What do I do?

National Center for Complementary and Integrative Health https://nccih.nih.gov/health/herbsataglance.htm

Cochrane Library http://www.cochranelibrary.com/

Evidence Analysis Library

FDA Health Claims http://www.fda.gov/Food/IngredientsPackagingLabeling/LabelingNutrition/ucm

2006876.htm

https://nccih.nih.gov/health/herbsataglance.htm

http://www.cochranelibrary.com/

http://www.fda.gov/Food/IngredientsPackagingLabeling/LabelingNutrition/ucm2006876.htm

http://www.fda.gov/Food/IngredientsPackagingLabeling/LabelingNutrition/ucm2006876.htm

Documents

Does It Work? - IntermountainPhysician · 2 Intermittent Fasting Studies 7 Alternate Day Fasting Studies 3-6% reduction in fasting glucose after 8-12 weeks treatment 10 Continuous