Transcription
We have a little bit of Ben's Science Corner. Yeah, what's with the big voice? Last time it was, then we don't know what the call is. The classroom. The reason we want to take a few minutes is because this week, Dr. Sher, Brett Sher of Diet Doc, referencing another article that was published this past week, and it started a conversation here at Insulin IQ. And so Ben thought that he might just get with Steve and Rich and spend a little time just talk about this particular article and Dr. Shore's uh comments on it. Yeah, probably take a few minutes to do that. So I'll turn the time over to Ben.
Yeah, yeah, thanks, thanks Jack. So you guys, this is something I thought might be fun to do from time to time, where I can pull out some relevant science in the actual manuscripts that have been published and just sort of give you guys a bit of a primer on some of these findings from time to time. So as Jack highlighted, this study came out very recently about fasting or time-restricted eating, that form of fasting where it's fasting within a 24-hour window. So I use the term time-restricted eating to refer to that when you when you're changing the eating window within a 24-hour window, rather than like alternate day or or, you know, because people can do a one-on-one fasting where they eat one day, fast another day, or they do a 5-2. Let's call that intermittent fasting where it's a full day or so. And then time-restricted eating when it's within one day.
Journal of the Journal of the American Medical Association, one of the preeminent biomedical journals. Um, you'll see the link, uh, the boys are gonna, I think, post that, that a picture of it. But the title of this one that was just published, "The Effects of Time Restricted Eating on Weight Loss and Other Metabolic Parameters in Women and Men with Overweight and Obesity." One of the strengths of this study, and they are, they are right to highlight this, is that it was a randomized clinical study. So there's a power there because in randomizing it, you're, you're hopefully eliminating, uh, or accounting for some of the inherent differences that people may well, that that we all have. We're, that's the problem with studying humans. Why so many of us rely on on rodent models? I can have a whole colony of mice that are basically genetically identical and are going to respond to the diets and everything we do identically. In humans, of course, we have such a variety. So it was a randomized trial and and it was fairly big, where they were, they had well over a hundred people included in the study. That's really good for a human study.
One concern I had from the get-go with the, so, so briefly, this study finds basically no significant improvements with the time-restricted eating. Just to kind of cut to the, cut to the, um, outcomes or the results. They found that there was a significant reduction in weight in the time-restricted eating group, but also a significant reduction in lean mass. In fact, it was a shocking amount. I think 65% of the weight lost was considered from lean mass. And that, I say shocking because it is a very high degree of lean mass loss. It also is a lean mass loss that is not seen in any other study of of fasting, to my knowledge. So that was a bit of an, a shocking finding and a bit of an anomaly. Now, some people I've seen in social media are citing that one finding as reason to avoid time-restricted eating because they want to get big with muscle mass gains or they want to maintain muscle mass gains. I would simply try to alleviate that concern by saying that is not a finding seen in other studies. So the degree to which that is, is real, and I'm not accusing this, the authors of this manuscript in any way of dishonesty. No, it could just be an artifact. It's something that's come up and it's just an anomaly, or there were a couple people that had a very high response and the rest didn't at all. So whether that's a real worry or not, I don't think it is, just because it's not been shown in other studies. But that's one of the key takeaways from this sort of negative study, if we want to call it that. There was a significant body mass reduction, but it was not because of fat loss based on how they measured this. It was because of a lean, a lean mass loss.
Now, one other problem with this recently published study, this randomized trial, people were reluctant, it seems, to be randomized into the time-restricted eating group, into that fasting group. And I say that they were reluctant to get into that group because in the results, they report something called lost to follow-up. So people who committed to study and once they were randomized into the two groups, and we'll emphasize another problem with those two groups in a moment, the people that were randomized in the time-restricted eating group, they, seven of them were lost to follow-up. So they were put into the group and then they didn't want to do anything to do with it, and they, then the researchers couldn't contact them again. Seven people were lost from the fasting group, only one was lost from the control group. So there's something, I think, about people very reluctantly being put into the fasting group, and they didn't want to.
Now, with that point in mind, I'll emphasize the second study that was published earlier this year that found a legion of benefits. Every outcome they looked at with time-restricted eating, they got better, whether it was fat loss, blood pressure loss, blood lipid improvements, insulin improvements, glucose improvements. And the boys will show that other study here. Uh, but here's the other one. Here's the other one that I'm emphasizing. Um, and I'm just, I think it's interesting to compare these two. One, both published this year, um, and have very different findings. Now, this study, which found significant improvements across the board, it was much, much smaller. I think, was it 19 people, Steve? Do you remember? I think it was 19 subjects, but they all were, they all self-selected in. So this is basically a case study where they had 19 patients who wanted to engage in time-restricted eating. I think there's something powerful to that, where this group of people in the positive results study, they wanted to do time-restricted eating, they self-selected, they volunteered, they wanted to do it, as opposed to the group that I believe apparently were very reluctant in, so far as the loss to follow-up was seven times higher.
And Ben, weren't they just showing they were not on a specific dietary response? They were just eating whatever they wanted to eat, right? They weren't eating an insulin-controlled diet or a ketogenic diet of any kind. And the time window was like 10 hours, wasn't it?
