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‘On-Demand’ Fast Mobilizes Fat; Low-Carb Breakfast Stymies Hunger

Greater fat tissue mobilization can be achieved through early-day fasting in comparison to consuming a low-carbohydrate breakfast or a Mediterranean-style breakfast, shows a small study that explored the short-term effects of intermittent fasting by lean people.

The study also found that consumption of a low-carbohydrate breakfast results in longer suppression of hunger compared to a Mediterranean breakfast.

Dimitrios Tsilingiris, MD, PhD, led the study and presented the findings recently at the virtual meeting of the European Association for the Study of Diabetes (EASD).

“Through fasting intervals as short as those achievable through a 16:8 restricted feeding scheme, a substantially and measurably increased fat tissue mobilization ― as indexed by increased ketone body production ― may occur,” said Tsilingiris, reporting the main finding.

He added that for most ketogenic diets, time is needed for the switch toward fat burning, but the findings from this study could provide support for an “on-demand” application of this strategy.

“The quite high subjective hunger scores at the end of the fasting sessions should also be taken into account, since the feeling of hunger may obviously drive the subsequent caloric quantity intake,” Tsilingiris, formerly of Laiko General Hospital, Athens, Greece, but now based at the University Hospital Heidelberg, in Germany, pointed out.

Anne-Marie Aas, PhD, clinical dietitian and associate professor at Oslo University Hospital, Oslo, Norway, was session moderator. She told Medscape Medical News that she welcomed the study because there is a lack of human studies of the clinical implications of different forms of intermittent fasting.

“The findings from this Greek study in healthy people is interesting but not surprising, since a prolonged fast would naturally prolong the time the metabolism yields energy from fat stores,” she said.

“The most interesting finding is perhaps that fasting resulted in increased hunger, while the low-carb breakfast suppressed appetite for longer than the typical Mediterranean breakfast.” she said.

“This is in line with an earlier study from the same group [as reported from EASD 2018] showing that morning-time carbohydrate restriction resulted in greater weight loss in obese individuals over a 2-month period,” she noted.

First Study of Short-term “On-Demand” Intermittent Fasting

Tsilingiris explained that evidence in the literature suggests that intermittent fasting is associated with numerous health benefits. The term refers to a relatively heterogeneous group of dietary habits that commonly include prolonged fasting intervals within a month (periodic fasting), a week (5:2, alternate day fasting), or a day (time-restricted feeding, 16:8).

In theory, intermittent fasting leads to loss of fat tissue through a metabolic milieu that promotes fat mobilization, he said.

“To our knowledge,” he said, “this hypothesis regarding the shortest-term application of intermittent fasting ―that is, the increasingly popular 16:8 ― has not been put to the test until now.”

He and his team investigated early-day fasting for adipose tissue mobilization, as indicated by β-hydroxybutyrate levels, and they compared this approach with two different kinds of breakfast.

“We compared the ketogenic response of [early-day] fasting to that following a zero-carb and a standard Mediterranean breakfast,” Tsilingiris

Military-Style Response at One Retirement Community Stymies COVID-19

Along with much of the country, Knollwood Life Plan Community in the District of Columbia went into lockdown in mid-March to try to protect residents and staff from the COVID-19 pandemic.

The retirement community includes sections for independent living, assisted living and skilled nursing. The leadership team stopped allowing visitors to the facility, which is typically home to 280 people – all of whom are retired military service members, former high-level federal government officials and family members. Residents range from those living independently to those needing a high level of care. They are served by 250 staffers, who all began wearing personal protective equipment, including masks, disposable gloves and full gowns, when the pandemic began.

The first weeks of lockdown seemed fine.

Everything changed six days before Easter, on April 6. That day, the District of Columbia Medical Examiner’s office called to notify community officials that a Knollwood hospice resident who had recently died, a woman in her 90s, had tested positive for COVID-19.

The deadly new virus had penetrated Knollwood.

Leaders quickly launched a military-style response to ramp up testing of residents and staff. “It was chaotic,” says Col. Paul Bricker, a retired Army helicopter pilot and Knollwood’s chief operating officer who commanded the effort. “It reminded me very much of being in Afghanistan in a firebase under attack. I almost started wearing camouflage to work.”

Bricker’s wartime aviation experience – he served in Afghanistan and Iraq – informed his efforts.

“When you fly into fog, you’re flying blind,” he says. “Testing provides a light through the (fog) to better understand what you’re dealing with.” As a helicopter pilot, Bricker could rely on his instruments when visibility was poor. Similarly, he knew that mounting a testing effort could illuminate who was infected by the virus, which would help Knollwood stop its spread by quarantining infected residents and staffers for two weeks – until they were no longer contagious, in accordance with guidance from the Centers for Disease Control and Prevention.

In early April, officials decided to launch an offensive against the virus start by testing everyone in the skilled nursing neighborhood, residents and staff.

Skilled nursing is the smallest of three neighborhoods at Knollwood, and is home to residents who are most vulnerable and require full-time care. This neighborhood includes a skilled memory care section, for people with conditions like Alzheimer’s disease. The majority of Knollwood residents live in independent living, and a smaller number in assisted living.

After the Medical Examiner’s notification, Bricker and his colleagues made a series of phone calls and obtained 150 COVID-19 tests. Then Bricker and his team met with CDC officials to discuss the plan to ramp up testing.

Soon after, with the help of CDC doctors who came to the community, Knollwood began testing residents and staff members. Testing began in the skilled nursing section, where the resident who had died with COVID-19 had lived. It’s also where Knollwood’s most vulnerable residents are; their average age