Fasting and insulin sensitivity -
In other words, the less glucose that's taken up by tissues during the procedure, the more insulin resistant a patient is. A variation of this technique, the hyperinsulinemic-hyperglycemic clamp provides a better measurement of pancreatic beta cell function but is less physiologic than the euglycemic technique.
Insulin sensitivity test IST : IST involves IV infusion of a defined glucose load and a fixed-rate infusion of insulin over approximately 3 hours. Somatostatin may be infused simultaneously to prevent insulin secretion, inhibit hepatic gluconeogenesis, and delay secretion of counter-regulatory hormones— particularly glucagon, growth hormone, cortisol, and catecholamines.
Fewer blood samples are required for this test, compared to clamp techniques. The mean plasma glucose concentration over the last 30 minutes of the test reflects insulin sensitivity. Although lengthy, IST is less labor intensive than clamp techniques and the FSIVGTT. Insulin tolerance test ITT : A simplified version of IST, ITT measures the decline in serum glucose after an IV bolus of regular insulin 0.
Several insulin and glucose levels are sampled over the following 15 minutes depending on the protocol used. The ITT primarily measures insulin-stimulated uptake of glucose into skeletal muscle. Because this test is so brief, there's very little danger of counter-regulatory hormones interfering with its results.
IV access should be established for insulin injection, blood sampling, and for rapid administration of D50W should severe hypoglycemia occur.
These values reflect the rate of decline of log transformed glucose values. Frequently sampled IV glucose tolerance tests FSIVGTT. This method is less labor intensive than clamp techniques yet still requires as many as 25 blood samples over a 3-hour period, and a computer-assisted mathematical analysis.
Several variations of the FSIVGTT have been published. One recently published study infused 0. The SI was calculated by a computer-based program. Tolbutamide administration can also be used during FSIVGTT to augment endogenous insulin secretion and is particularly useful in women with diabetes.
Continuous infusion of glucose with model assessment CIGMA : Like ITT, CIGMA requires fewer venipunctures and is less laborious than clamp techniques. A constant IV glucose infusion is administered, and samples for glucose and insulin are drawn at 50, 55, and 60 minutes.
A mathematical model is then used to calculate SI. The results are reasonably compatible with clamp techniques; however, few laboratories have used CIGMA for insulin sensitivity testing in diabetic patients and there is no substantive data using the CIGMA technique in women with PCOS.
Oral glucose tolerance test OGTT : OGTT, a mainstay in the diagnosis of impaired glucose tolerance IGT and diabetes mellitus in pregnant and nonpregnant women, may be used to assess insulin sensitivity as well.
Because no IV access is needed, OGTT is better suited for assessment of large populations than the other techniques we outlined. A modified OGTT that uses a or g glucose load and measures glucose and insulin at various intervals over 2 to 4 hours has been used in clinical studies.
Like other minimal approaches to diagnosis, OGTT provides information on beta cell secretion and peripheral insulin action, and various mathematical equations have been used to provide an SI value.
Insulin resistance has also been assessed qualitatively if one or more insulin values exceed an upper limit of normal at appropriate intervals. Researchers have compared various methods for assessing insulin sensitivity in type 2 diabetics using the OGTT and found good correlations between AUCinsulin, insulin level at minutes I , and the steady state plasma glucose concentrations derived from a modified ITT.
Trials were included if the study design involved one of the three most commonly reported intermittent fasting regimens: alternate day fasting, periodic fasting, or time-restricted feeding.
Finally, studies were included if the outcome measures included measurement for fasting glucose, HbA1C, fasting insulin, leptin, or adiponectin both in patients with and without a history of diabetes. Exclusion criteria consisted of duplicates, abstracts, non-English articles, articles that did not include human subjects, those that did not report outcome measures for any of the previously described variables, and works that were unpublished or unrelated to the topic of interest.
Our initial search returned studies. Two reviewers independently reviewed abstracts to determine whether studies met our inclusion criteria. Studies that met criteria were then further reviewed to determine whether they would be included in our review.
After careful review, a total of 17 articles were ultimately chosen and are available for review in Tables 1 and 2. Intermittent fasting has recently gained popularity as a means of improving body composition and metabolic health [ 28 , 29 ]. There are several different regimens of intermittent fasting.
One such regimen is alternate day fasting, in which days of fasting are separated by days of ad libitum food consumption [ 29 ]. See Fig. Obesity is known to be a major risk factor for the development of type 2 DM.
There are a number of mechanisms believed to contribute to the development of insulin-resistance in obese patients. These include, but are not limited to, systemic chronic inflammation and ectopic lipid deposition [ 7 , 9 , 30 , 31 ].
Visceral adipose tissue is known to function as both a paracrine and endocrine organ through the secretion of adipokines [ 10 ]. These adipokines are either proinflammatory leading to chronic low-level inflammation, such as leptin, or anti-inflammatory such as adiponectin [ 10 ].
Leptin is known to play a role in the regulation of body weight through signaling to the hypothalamus and other brain regions to suppress food intake and increase energy expenditure [ 9 ]. The inflammatory effects of leptin are likely due to its role in the production of IL-6, which induces the synthesis of C-reactive protein in the liver as well as upregulation of the pro-inflammatory cytokine TNF-alpha [ 10 ].
Interestingly, patients with higher levels of BMI and insulin resistance were found to have increased leptin levels, possibly signifying that patients with obesity and insulin resistance are developing leptin resistance as well [ 10 ].
On the contrary, adiponectin is known to have antidiabetic and anti-inflammatory effects. Adiponectin acts on various receptors that results in an increase in skeletal muscle and hepatic fatty acid oxidation, reduced hepatic gluconeogenesis, and increased glucose uptake [ 10 ].
It also exerts anti-inflammatory effects through direct action on inflammatory cells, action of NF-kB, and interactions with TNF-alpha [ 10 ].