Yes, so that's the next important, that's another point. Yeah. So what these studies both have in common is that neither gave specific dietary advice beyond, here's your eating window, stick to it. So that's a strength that they both have in common. But it's a weakness that we would all agree to. If you're going to encourage someone to time-restricted eat, to time-restricted eating or fasting, I think you really ought to be playing with that other lever, which is arguably at least as relevant, which is manipulate, manage your macronutrients in a way that, if much of the power of time-restricted eating and fasting is that you lower your insulin, imagine if you can couple the insulin-lowering effect of fasting or time-restricted eating with the insulin-lowering effect of controlling carbohydrates, prioritizing protein, and filled with fat. So I do think there's a lot of synergy. I hate to use that word because it's so cliché, but there's a lot of power in combining time-restricted eating with managed macronutrients, which they didn't do. But that, that's okay because it allows us to compare these two studies head to head.
Now, Rich, you'd mentioned the eating window. I think that's another point to mention in the negative results study finding nothing really beneficial about the time-restricted eating. The, the time of ending your diet, the food for the day was 8 p.m. as opposed to the positive finding, their last meals on average were at 6 p.m. And they actually measured that on average, the average subject was eating their last calories four hours before they were going to bed. And that wasn't, they didn't report on that in the negative results study. And I can't help but wonder to what degree were the benefits, the positive study, was the benefit partly because they were sleeping better, which they did indicate, as opposed to no improvements in sleeping in the time-restricted eating study? No longer window after they finish eating before that. Yeah, more time for the food to digest. I worry if these people in the negative results study, or anything like me, they had to fight the temptation to just binge all evening, you know, when suddenly they're home, they, they are, you know, that's quiet time, the day has slowed down, they're ready to sit down and binge watch Netflix, and they're ready to binge eat something they shouldn't, and they feel okay about it because it's in their eating window, and they weren't told to restrict calories. And that's another point. In the negative results study, there was no difference in calories. They were eating the exact same amount of calories as they were before the study started. That shouldn't be viewed as a weakness because we don't tell people to control calories with Insulin IQ education, and I don't think we ever should. But one of the things that just tends to happen is people just tend to start controlling their calories a little better. That was evidenced in the positive results study. They were eating, just by self, their own will, their own choice, just by nature of the eating window changing, they were eating about 10, 10 fewer calories per day, just of their own volition. I think there's something meaningful there.
Well, and Ben, involving people into an insulin-controlled protocol where they're eating a little more fat, protein, and, and the window is a little more like an 18-6 kind of window, not, I mean, a 10-hour window of eating, that's big. Is that really fasting? That's big. I know, I mean, I know who eats more than 10 hours a day. Yeah, that's a small step. I don't know how they call that fasting, right?
Yeah, I think these are two, that's a day that ends with why. I think these are two completely different studies, and I think they were set up completely differently. Uh, and, you know, the, uh, the larger study, the smaller study was 19 people, and they didn't really have a control group. The larger study, the control group was told to eat three meals a day. Yeah, yeah. I don't know many people that in a, in a measured period of time, actually get three separate meals a day, every day. And that may, I think that's an artificial, uh, element involved in this study as well, that they are asked to eat three meals a day. I don't know how that that came through.
An excellent point. Yeah, I'm glad you, I meant to, I wanted to bring that up. So when they split these two groups in a negative study, they split them into two groups. One was the time-restricted eating, the other one was, I believe, just as much an intervention where they were told, you eat three meals per day. People don't do that. That alone is an intervention, which I think creates a bit of a confounding variable. That if they had been told, eat whatever you want, you're the control group, don't change anything, you eat what you're doing, and then maybe try to attempt, um, to, in the time-restricted eating group, kind of try to calorie match them, which isn't some, that's not easy to do. It is admittedly kind of next-level difficulty. But, but in a rodent study, when we do this kinds of things in the perfectly controlled environment of rodent work, we, we will pair feed them. We will say, okay, the control group ate this much. We're going to try to help these other animals eat this much. Same calorie, maybe it's a ketogenic diet, or maybe it's a narrowed eating window or time-restricted eating. But again, one of the problems with the negative results study is that the control group was just as much of an intervention. They were told, I believe, in just as much a way to change their diet than the time-restricted eating group, because going to the average person and telling them, you need to eat three, what did they call them? Consistent meal timing. So that was the group that was the control group. Consistent meal timing. That's not how much, that's not a controller. That is a confounding variable that I think was a bit of a problem.
So those are some of the main concerns with the negative results study. I think there's a problem in forcing people to time-restricted eat when they don't want to. Also, I think the control group was a bit problematic, insofar as it was as much an intervention as the intervention group, the fasting group. And in the time, the eating window actually ended up going pretty late into the day, and I think it probably was pushing up till bedtime a little too closely, and that would offset some of the benefits.
