12 Burning Questions About Intermittent Fasting, Answered

Become an expert in everything related to IF: how it works, why it’s beneficial, who it’s risky for, and what to know before you start.

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Restricting the hours or days that you eat may promote temporary weight loss.iStock (2)

Forget counting calories or swearing off carbs — the latest diet fad doesn’t put limitations on what you eat. Rather, it focuses on the when. This way of eating is called intermittent fasting (IF), and in the past several years it has risen through the ranks of popular diets, until it’s now one of the most-searched diets on Google, racking up hundreds of thousands of searches on average each month.

What’s the reason for its popularity? “It seems a lot easier for some people. Traditional lifestyle changes tend to rely a lot on calorie counting or point watching or rules, and for some people — especially people with busy lives or who feel pulled in a lot of directions — that feels like a lot of work and effort. So for this, where they literally have to do nothing but skip a meal, it's just a lot easier for them to maintain,” says Elizabeth Lowden, MD, a bariatric endocrinologist at the Northwestern Medicine Metabolic Health and Surgical Weight Loss Center at Delnor Hospital in Geneva, Illinois.

RELATED: 12 Possible Health Benefits of Intermittent Fasting

Here, we explore the ins and outs of IF, and answer all the questions you’re probably asking.

1. What Is Intermittent Fasting, and How Is the Diet Different From Starvation? 

IF is a way of eating that calls for alternating between fasting (or significant reduction of calorie intake) and eating at specific times, according to Johns Hopkins Medicine. It’s different from other diets in that it’s not about eating specific foods. IF is not about depriving yourself either. Rather, it’s about eating your meals during a certain time frame and fasting for the rest of the day and night.

2. What Is the History of Intermittent Fasting (and Fasting in General)? 

Fasting has been around since ancient times and has predominantly been practiced within religions, according to a study published in the Journal of the Academy of Nutrition and Dietetics in August 2015. But the version of IF that’s talked about today arose in the past eight years or so. According to Harvard Health, IF became more popular around 2012 when the documentary Eat, Fast and Live Longer aired. The Journal of the Academy of Nutrition and Dietetics study says many books on the topic were published around that time as well, including 2013’s The Fast Diet, which added to the buzz. Research followed. “Over the past five years, rigorous research has shown the remarkable benefits of intermittent fasting, which is behind this sudden interest,” says Sara Gottfried, MD, the Berkeley, California–based author of Brain Body Diet.

3. How Does Intermittent Fasting Work?

There are a few different versions of IF (outlined below), but each version follows the basic premise of designating a certain period of time during the week meant for eating and certain periods when food and drink should be restricted (or severely limited), according to Harvard Health.

4. What Are the Different Types of Intermittent Fasting?  

The most popular are:

  • 16:8 This method calls for 16 hours of fasting and 8 hours of eating during the day. Followers of this method most commonly will skip breakfast and eat between the hours of 11 a.m. and 7 p.m. or noon and 8 p.m. The rest of the night and morning is spent fasting. Dr. Lowden says this approach is commonly referred to as “time-restricted eating.”
  • Alternate-day fasting This involves limiting your calories to 25 percent of your usual calorie intake followed by a normal eating day, according to a study published in October 2014 in Translational Research. For instance, you might severely restrict calories on Monday, Wednesday, and Friday, and then eat normally on the other days.
  • 5:2 fasting A very low number of calories (around 400 to 500 calories) is allowed on the two nonconsecutive “fasting” days of the week. The other five days have no eating restrictions, per Harvard T.H. Chan School of Public Health.

RELATED: 6 Types of Intermittent Fasting

5. Can Intermittent Fasting Help You Lose Weight? 

The short answer: probably. “IF gets a lot of press as a weight loss tool, and I recommend it in my practice for weight loss and weight management,” Dr. Gottfried says. It’s linked to weight loss because not eating between meals forces the body to turn to the fat stored in cells for energy, according to Harvard Health. Insulin levels decline through this process as the body burns fat.

Lowden believes what it really comes down to, though, is calorie restriction. “Overall, people tend to consume fewer calories in a smaller window of time compared with eating all day, and that's what leads to weight loss,” she says. A study published in June 2018 in Nutrition and Healthy Aging involving 23 obese adults found the study participants took in about 300 fewer calories per day when participating in the 16:8 approach to IF.