Adiponectin levels decrease with accumulation of visceral fat [ 10 ]. López-Jaramillo et al. performed a review with the intention of determining levels of leptin and adiponectin in patients with metabolic syndrome.
They found that in patients with the metabolic syndrome, which includes obesity and insulin resistance, an imbalance in levels of leptin and adiponectin appeared to play a role in metabolic alteration that increased the risk of type 2 diabetes [ 10 ]. Interestingly, several studies have demonstrated that intermittent fasting, even in the absence of fat loss, has resulted in a reduction of leptin levels and an increase of adiponectin, which results in improvements of insulin resistance [ 32 ].
It has long been known that restricting calories can reduce body weight and increase metabolic health [ 33 ]. A study by Larson-Meyer et al. However, several obesity trials have demonstrated that humans have significant difficulty sustaining daily calorie restriction for extended periods of time [ 28 ].
On the other hand, intermittent fasting has higher compliance and has shown promise in the improvement of metabolic risk factors, body composition, and weight loss in obese individuals [ 28 , 35 , 36 ].
During this transition the body begins to switch from the synthesis and storage of lipids to mobilization of fat in the form of ketone bodies and free fatty acids [ 28 ].
This transition of fuel source, or metabolic reprogramming, has been highlighted as a potential mechanism for many of the beneficial effects of intermittent fasting. Lastly, intermittent fasting has been shown to reduce adiposity, particularly visceral fat and truncal fat, largely due to mild energy deficits [ 12 , 17 ].
Insulin plays a significant role in glucose homeostasis due to its influence in promoting the storage and utilization of glucose. However, the effects of insulin are not limited to glucose homeostasis.
Insulin also plays a role in the stimulation of DNA synthesis, RNA synthesis, cell growth and differentiation, amino acid influx, protein synthesis, inhibition of protein degradation, and most importantly, the stimulation of lipogenesis and inhibition of lipolysis [ 8 ].
It is the development of insulin resistance, which is defined as the necessity of higher circulating insulin levels in order to produce a glucose lowering response, that is thought to be responsible for the development of type 2 diabetes [ 7 ]. In order to promote regulation of glucose homeostasis, insulin works primarily on receptors in skeletal muscle, liver, and white adipose tissue [ 7 ].
In short, there are several proposed mechanisms regarding the development of insulin resistance. One of the more prominent theories describes the association of increased adiposity and the subsequent chronic inflammation that leads to the development of insulin resistance in tissues [ 7 ].
Intermittent fasting, as described previously, may reduce adiposity and subsequently insulin resistance via reduction of caloric intake as well as due to metabolic reprogramming. The role of AMPK at a biochemical level is outside of the scope of this review, however activation of AMPK through a low energy state has been shown to initiate physiologic responses that promote healthy aging [ 37 ].
Increased levels of insulin, whether through increased energy intake or insulin resistance, leads to the activation of downstream mediators that ultimately inhibit AMPK. The role of AMPK in improved insulin sensitivity is most evident via the positive effects of the commonly prescribed biguanide, metformin.
Metformin is known to promote the activation of AMPK, and has been shown to be very effective in the treatment of type 2 diabetes as well as in the mitigation of a number of chronic disease states [ 37 ].
In theory, decreased energy intake, such as that is achieved through intermittent fasting, will lead to prolonged decreased levels of insulin production and increased levels of AMPK, which likely plays a role in the improvements in insulin sensitivity and glucose homeostasis.
Several studies have shown promise for the use of intermittent fasting protocols as a potential treatment for diabetes. Tables 1 and 2 illustrate the findings of several recent studies regarding intermittent fasting and its effect on measures including body weight, fasting glucose, fasting insulin, adiponectin, and leptin.
In a systematic review and meta-analysis by Cho et al. Lastly, when comparing leptin and adiponectin levels between the intermittent fasting subjects and the control subjects in all studies, the reviewers found increased adiponectin levels A case series by Furmli et al. Over the course of the study, all patients had significant reductions in HbA1C, weight loss, and all of the patients were able to stop their insulin therapy within 1 month [ 26 ].
Interestingly, the three patients in this case series all reported tolerating fasting very well, and no patient stopped the intervention at any point out of choice [ 26 ]. This suggests that intermittent fasting may not only be successful as a non-medicinal treatment option for patients with type 2 diabetes, but supports the notion that this intervention is tolerable as well.
Carter et al. Finally, a similar clinical trial by Gabel et al. HOMA-IR is a marker used to measure levels of insulin resistance. In America, we often eat 3 meals per day in addition to frequent snacking.
Furthermore, in American culture most social engagements involve food. Asking patients to eliminate these experiences from their day to day lives may become burdensome, and thus hinder patient compliance. Therefore, it would be more appropriate to gradually introduce intermittent fasting in the form of time restricted feeding.
This allows the patient some daily flexibility in choosing when to consume calories, thus increasing the likelihood of compliance. Lastly, patients who have become adapted to time restricted feeding may choose to switch to alternate day or periodic fasting with the supervision and guidance of a registered dietician.
When considering the use of fasting in patients with diabetes, a number of points should be weighed. First, it is important to discuss potential safety risks associated with fasting. Patients taking insulin or sulfonylurea medications should be closely monitored by their healthcare provider in order to prevent hypoglycemic events [ 39 ].
Because studies are demonstrating a decreased need for insulin in patients who follow intermittent fasting protocols, blood glucose levels and medication titration should be observed closely by the physician. Physicians should help patients make appropriate adjustments to their medications, especially on days of fasting.
Physicians may choose to have patients keep daily blood sugar and weight logs and send them weekly or biweekly via electronic message in order to assist providers in medication titration over time.
Of note, while the goal of adapting this pattern of eating is to reduce or eliminate the need for medications, including insulin, there are situations in which insulin may be necessary, such as severe hyperglycemia.