Now, another thing else, in fact, to emphasize that point, to these authors' credit, in the negative study, they cite a study. They cite one of the concerns in their negative findings could be that the eating window was too late. That maybe if they pushed it into the earlier in the day, there could have been a benefit. And they cite a study where the eating window ended at 3 p.m. And, you know, that's a wonderfully long period of time before you go to bed. And I, the more the older I get, and the more I kind of manipulate my own lifestyle, the more power I see in my life of going to bed on a relatively empty stomach. I'm not going to bed hungry, but I'm not going to bed full. That, tim, that in my, as I'm in my mid-40s now, is the single greatest variable on how well I sleep and how well I feel the next day, how energetic I am. Don't go to bed full. Anyway, there's some thoughts. So what am I missing? What else? Anything to add on that, Steve?
Well, I would just like to say, what do you see? Well, physician, I agree a lot with, with, uh, what you've said, Dr. Bickman. I, I just have to say, in my practice, I don't have any of my patients in this negative finding study follow this at all. Because, as we emphasize here, it's about controlling insulin. And intermittent fasting is one of the many tools that we have. And insulin control is by far the most important factor to focus on. And my patients that focus on insulin control have tremendous success. The ones that combine time-restricted eating, the having a six or eight-hour period a day where they're focusing on controlling insulin, keeping it low during that window, combining those two variables have tremendous success. So this is a very interesting study that did not at all focus on insulin control. And I think that's, as far as I'm concerned, is the greatest variable that didn't play out in this study. It may explain why they had a negative result, because that wasn't their, that wasn't their focus. And controlling insulin is the most important focus when you look at your, your nutrition.
In fact, speaking of controlling insulin, what I ought to have done is also bring in the case studies that Dr. Jason Fung has reported, where they find, they take profoundly insulin-resistant type 2 diabetics that are on insulin therapy. They're that insulin-resistant that they need more insulin to control their glucose, which is lots of patients, which is which is terrible. But they find that within just a couple weeks, the intermittent fasting is so effective that they're able to get off all insulin. I find that as well with my type 2 diabetics. Insulin controlled. Yeah, within two weeks, 20 years on insulin, they're off. That's, uh, crazy. The power and benefit. We're also talking about behavior here, where, where if somebody has the will and the ability to fast, it's just that they're so much more intuitive around their eating patterns when they're fasting. They can feel when they're hungry. They're not saying, hey, I gotta eat, you know, at eight and at 10 and at 12. And they're starting to be way more intuitive around their behavior around food. I just don't want him to get discouraged. If you have just discovered this intermittent fasting tool, remember it's a tool, and you have to apply it to your lifestyle and what works best for you. I think it's more important that you're intuitive about your nutrition and that you don't make yourself suffer, because you're much more likely to, to not be consistent and not be successful if you are miserable with what you're doing. I enjoy the window of opportunity to eat, and I feel so much better going to bed on an emptier stomach. But boy, let me tell you, there are times, once in a while, after if I've worked out real hard, I'm still hungry. And I will still satisfy my hunger, even though it's a little outside the window, with my focus being insulin control. And that by far gives me the greater benefit. And for all my patients, I tell them, that is your first focus, is keeping your insulin low. The second one is being intuitive about your hunger. So don't get discouraged by this study. It's an interesting study, but it in no way reflects how I teach my patients. Intermittent fasting is a tool, but it's not by any means the most effective way to achieve health by avoiding the plagues of insulin resistance.
Great. Yeah, yeah. You guys let us know what you think. If this sort of metabolic classroom, um, manuscript discussion is, uh, helpful, then we'll keep doing them because there are a lot of cool studies we can get to in the future. Yeah, and studies can be very confusing. You need several of them to understand what a real outcome is. This other study, the positive one, only had 19 participants, and they were very well controlled. And that's much more similar to how I wrote my practice. So I see that this positive result study is much more like I see day in and day out in my practice, because it's very controlled. There's a specific purpose. The patients are well screened, they're motivated, and they're motivated. And, uh, and that's what we're here to do is to help you see the motivation. Thank you. Thanks for discussing that. It's important that our audience know. We know our audience at Insulin IQ. We have very, very science-focused folks in the community that follow every single bit of research that Dr. Pickman does. And then we have folks watching today that are on the total other end of the scale. They're just coming to this whole space. And, and some of the things are just far too deep and too technical. Our mission is to try to take the science and dissect it and work it and we bash it around and spend a lot of time, but then we try to condense it down and hone it in so that we have actionable things that Insulin IQ, uh, clients and, and students can do. So Steve, I appreciate that you kind of brought that home with, and you too, uh, Rich, as far as behavior and don't be discouraged about intermittent fasting. Don't think that because there is conflicting science that it, we don't see a huge amount of, of patients and, and students that we help. And ultimately, Jack, it's N equals one. I mean, how it affects you, N equals one. Yeah, you are the study. You are the study. You are the study. Yeah. So N, in fact, to be scientific, N refers to a sample size. So this study, you know, was an N of 19 or an N of 116. And this refers to the sample size. So Rich's point is that anecdotes matter. That if you yourself are seeing a benefit, you are conducting your own study. An N of you, you're your own sample size. Great. So I said something smart. It was brilliant. Brilliant. Tell your kids. I know. I hope my kids are watching. I hope my wife's watching. We're going to transition to a few questions and