Q My doctor advised me to lose weight to reduce my risk of having a heart attack. Is intermittent fasting a good strategy to use? RJ, Greenville

A Intermittent fasting (IF) once was considered a fad approach to weight loss. There now is ongoing research to see who might benefit from IF and what specific type of IF. The key to weight management is finding the health promoting strategy that works for you. Kyle Luke, a graduating Brody medical student found this information for you.

Heart disease is the leading cause of death in the U.S. According to the Centers of Disease Control, it kills one person every 36 seconds. Risk factors such as high cholesterol, high blood pressure, obesity and diabetes are preventable. Like you, many patients at risk for heart disease are asked to diet to lose weight.

Typically, patients are advised to reduce their daily calories, creating an imbalance between the food calories consumed and the energy expended. For example, an individual whose body requires 2,000 calories a day needs to reduce calories by 500 to achieve a weekly weight loss of 1-2 pounds. For some people this can lead to poor adherence due to increases in appetite and slowing down of the body’s metabolism.

Intermittent fasting is a different strategy with a focus on adjusting the timing of eating and drinking. There are different subtypes of IF as some people, for example, combine fasting with following a ketogenic diet. Two popular strategies are Alternate Day Fasting and Time Restricted Eating. An example of Alternate Day Fasting is the popular 5:2 method in which two days of fasting are mixed into five nonrestrictive eating days.

The time-restricted method of fasting usually follows hourly cycles such as fasting for 16 hours with an 8-hour window to consume meals and calorie-containing beverages. Unlike calorie restriction, IF does not require eating fewer calories. Weight loss and reductions in blood pressure, cholesterol and blood sugar levels are thought to be achieved by the production of antioxidants, a balanced sleep/wake cycle, and the induction of a ketogenic state. In ketosis, the body uses fats instead of carbohydrates to produce energy the body needs.

Although research on the long-term benefits of fasting is limited, there have been promising short-term studies that showed evidence that IF can reduce risk factors for heart disease. One 12-week study included men with obesity and Type 2 Diabetes. Overall, fasting men reduced body fat, weight, cholesterol, and fasting blood sugar levels. Although these results seem promising, the same results were seen in men who reduced their calorie intake.

There are other studies. The benefits of fasting on heart health of Muslims who celebrate Ramadan has been studied. Ramadan is an Islamic holiday that involves daytime fasting over a one-month period. Those who partake in this month-long religious fast have been observed to have decreased fasting blood sugar and improved blood pressure and cholesterol levels. In addition, the number of new cases of heart failure in Muslims with prior damage to the heart decreased during Ramadan when compared to the other months of the year.

Your doctor may have told you about your Framingham Risk Score, a gender-specific calculation used to assess an individual’s risk of an adverse heart-related event over a 10-year period. The calculation is used in individuals without diabetes, 30-79 years of age, and without prior history of heart disease. The Muslims participating in Ramadan showed a reduction of 3 points in their score a reduction of 10 percent of risk during the Ramadan fast.

IF can be considered a promising short-term diet. It may reduce heart disease risk factors such as obesity, hypertension, blood sugar levels and cholesterol, but further research is still required to determine if the effects of fasting long-term can provide additional benefits compared to routine calorie restriction.

Fasting appears to promote the greatest weight loss in those with a high Body Mass Index and could promote better adherence when compared to simple calorie restriction for some who find this strategy comfortable for them. In addition, fasting diets promote ketogenesis, which is a switch to a fat-burning metabolism. A mechanism of metabolism that could be responsible for the decreases in cholesterol and triglycerides seen in the studies.

Your provider should balance your dietary goals with your medical history to find the most successful dietary intervention. The best diet is one that promotes adherence and minimizes side effects.

Please get your vaccine when you have an opportunity. It is crucial for us to reach herd immunity and get back to “normal.” If you had your shot, encourage a friend or family member who has yet to get a jab. And everyone still wear your mask.

Professor emeritus Kathy Kolasa, a registered dietitian nutritionist and Ph.D., is an affiliate professor in the Brody School of Medicine at ECU. Contact her at kolasaka@ecu.edu.