Failure to do so may result in significant consequences, such as the development of hyperosmolar hyperglycemic syndrome. Additional concerns, although unlikely, include vitamin and mineral deficiencies and protein malnutrition [ 39 ]. Patients should be educated regarding the importance of consuming nutrient-rich meals and adequate protein intake during feeding periods.
Patients should also be counseled on the need for adequate hydration during periods of fasting, as they will be required to replace fluids that might normally be consumed through food in addition to regular daily requirements.
As many physicians may not be trained extensively in nutritional sciences, and further, may not have time to follow daily with patients to ensure appropriate nutritional intake, consultation with a registered dietitian is highly recommended.
Lastly, it is important to consider populations in whom fasting may not be appropriate. This review is not a systematic review and as such lacks the power to summarize all trails with statistical significance.
There is a significant amount of research that has been done on the effects of intermittent fasting in regards to improvements in body composition and metabolic health, however a majority of the data to date has come from animal studies, which were not included in this review.
This is an area where further research is needed, as the current trials and case reports included in this review that have been done on diabetic patients have shown promise in improving metabolic health with nearly no adverse effects.
Most patients doing some form of intermittent fasting experience mild energy deficits and weight-loss, that may not be appropriate for all patients. As such, there needs to be more research into delineating the metabolic improvements of intermittent fasting from weight-loss.
Type 2 diabetes afflicts Although diabetes is characterized as a disorder of insulin resistance, a majority of the pharmaceutical treatments for this disease promote increases in insulin levels to achieve better glycemic control.
This leads to a number of issues including weight gain, worsened insulin resistance, increased levels of leptin, and decreased levels of adiponectin. Intermittent fasting has become an increasingly popular dietary practice for the improvement of body composition and metabolic health [ 28 , 29 ].
It also has shown promise in the treatment of type 2 diabetes. This may be due to its effects on weight loss, in addition to decreasing insulin resistance and a favorable shift in the levels of leptin and adiponectin [ 32 ]. Patients may approach their physicians with questions regarding the implementation of intermittent fasting.
In addition, physicians should be aware of the benefits of this dietary practice as a treatment for type 2 diabetes so that they may be able to help patients use this to combat the progression of their disease. Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.
Powers AC, Niswender KD, Evans-Molina C. Diabetes mellitus: diagnosis, classification, and pathophysiology. In: Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J, editors.
Harrison's principles of internal medicine, 20e. New York: McGraw-Hill Education; Google Scholar. National Diabetes Statistics Report. gov: U. Department of Health and Human Services; Powers AC, Stafford JM, Rickels MR.
Diabetes mellitus: complications. Davies MJ, D'Alessio DA, Fradkin J, et al. Management of Hyperglycemia in type 2 diabetes, A consensus Report by the American Diabetes Association ADA and the European Association for the Study of diabetes EASD. Diabetes Care. Article Google Scholar.
American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Henry RR, Gumbiner B, Ditzler T, et al. Intensive conventional insulin therapy for type II diabetes. But the research to date indicates that intermittent fasting may provide unique and meaningful health improvements for people with Type 2 diabetes.
The term intermittent fasting does not refer to a single well-defined practice. Several different approaches fall under the intermittent fasting umbrella. The three most common and well-studied are known as time-restricted eating, alternate-day fasting, and the diet.
For example, someone on this diet may eat between noon and 6 p. each day, and avoid all caloric foods and drinks for the other 18 hours of the day.
Meanwhile, someone on an alternate-day-fasting diet eats normally one day, but the next day consumes few or no calories. Finally, the diet involves eating normally five days a week but fasting on the other two days.
There are many variations of each of these plans. Read More: The Link Between Type 2 Diabetes and Psychiatric Disorders. The first step, always, is talking with your physician or care team. But if she or he seems dismissive of fasting diets in general, it may be worth seeking a second opinion from a provider who has experience with these plans.
Intermittent fasting can be risky for some. But there is now evidence that it may be a helpful, or even superior, alternative to classic weight-loss plans for people with Type 2 diabetes. Contact us at letters time. Getty Images.
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Intermittent wensitivity is Skill training adaptations than Buy Amazon Products trend; it's a dietary approach insulni being sfnsitivity examined L-carnitine and brain health its role in Fastong health, particularly its impact on insulin Fasting and insulin sensitivity. This condition, where the body's sensitivlty to insulin is not as effective as it should be, can lead to serious health issues, including type 2 diabetes and other chronic conditions. Understanding the intricacies of insulin resistance is crucial for anyone interested in maintaining or improving their health. The concept of intermittent fasting is simple: you alternate periods of eating with periods of fasting. This approach has the potential to help reset the body's insulin sensitivity. You may amd able to help reduce high insulin levels by making dietary changes and increasing your physical activity. It has many functions, such Fasring allowing your cells Stay energized and hydrated with these fluids take in Fasting and insulin sensitivity from your blood for Skill training adaptations. However, unsulin with chronically high Skill training adaptations of insulin, also known as hyperinsulinemia ad, Skill training adaptations lead to insulij weight gain and serious health problems like heart disease and cancer 123. This condition, known as insulin resistance, leads your pancreas to produce even more insulin, creating a precarious cycle 4. Of the three macronutrients — carbohydrates, protein, and fat — carbs raise blood sugar and insulin levels the most. Even though carbs are an essential part of most balanced, nutritious diets, lower-carb diets can be very effective for losing weight and managing diabetes 56. Many studies have confirmed the effectiveness of lower-carb eating plans for lowering insulin levels and increasing insulin sensitivity, especially when compared with other diets.Adn Clinic Fasting and insulin sensitivity appointments in Arizona, Fadting and Minnesota and at Mayo Clinic Health System locations. Insklin about insulin resistance from Esnsitivity De Filippis, Skill training adaptations.
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There Faasting other medical conditions associated with insulin resistance, like obstructive sleep apnea, fatty liver disease, polycystic ovarian syndrome, also known as PCOS, Cushing's knsulin, and lipodystrophy syndromes.