Versions of IF that restrict eating after a certain time, say 7 p.m., also help eliminate nighttime eating, which has been shown to contribute to metabolic syndrome and obesity, according to a study published in December 2018 in BMC Public Health.

Some critics, however, say the amount of weight loss to expect from IF isn’t any more significant than what you’d see with other calorie-restrictive diets. A study published in the American Journal of Clinical Nutrition in November 2018 found that a diet that cut calories by 20 percent resulted in a similar amount of weight loss to the 5:2 version of IF after one year. Still, IF may be a good option if you find it easier to stick to than other diets.

6. What Are the Touted Benefits of Intermittent Fasting, and Are They Legit?  

Here are some of the proposed benefits of IF:

  • Boost weight loss A review published in Current Obesity Reports in June 2018 found most research on IF has supported its link to weight loss, and the data suggest that it can result in between a 5 and 9.9 percent loss of body weight. The 2018 study published in Nutrition and Healthy Aging suggests alternate-day fasting may produce greater weight loss than time-restricted eating, but that alternate-day fasting may be harder to stick with than time-restricted eating. Ultimately, more research is needed on whether IF can result in real, sustainable weight loss.
  • Lengthen life A study published in Cell in December 2014 suggests calorie restriction may slow aging. The study involved animals, however, and the same findings haven’t been shown among humans yet.
  • Reduce insulin resistance This condition is the hallmark of type 2 diabetes, and being overweight increases the likelihood of insulin resistance, according to a study published in February 2014 in Frontiers of Medicine. IF can help with insulin resistance by reducing the number of calories consumed overall, according to a study published in Nutrients in April 2019.
  • Better heart health A study published in Nutrition Journal reported IF helped study participants lose weight, lose fat, and lower cholesterol levels, leading researchers to conclude eating this way may help people lower their risk of coronary artery disease.
  • Improve metabolic parameters “What we do know is a lot of those metabolic parameters respond to weight loss in general,” Lowden says. “No matter how you lose the weight, you'll have decreased visceral (belly) fat, decreased fasting blood sugars, decreased triglycerides, blood sugar, all those things.” Lowden says this has been shown in a few animal studies, but “a lot of the things you'd physiologically expect from a longer fast time aren't necessarily panning out in population studies,” she says.

RELATED: ‘Intermittent Fasting Helped Me Lose 48 Pounds — Here’s What I Ate (and When)’

7. Who Shouldn’t Try Intermittent Fasting, Because of Safety Concerns?  

The following types of people should avoid IF:

  • People with diabetes (at least not before consulting a doctor). While IF may improve insulin sensitivity and therefore may be beneficial for people with type 2 diabetes, it can also be risky for people on diabetes medications associated with hypoglycemia (low blood sugar), such as insulin, according to a study published in April 2019 in Nutrients. Therefore, IF isn’t recommended for people with type 1 diabetes, who rely on insulin.
  • People with other chronic diseases Not much is known about how fasting will affect many chronic diseases, including diabetes, but negative side effects such as dizziness and nausea may be more pronounced for these people, according to the 2019 Nutrients study. “You have to be careful when you have medical issues that could be worsened by not eating regularly,” Lowden says.
  • Underweight people Those with a body mass index (BMI) of less than 18.5 aren’t advised to try weight loss diets including IF, according to a study published in Nutrients in March 2019.
  • People with current or a history of eating disorders IF may encourage an unhealthy relationship with food, according to Harvard T.H. Chan School of Public Health. A study published in June 2019 in Current Obesity Reports notes that some people may be tempted to use the end of their fast as an excuse to binge on unhealthy foods.
  • Elderly people Fasting can increase the risk of cardiovascular disease, stroke, and arrhythmia among elderly people, according to the March 2019 Nutrients study.
  • Women who are pregnant or breastfeeding. According to that same study, breastfeeding also isn’t the best time to be fasting or reducing calorie intake, since women need an extra 300 to 500 calories per day to keep up energy levels and milk production, according to the Mayo Clinic.

Also, people who need to take medication with food should eat at regular intervals so as not to miss a dose, according to Harvard Health.

It’s a good idea for everyone — whether you have any of the conditions listed above or not — to check with a doctor before starting to fast, according to Johns Hopkins Medicine.

