I am a 42-year-old black woman living in the US. I have five children, work as a cleaner in offices. I suffer from obesity. I am five foot four inches tall and weigh 190 lbs. I have tried everything to lose weight. I read about a diet in which one fasts (except drinking water) for a day and then eats pretty normally the next day. Will this help me lose weight. W.E., Atlanta, Georgia.
Judy Siegel-Itzkovich comments:
This technique is called intermittent fasting. According to a new study from Heidelberg University and the German Cancer Research Center (DKFZ), this type of diet could help the obese and overweight lose weight, but it has no advantage over conventional weight-loss diets.
Their study, called HELENA – the largest investigation on intermittent fasting so far, concluded that there are many ways leading to a healthier weight. Everybody must find a diet plan that fits him or her best and then just do it.
Some people who implement intermittent fasting don’t eat anything for eight hours and then fast the following 16 hours. Others fast two whole days a week and then eat what they want for the rest of the week. In general, fasting for any amount of time is very difficult for most people, given the accessibility and visibility of food all around us.
Numerous popular self-help books on this topic promise weight loss without yo-yo effect as well as sustained changes in metabolism and resulting health benefits. The German Nutrition Society (DGE), on the other hand, warns that intermittent fasting is not suitable for long-term weight regulation. In addition, the society experts said there is not enough scientific evidence on the long-term effects of this dieting method.
The DKFZ’s Dr. Ruth Schubel wrote that there are in fact only a few smaller studies on intermittent fasting so far, but they have come up with strikingly positive effects for metabolic health (levels of blood sugar and insulin). “This made us curious, and we intended to find out whether these effects can also be proven in a larger patient group and over a prolonged period.”
In collaboration with a team of DKFZ researchers and scientists from Heidelberg University Hospital, Schubel examined 150 overweight and obese study participants over one year as part of the HELENA study. At the start of the study, they were randomly classified in three groups: One third followed a conventional calorie-restriction diet that reduced daily calorie intake by 20 percent.
The second group kept to a dietary plan for fasting two days and eating normally for five; it also saved 20% of calorie intake over the whole week. The control group followed no specific diet plan but was advised, like all other participants, to eat a well-balanced diet as recommended by DGE. Following the actual dieting phase, the investigators documented the participants’ weight and health status for another 38 weeks.
The result may be as surprising as it is sobering for all followers of intermittent fasting. The HELENA researchers found that improvements in health status were the same with both dietary methods. In participants of both group, body weight and, along with it, visceral fat – unhealthy belly fat – were lost and extra fat in the liver reduced, Schubel reported.
The changes in body weight distribution in the study participants were exactly determined using special magnetic resonance tomography imaging executed by Johanna Nattenmüller at Heidelberg University Hospital. The good news is: a small dieting success is already a big gain for health. Those who reduce their body weight by only five percent, lose about 20% of dangerous visceral fat and more than a third of fat in the liver – no matter which dietary method they have used.
The investigators also did not find any difference between the two dieting methods in any other metabolic values that were analyzed or biomarkers and gene activities under investigation.
Although the HELENA study does not confirm the euphoric expectations placed in intermittent fasting, it also shows that this method is not less beneficial than conventional weight loss diets. “In addition, for some people it seems to be easier to be very disciplined on two days instead of counting calories and limiting food every day,” explained Tilman Kuhn, leading scientist of the trial. “But in order to keep the new body weight, people must also permanently switch to a balanced diet following DGE recommendations”, he added.
According to Kuhn, the study results show that it is not primarily the dietary method that matters but that it is more important to decide on a method and then follow through with it. “The same evidence is also suggested in a current study comparing low-carb and low-fat diets, that is, reducing carbohydrates versus reducing fat intake while otherwise having a balanced diet,” said Kuhn. In this study, participants also achieved comparable results with both methods.
The scientists’ credo is therefore: “Just do it!” Body and health will benefit from weight loss in any case, as long as it is achieved by regular exercise and a reliable dieting method and on the basis of a well-balanced diet.
I am a 75-year-old American woman. My MRIs show extensive disc degenerative disease especially lower back. I receive RFA (radiofrequency ablation) injections for arthritis pain every six months, but they are no longer are effective. My left shoulder cartilage is practically non-existent so I receive Effexor injections, but these too don’t help. I am not able to sleep much, as the pain is constant and ibuprofen helps only a little.
I do not wish to take anything stronger. I am active, do medical missions, have a full-time job and take classes online from Israel. What options are open to me? I am willing to travel to Israel or anywhere to relieve the pain and be able to function more freely. M.S., Nashville, Tennessee
Prof. Meir Lieberall, director of orthopedic surgery at Hadassah University Medical Center in Jerusalem’s Ein Kerem, replies:
Unfortunately, we do not have additional treatment options in Israel or clinical trials that don’t exist in the US that can provide a solution to your condition. This is a condition in which cartilage has worn down and is treated in a variety of US orthopedic centers. It is best that you go to the best orthopedist available near you.
If you want an Israeli expert to answer your medical questions, write to Breaking Israel News health and science senior reporter Judy Siegel-Itzkovich at firstname.lastname@example.org with your initials, age, gender and place of residence and details of the medical condition, if any.