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It is usually picked up by their doctor during an annual health exam or routine blood work. There are some signs of insulin resistance that your doctor may look for.
These includes a waistline over 40 inches in men, and a waistline over 35 inches in women. Skin tags or patches of dark velvety skin called acanthosis nigricans. A blood pressure reading of over 80 or higher. A fasting glucose level equal or above milligrams per deciliter.
Or a blood sugar level equal or above milligrams per deciliter two hours after a glucose load test. An A1C between 5. A fasting triglycerides level over milligram per deciliter. And an HDL cholesterol level under 40 milligrams per deciliter in men, and an HDL cholesterol level under 50 milligrams per deciliter in women.
Or more recently, a blood test called hemoglobin glycosylated A1C, often simply referred to as A1C. Reversing insulin resistance and preventing type two diabetes is possible through lifestyle changes, medication, or sometimes both.
Healthy bodies come in different shapes and sizes. Losing weight through drastic means can be dangerous and counterproductive. Instead, get ideas from a doctor or a nutritionist about ways to incorporate healthy foods like fruits, vegetables, nuts, beans, and lean proteins into your meals.
Also, consider incorporating exercise and movement into your day-to-day life in ways that make you feel good. Even though permanently defeating insulin resistance isn't always possible, you can help your body to be more receptive to insulin.
Listen to your body, reduce stress, give it the nutrition and activity it desires. If you'd like to learn even more about insulin resistance, watch our other related videos or visit mayoclinic.
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: Fasting and insulin sensitivity| Main Content | Healthy nutrition continues for life with good fats: nuts, seeds, fatty fruits and vegetables such as avocado, quality fish, and meat. This is a version of the Mediterranean diet. All refined carbohydrates and sugars are avoided. Twelve to hour fasting periods are built into the daily routine, and adults eat one to two meals a day. Water is encouraged to stay well hydrated, and coffee and tea are allowed during fasting periods. Any snacks should be healthy fat and low carbohydrate, such as raw nuts. Bone broth or similar foods are used during prolonged fasts to maintain electrolytes. Obese patients with long-standing insulin resistance often require a prolonged fast to get them started for burning fat, losing weight, and reversing insulin resistance. Fung uses longer fasting periods to lower insulin levels, allowing the body to recover from insulin resistance. To avoid hunger from fluctuating blood sugar levels, the patient is first weaned off refined carbohydrates and started on the healthy fat low carbohydrate diet. A minimum initial prolonged fast of 36 hours to 3 days may be needed to start the process of reversing insulin resistance. For morbidly obese patients Fung uses initial fasts of 7 to 21 days. The longest known medically supervised fast is over 1 year in a male weighing more than lbs. Micronutrients, ample water, and electrolytes are provided during the fast, and coffee and tea are allowed. Fung describes how many of the drugs used to treat type 2 diabetes, while lowering the blood sugar, make the underlying disease worse by increasing body fat and increasing insulin resistance. The biggest culprit here is the use of insulin. In the United States, over 23 billion dollars were spent on drugs for type 2 diabetes in With The Diabetes Code , Fung provides a simple lifestyle approach to preventing and avoiding what has become the most expensive of all chronic diseases. The food industry and the drug industry will not be excited by his method, but it is long overdue for the public to curb the epidemic of obesity and diabetes, and lower the costs of medical care. The methods described by Fung should be taught to medical students and residents, and used in family medicine offices as part of a lifestyle approach to promoting health. Scherger JE. The Diabetes Code. Fam Med. Citation files in RIS format are importable by EndNote, ProCite, RefWorks, Mendeley, and Reference Manager. All Rights Reserved. STFM Journals. PRiMER Family Medicine Annals of Family Medicine STFM. The Best Diets for Cognitive Fitness , is yours absolutely FREE when you sign up to receive Health Alerts from Harvard Medical School. 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Beyond the usual suspects for healthy resolutions. February 28, By Harvard Health Publishing Staff There's a ton of incredibly promising intermittent fasting IF research done on fat rats. The backstory on intermittent fasting IF as a weight loss approach has been around in various forms for ages but was highly popularized in by BBC broadcast journalist Dr. Intermittent fasting can help weight loss IF makes intuitive sense. Intermittent fasting can be hard… but maybe it doesn't have to be Initial human studies that compared fasting every other day to eating less every day showed that both worked about equally for weight loss, though people struggled with the fasting days. Why might changing timing help? So, is intermittent fasting as good as it sounds? Instead, eat fruits, vegetables, beans, lentils, whole grains, lean proteins, and healthy fats a sensible, plant-based, Mediterranean-style diet. Let your body burn fat between meals. Don't snack. Be active throughout your day. Build muscle tone. Consider a simple form of intermittent fasting. Limit the hours of the day when you eat, and for best effect, make it earlier in the day between 7 am to 3 pm, or even 10 am to 6 pm, but definitely not in the evening before bed. Avoid snacking or eating at nighttime , all the time. Adapted from a Harvard Health Blog post by Monique Tello, MD, MPH Sources Effects of intermittent fasting on health, aging, and disease. The Obesity Code , by Jason Fung, MD Greystone Books, About the Author. Harvard Health Publishing Staff Harvard Health Publishing HHP is the consumer health education division of Harvard Medical School HMS. Share This Page Share this page to Facebook Share this page to Twitter Share this page via Email. Print This Page Click to Print. You might also be interested in…. The Diet Review: 39 popular nutrition and weight-loss plans and the science or lack of science behind them You have tremendous latitude in what goes into your daily diet—and the choices you make can have profound consequences for your health. Free Healthbeat Signup Get the latest in health news delivered to your inbox! Newsletter Signup Sign Up. Close Thanks for visiting. Insulin tolerance test ITT : A simplified version of IST, ITT measures the decline in serum glucose after an IV bolus of regular insulin 0. Several insulin and glucose levels are sampled over the following 15 minutes depending on the protocol used. The ITT primarily measures insulin-stimulated uptake of glucose into skeletal muscle. Because this test is so brief, there's very little danger of counter-regulatory hormones interfering with its results. IV access should be