8. Is It Good or Bad to Exercise While Intermittent Fasting?  

According to Harvard Health, one theory is that exercising in a fasted state may help burn fat. Lowden explains that the body needs sugar or some sort of energy to perform well while exercising. Normally, the energy comes from sugar molecules, which are stored as glycogen in the liver. “If you start exercising, you’re more likely to deplete those stores and then your body has no choice but to go into a more anaerobic breakdown to give you the energy you need,” she says. Instead of burning through sugars that aren't available, your body is forced to burn through another energy source: fat.

But you may not have enough energy to exercise as intensely as you normally would. “Peak performance or even feeling good while exercising it's much easier to do if you eat,” Lowden says.

RELATED: Skipping Breakfast Before Exercising May Help You Lose Weight

9. What’s the Best Way to Manage Hunger While Fasting? 

You will likely feel hungry as your body adjusts to IF, but Gottfried says it will adjust. “From my own experience and feedback from my patients, it gets easier,” she says. According to Harvard, research has found that IF doesn’t increase overall appetite. Gottfried says the 16:8 diet (or some variation thereof) seems to be the easiest for most people to integrate into their lives without feeling too hungry.

10. What Side Effects Can I Expect on an Intermittent Fasting Diet?

For many people, transitioning to eating this way is not easy. Per the April 2019 Nutrients research, IF can lead to migraine, dizziness, nausea, and insomnia. It can also make people feel hungry and weak in general, limiting their activity throughout the day.

Some women might stop menstruating as a result of calorie restriction, according to the same Nutrients study. If you miss three periods in a row, it’s time to see a doctor, says the Mayo Clinic.

11. What Is the Best Way to Get Started on a Fasting Diet?  

In addition to considering your health goals, follow these steps before diving into IF:

  • Talk to your primary care doctor. He or she can determine if this eating style would be beneficial for your body. “If you have questions about what is right for you, it's important to talk to healthcare professionals,” Lowden says. “Everybody is an individual and your specific doctor might have preferences about what you do and don't do based on your specific circumstances.”
  • Choose the best type of IF for you. For instance, if you often socialize late at night, 5:2 likely will be a better fit than 16:8. If you decide to try 16:8, Gottfried says to ease into it. “I recommend starting slowly at first and ramping up, with a 12-hour fast and a 12-hour eating window, then move to a 14-hour fast with a 10-hour eating window, and from there to 16:8,” she says. She also says to keep in mind that there is flexibility with the eating and fasting window. “Some like to eat at 10 a.m. and stop at 6 p.m.; others prefer to wait until 12 p.m. and stop eating at 8 p.m.,” she says. “Find what works for you.”
  • Make sure you have water handy. The 2019 Nutrients study suggests drinking plenty of water during the day to reduce your risk of dehydration and to help replace fluids that you normally would source from foods.
  • Limit physical activity. It’s also a good idea to limit your activities during your fasting windows until you know how your body will react, Gottfried says.

RELATED: Intermittent Fasting Offers Benefits Beyond Weight Loss, Article Suggests

12. What Is the Best Way to Break a Fast and Begin Eating Again? 

Don’t take the end of your fast as an excuse to go wild with unhealthy foods — that’ll undermine the potential success of the diet. “The principles of healthful eating and breaking a fast are the same whether or not it's a normal overnight fast or time-restricted eating,” Lowden says. Focus on breaking your fast with a healthy, balanced meal filled with lean proteins, healthy carbohydrates, and healthy fats.

Pay particular attention to protein, especially if you have diabetes. “In order [for people with diabetes] to maintain normal sugar levels and avoid worsening insulin resistance, we always recommend eating a form of protein with every meal, particularly when you're breaking a fast,” Lowden says. Protein doesn’t break down into glucose as efficiently as carbs, so it has a slower, less immediate effect on blood sugar levels, according to Diabetes.co.uk.

Gottfried says having a healthy source of carbs when breaking your fast will help restore depleted glycogen levels. She recommends a Mediterranean-style meal with 40 percent carbohydrates, 30 percent protein, and 30 percent fat.

Lowden also says your timing when breaking the fast could make a difference as well. “There are studies that show people who eat their calories later in the day — even if it’s the same amount of calories — they weigh more than people who do that earlier in the day,” Lowden says. According to a study published April 2015 in Nutrients , sleep-restricted adults with late bedtimes are more susceptible to weight gain because the foods eaten at night tend to be higher in fat compared with those eaten earlier in the day. Take that into consideration when you’re determining your eating window.