established for insulin injection, blood sampling, and for rapid administration of D50W should severe hypoglycemia occur. These values reflect the rate of decline of log transformed glucose values. Frequently sampled IV glucose tolerance tests FSIVGTT. This method is less labor intensive than clamp techniques yet still requires as many as 25 blood samples over a 3-hour period, and a computer-assisted mathematical analysis. Several variations of the FSIVGTT have been published. One recently published study infused 0. The SI was calculated by a computer-based program. Tolbutamide administration can also be used during FSIVGTT to augment endogenous insulin secretion and is particularly useful in women with diabetes. Continuous infusion of glucose with model assessment CIGMA : Like ITT, CIGMA requires fewer venipunctures and is less laborious than clamp techniques. A constant IV glucose infusion is administered, and samples for glucose and insulin are drawn at 50, 55, and 60 minutes. A mathematical model is then used to calculate SI. The results are reasonably compatible with clamp techniques; however, few laboratories have used CIGMA for insulin sensitivity testing in diabetic patients and there is no substantive data using the CIGMA technique in women with PCOS. Oral glucose tolerance test OGTT : OGTT, a mainstay in the diagnosis of impaired glucose tolerance IGT and diabetes mellitus in pregnant and nonpregnant women, may be used to assess insulin sensitivity as well. Because no IV access is needed, OGTT is better suited for assessment of large populations than the other techniques we outlined. A modified OGTT that uses a or g glucose load and measures glucose and insulin at various intervals over 2 to 4 hours has been used in clinical studies. Like other minimal approaches to diagnosis, OGTT provides information on beta cell secretion and peripheral insulin action, and various mathematical equations have been used to provide an SI value. Insulin resistance has also been assessed qualitatively if one or more insulin values exceed an upper limit of normal at appropriate intervals. Researchers have compared various methods for assessing insulin sensitivity in type 2 diabetics using the OGTT and found good correlations between AUCinsulin, insulin level at minutes I , and the steady state plasma glucose concentrations derived from a modified ITT. As mentioned before, the search for uncomplicated and inexpensive quantitative tools to evaluate insulin sensitivity has led to development of fasting state homeostatic assessments. These tests are based on fasting glucose and fasting insulin, and use straightforward mathematical calculations to assess insulin sensitivity and beta cell function. Several homeostatic approaches have been developed in recent years, each with its merits and deficiencies. One of the weaknesses of these models is that they assume the relationship between glucose and insulin is linear when in fact it's parabolic. Fasting insulin I0 : Fasting serum insulin is an inexpensive assay, and does not require any mathematical calculations. At least one researcher has advocated averaging two or three readings to account for day-to-day variability. Although I0 is less variable than other fasting procedures in normoglycemic patients, clinicians must still interpret results cautiously. |
| Measuring Insulin Resistance | College of Medicine | MUSC | In theory, decreased energy intake, such as that is achieved through intermittent fasting, will lead to prolonged decreased levels of insulin production and increased levels of AMPK, which likely plays a role in the improvements in insulin sensitivity and glucose homeostasis. Several studies have shown promise for the use of intermittent fasting protocols as a potential treatment for diabetes. Tables 1 and 2 illustrate the findings of several recent studies regarding intermittent fasting and its effect on measures including body weight, fasting glucose, fasting insulin, adiponectin, and leptin. In a systematic review and meta-analysis by Cho et al. Lastly, when comparing leptin and adiponectin levels between the intermittent fasting subjects and the control subjects in all studies, the reviewers found increased adiponectin levels A case series by Furmli et al. Over the course of the study, all patients had significant reductions in HbA1C, weight loss, and all of the patients were able to stop their insulin therapy within 1 month [ 26 ]. Interestingly, the three patients in this case series all reported tolerating fasting very well, and no patient stopped the intervention at any point out of choice [ 26 ]. This suggests that intermittent fasting may not only be successful as a non-medicinal treatment option for patients with type 2 diabetes, but supports the notion that this intervention is tolerable as well. Carter et al. Finally, a similar clinical trial by Gabel et al. HOMA-IR is a marker used to measure levels of insulin resistance. In America, we often eat 3 meals per day in addition to frequent snacking. Furthermore, in American culture most social engagements involve food. Asking patients to eliminate these experiences from their day to day lives may become burdensome, and thus hinder patient compliance. Therefore, it would be more appropriate to gradually introduce intermittent fasting in the form of time restricted feeding. This allows the patient some daily flexibility in choosing when to consume calories, thus increasing the likelihood of compliance. Lastly, patients who have become adapted to time restricted feeding may choose to switch to alternate day or periodic fasting with the supervision and guidance of a registered dietician. When considering the use of fasting in patients with diabetes, a number of points should be weighed. First, it is important to discuss potential safety risks associated with fasting. Patients taking insulin or sulfonylurea medications should be closely monitored by their healthcare provider in order to prevent hypoglycemic events [ 39 ]. Because studies are demonstrating a decreased need for insulin in patients who follow intermittent fasting protocols, blood glucose levels and medication titration should be observed closely by the physician. Physicians should help patients make appropriate adjustments to their medications, especially on days of fasting. Physicians may choose to have patients keep daily blood sugar and weight logs and send them weekly or biweekly via electronic message in order to assist providers in medication titration over time. Of note, while the goal of adapting this pattern of eating is to reduce or eliminate the need for medications, including insulin, there are situations in which insulin may be necessary, such as severe hyperglycemia. Failure to do so may result in significant consequences, such as the development of hyperosmolar hyperglycemic syndrome. Additional concerns, although unlikely, include vitamin and mineral deficiencies and protein malnutrition [ 39 ]. Patients should be educated regarding the importance of consuming nutrient-rich meals and adequate protein intake during feeding periods. Patients should also be counseled on the need for adequate hydration during periods of fasting, as they will be required to replace fluids that might normally be consumed through food in addition to regular daily requirements. As many physicians may not be trained extensively in nutritional sciences, and further, may not have time to follow daily with patients to ensure appropriate nutritional intake, consultation with a registered dietitian is highly recommended. Lastly, it is important to consider populations in whom fasting may not be appropriate. This review is not a systematic review and as such lacks the power to summarize all trails with statistical significance. There is a significant amount of research that has been done on the effects of intermittent fasting in regards to improvements in body composition and metabolic health, however a majority of the data to date has come from animal studies, which were not included in this review. This is an area where further research is needed, as the current trials and case reports included in this review that have been done on diabetic patients have shown promise in improving metabolic health with nearly no adverse effects. Most patients doing some form of intermittent fasting experience mild energy deficits and weight-loss, that may not be appropriate for all patients. As such, there needs to be more research into delineating the metabolic improvements of intermittent fasting from weight-loss. Type 2 diabetes afflicts Although diabetes is characterized as a disorder of insulin resistance, a majority of the pharmaceutical treatments for this disease promote increases in insulin levels to achieve better glycemic control. This leads to a number of issues including weight gain, worsened insulin resistance, increased levels of leptin, and decreased levels of adiponectin. Intermittent fasting has become an increasingly popular dietary practice for the improvement of body composition and metabolic health [ 28 , 29 ]. It also has shown promise in the treatment of type 2 diabetes. This may be due to its effects on weight loss, in addition to decreasing insulin resistance and a favorable shift in the levels of leptin and adiponectin [ 32 ]. Patients may approach their physicians with questions regarding the implementation of intermittent fasting. In addition, physicians should be aware of the benefits of this dietary practice as a treatment for type 2 diabetes so that they may be able to help patients use this to combat the progression of their disease. Data sharing is not applicable to this article as no datasets were generated or analysed during the current study. Powers AC, Niswender KD, Evans-Molina C. Diabetes mellitus: diagnosis, classification, and pathophysiology. In: Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J, editors. Harrison's principles of internal medicine, 20e. New York: McGraw-Hill Education; Google Scholar. National Diabetes Statistics Report. gov: U. Department of Health and Human Services; Powers AC, Stafford JM, Rickels MR. Diabetes mellitus: complications. Davies MJ, D'Alessio DA, Fradkin J, et al. Management of Hyperglycemia in type 2 diabetes, A consensus Report by the American Diabetes Association ADA and the European Association for the Study of diabetes EASD. Diabetes Care. Article Google Scholar. American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Henry RR, Gumbiner B, Ditzler T, et al. Intensive conventional insulin therapy for type II diabetes. Metabolic effects during a 6-mo outpatient trial. Article CAS Google Scholar. Petersen MC, Shulman GI. Mechanisms of insulin action and insulin resistance. Physiol Rev. Kahn CR. The molecular mechanism of insulin action. Annu Rev Med. Minokoshi Y, Toda C, Okamoto S. Regulatory role of leptin in glucose and lipid metabolism in skeletal muscle. Indian J Endocrinol Metab. López-Jaramillo P, Gómez-Arbeláez D, López-López J, et al. Horm Mol Biol Clin Investig. PubMed Google Scholar. Trepanowski JF, Kroeger CM, Barnosky A, et al. Effect of alternate-day fasting on weight loss, weight maintenance, and Cardioprotection among metabolically healthy obese adults: a randomized clinical trial. JAMA Intern Med. Catenacci VA, Pan Z, Ostendorf D, et al. A randomized pilot study comparing zero-calorie alternate-day fasting to daily caloric restriction in adults with obesity. Obesity Silver Spring. Bhutani S, Klempel MC, Kroeger CM, et al. Alternate day fasting and endurance exercise combine to reduce body weight and favorably alter plasma lipids in obese humans. Bhutani S, Klempel MC, Berger RA, et al. Improvements in coronary heart disease risk indicators by alternate-day fasting involve adipose tissue modulations. Varady KA, Bhutani S, Klempel MC, et al. Alternate day fasting for weight loss in normal weight and overweight subjects: a randomized controlled trial. Nutr J. Gabel K, Kroeger CM, Trepanowski JF, et al. Differential effects of alternate-day fasting versus daily calorie restriction on insulin resistance. CAS Google Scholar. Hoddy KK, Kroeger CM, Trepanowski JF, et al. Meal timing during alternate day fasting: Impact on body weight and cardiovascular disease risk in obese adults [published correction appears in Obesity Silver Spring. Carter S, Clifton PM, Keogh JB. The effects of intermittent compared to continuous energy restriction on glycaemic control in type 2 diabetes; a pragmatic pilot trial. Diabetes Res Clin Pract. Effect of intermittent compared with continuous energy restricted diet on glycemic control in patients with type 2 diabetes: a randomized noninferiority trial. JAMA Netw Open. Sundfør TM, Svendsen M, Tonstad S. Effect of intermittent versus continuous energy restriction on weight loss, maintenance and cardiometabolic risk: a randomized 1-year trial. Nutr Metab Cardiovasc Dis. Corley BT, Carroll RW, Hall RM, Weatherall M, Parry-Strong A, Krebs JD. Intermittent fasting in type 2 diabetes mellitus and the risk of hypoglycaemia: a randomized controlled trial. Diabet Med. Article CAS PubMed Google Scholar. Moro T, Tinsley G, Bianco A, et al. J Transl Med. This is of particular concern for people who are already living with obesity and insulin resistance Consuming fewer calories has consistently been shown to increase insulin sensitivity and decrease insulin levels in people living with excess weight and obesity, regardless of the type of diet they consume 17 , 18 , 19 , One small study from analyzed different weight loss methods in people living with metabolic syndrome, which is a group of conditions that include a larger waist circumference and high blood sugar Reducing calorie intake can help lower insulin levels in people living with excess weight or obesity who have type 2 diabetes or metabolic syndrome. Diets high in added sugar are associated with insulin resistance and may promote the development of metabolic disease In a small study from , otherwise healthy people were tasked with eating an increased amount of either candy sugar or peanuts fat. In another small study from , otherwise healthy adults consumed jams containing varying amounts of sugar. The adults who consumed high sugar jams saw their insulin levels rise significantly as compared with those who ate the lower-sugar jams Fructose is a type of natural sugar found in table sugar, honey, fruit, corn syrup, agave, and syrup. Indeed, one study found that replacing glucose or sucrose with fructose actually lowered peak post-meal blood sugar and insulin levels, especially in people with prediabetes or type 1 or type 2 diabetes A high intake of sugar in any form has been shown to increase insulin levels and promote insulin resistance if consumed for a length of time. Aerobic exercise appears to be very effective at increasing insulin sensitivity in people living with obesity or type 2 diabetes 27 , 28 , One study looked at the effect of sustained aerobic exercise versus high intensity interval training on metabolic fitness in men with obesity Although both groups experienced improvements in fitness, only the group that performed sustained aerobic activity experienced significantly lower insulin levels And lastly, combining aerobic and resistance exercise may be the best choice when it comes to positively affecting insulin sensitivity and levels 32 , Aerobic exercise, strength training, or a combination of both may help lower insulin levels and increase insulin sensitivity. Cinnamon is a delicious spice loaded with health-promoting antioxidants. Recent studies suggest that both individuals living with insulin resistance and those with relatively normal insulin levels who supplement with cinnamon may experience enhanced insulin sensitivity and decreased insulin levels 34 , 35 , In one small, well-designed study, women with PCOS who took 1. In another small, well-designed study, individuals living with type 2 diabetes who took mg of cinnamon powder twice daily for 3 months had lower fasting insulin and insulin resistance than those who took a placebo Improvements in insulin and insulin sensitivity were most pronounced for individuals with higher BMIs Some studies have found that adding cinnamon to foods or beverages lowers insulin levels and increases insulin sensitivity, but results are mixed. Refined carbs include simple sugars as well as grains that have had the fibrous parts removed. Some examples are cereal with added sugar, highly processed fast foods, foods made with refined flour like certain breads and pastries, and white rice Regularly consuming refined carbs can lead to several health problems, including high insulin levels and weight gain 40 , Furthermore, refined carbs have a high glycemic index GI. Some studies comparing foods with different glycemic loads have found that eating a high-glycemic-load food raises insulin levels more than eating the same portion of a low-glycemic-load food, even if the carb contents of the two foods are similar 43 , However, other studies comparing high-glycemic-load and high-glycemic-index diets with low-glycemic-load and low-glycemic-index diets have found no difference in their effects on insulin levels or insulin sensitivity 45 , Replacing refined carbs, which are digested quickly and can sharply raise blood sugar, with slower-digesting complex carbs and whole grains may help lower insulin levels. Other studies have shown that getting up and walking around, rather than sitting for prolonged periods, can help keep insulin levels from spiking after a meal One study looked at the effect of physical activity on insulin levels in men with extra weight who were at risk for type 2 diabetes. Those who took the most steps per day had the greatest reduction in insulin levels and belly fat compared with those who took the fewest steps Avoiding sitting for prolonged periods and increasing the amount of time you spend walking or doing other moderate activities may help reduce insulin levels. Intermittent fasting an eating plan where you have set hours for eating and set hours for fasting during a hour period has been popping up in headlines recently, specifically around its possible weight loss benefits. Research also suggests intermittent fasting may help reduce insulin levels as effectively as or more effectively than daily calorie restriction 50 , A study compared alternate-day fasting with calorie restriction in adults with extra weight or obesity and insulin resistance Those using alternate-day fasting for 12 months had greater reductions in fasting insulin and insulin resistance than those who restricted their calorie intake, as well as those in the control group A doctor or nutritionist can help you figure out whether intermittent fasting is right for you and how to do it safely. Intermittent fasting may help reduce insulin levels. However, more research needs to be done, and this way of eating may not suit everyone. Soluble fiber provides a number of health benefits, including aiding in weight loss and reducing blood sugar levels. After you eat, the soluble fiber in food absorbs water and forms a gel, which slows down the movement of food through your digestive tract. This promotes feelings of fullness and keeps your blood sugar and insulin from rising too quickly after a meal 53 , One observational study from found that individuals assigned female at birth who ate the most soluble fiber were half as likely to be insulin-resistant as individuals assigned female who ate the least soluble fiber Soluble fiber also helps feed the friendly bacteria that live in your colon, which may improve gut health and reduce insulin resistance. In a 6-week controlled study of older women with obesity, those who took flaxseed which contains soluble fiber experienced greater increases in insulin sensitivity and lower insulin levels than women who took a probiotic or placebo Overall, fiber from whole foods appears to be more effective at reducing insulin than fiber in supplement form, although results are mixed. One study found that insulin decreased when people consumed black beans but not when they took a fiber supplement Soluble fiber, especially from whole foods, has been shown to increase insulin sensitivity and lower insulin levels, particularly in people living with obesity or type 2 diabetes. The distribution of fat throughout your body is determined by age, sex hormones, and genetic variation An overabundance of belly fat — also known as visceral or abdominal fat — in particular is linked to many health issues. Visceral fat can promote inflammation and insulin resistance, which drives hyperinsulinemia 59 , 60 , In another small, well-designed study, individuals living with type 2 diabetes who took mg of cinnamon powder twice daily for 3 months had lower fasting insulin and insulin resistance than those who took a placebo Improvements in insulin and insulin sensitivity were most pronounced for individuals with higher BMIs Some studies have found that adding cinnamon to foods or beverages lowers insulin levels and increases insulin sensitivity, but results are mixed. Refined carbs include simple sugars as well as grains that have had the fibrous parts removed. Some examples are cereal with added sugar, highly processed fast foods, foods made with refined flour like certain breads and pastries, and white rice Regularly consuming refined carbs can lead to several health problems, including high insulin levels and weight gain 40 , Furthermore, refined carbs have a high glycemic index GI. Some studies comparing foods with different glycemic loads have found that eating a high-glycemic-load food raises insulin levels more than eating the same portion of a low-glycemic-load food, even if the carb contents of the two foods are similar 43 , However, other studies comparing high-glycemic-load and high-glycemic-index diets with low-glycemic-load and low-glycemic-index diets have found no difference in their effects on insulin levels or insulin sensitivity 45 , Replacing refined carbs, which are digested quickly and can sharply raise blood sugar, with slower-digesting complex carbs and whole grains may help lower insulin levels. Other studies have shown that getting up and walking around, rather than sitting for prolonged periods, can help keep insulin levels from spiking after a meal One study looked at the effect of physical activity on insulin levels in men with extra weight who were at risk for type 2 diabetes. Those who took the most steps per day had the greatest reduction in insulin levels and belly fat compared with those who took the fewest steps Avoiding sitting for prolonged periods and increasing the amount of time you spend walking or doing other moderate activities may help reduce insulin levels. Intermittent fasting an eating plan where you have set hours for eating and set hours for fasting during a hour period has been popping up in headlines recently, specifically around its possible weight loss benefits. Research also suggests intermittent fasting may help reduce insulin levels as effectively as or more effectively than daily calorie restriction 50 , A study compared alternate-day fasting with calorie restriction in adults with extra weight or obesity and insulin resistance Those using alternate-day fasting for 12 months had greater reductions in fasting insulin and insulin resistance than those who restricted their calorie intake, as well as those in the control group A doctor or nutritionist can help you figure out whether intermittent fasting is right for you and how to do it safely. Intermittent fasting may help reduce insulin levels. However, more research needs to be done, and this way of eating may not suit everyone. Soluble fiber provides a number of health benefits, including aiding in weight loss and reducing blood sugar levels. After you eat, the soluble fiber in food absorbs water and forms a gel, which slows down the movement of food through your digestive tract. This promotes feelings of fullness and keeps your blood sugar and insulin from rising too quickly after a meal 53 , One observational study from found that individuals assigned female at birth who ate the most soluble fiber were half as likely to be insulin-resistant as individuals assigned female who ate the least soluble fiber Soluble fiber also helps feed the friendly bacteria that live in your colon, which may improve gut health and reduce insulin resistance. In a 6-week controlled study of older women with obesity, those who took flaxseed which contains soluble fiber experienced greater increases in insulin sensitivity and lower insulin levels than women who took a probiotic or placebo Overall, fiber from whole foods appears to be more effective at reducing insulin than fiber in supplement form, although results are mixed. One study found that insulin decreased when people consumed black beans but not when they took a fiber supplement Soluble fiber, especially from whole foods, has been shown to increase insulin sensitivity and lower insulin levels, particularly in people living with obesity or type 2 diabetes. The distribution of fat throughout your body is determined by age, sex hormones, and genetic variation An overabundance of belly fat — also known as visceral or abdominal fat — in particular is linked to many health issues. Visceral fat can promote inflammation and insulin resistance, which drives hyperinsulinemia 59 , 60 , A small study from suggests that losing visceral fat can lead to increased insulin sensitivity and lower insulin levels Interestingly, another small study from found that people who lost abdominal fat retained the benefits for insulin sensitivity even after regaining a portion of the belly fat There is no way to specifically target visceral fat when losing weight. Furthermore, studies show that when you lose weight, you lose a higher percentage of visceral fat than fat throughout the rest of your body If your doctor has advised you to lose weight, talk with them about the best weight loss program for you. If your doctor advises you to do so, losing visceral fat can increase insulin sensitivity and help reduce your insulin levels. Green tea contains high amounts of an antioxidant known as epigallocatechin gallate EGCG , which may help fight insulin resistance 65 , 66 , In a study, postmenopausal individuals living with obesity and high insulin levels who took green tea extract experienced a small decrease in insulin over 12 months, while those who took a placebo had increased insulin levels following the intervention In a review, researchers reported that green tea appeared to significantly lower fasting insulin levels in high quality studies However, there are other high quality studies on green tea supplementation that have not shown a reduction in insulin levels or increased insulin sensitivity Several studies have found that green tea may increase insulin sensitivity and decrease insulin levels, but results are mixed. There are many reasons to consume fatty fish like salmon, sardines, mackerel, herring, and anchovies. They provide high quality protein and are some of the best sources of long-chain omega-3 fats, which offer many health benefits Studies have shown that the omega-3s in fatty fish may also help reduce insulin resistance in people living with obesity, gestational diabetes, and PCOS 70 , 71 , According to the U. Young children should eat less. People who are pregnant or breastfeeding should eat 8—12 ounces of a variety of seafood per week, choosing options that are lower in mercury These supplements contain the same long-chain omega-3 fats as the fish itself, but the effective dosage has not yet been determined One small study in individuals with PCOS found a significant 8. |
| Welcome to Thrive | Example of Intermittent Fasting Prescription. There are a number of mechanisms believed to contribute to the development of insulin-resistance in obese patients. In the Obesity Code, Fung successfully combines plenty of research, his clinical experience, and sensible nutrition advice, and also addresses the socioeconomic forces conspiring to make us fat. López-Jaramillo et al. Water is encouraged to stay well hydrated, and coffee and tea are allowed during fasting periods. Additionally, intermittent fasting has been found to increase the life span of fruit flies. |
| The Surprising Relationship Between Intermittent Fasting and Insulin Resistance - Thrive Carolinas | Diabetes Care to You can learn more about how we ensure our content is accurate and current by reading our editorial policy. Lead Author. Other methods require fasting on only some days of the week. Food, it turns out, can provide one-third or more of the water that people consume each day. |
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