- Maintaining a healthy weight is key to helping people with diabetes manage their blood sugar.
- New research indicates that time-restricted eating is more effective for weight loss than counting calories.
- Simplicity and effects on hormones are two reasons why fasting can promote weight loss.
- However, people with diabetes should be aware of time-restricted eating, especially if they are on medication.
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New study results, shared this week on NUTRITION 2023, the flagship meeting of the American Society for Nutrition, indicate that traditional calorie restriction is not the most effective way for people with type 2 diabetes to shed extra pounds.
Instead, they suggest that time-restricted eating, also known as intermittent fasting — consuming food only within an eight-hour window — is a more beneficial approach for those looking to lose weight.
While the study is currently undergoing peer review and awaiting publication in a journal, the results highlight new opportunities for people with type 2 diabetes looking to reduce weight and improve blood sugar levels.
Studies have already explored the effectiveness of different dieting approaches in obese people. However, none have studied the potential impact of time-restricted eating in people with obesity and type 2 diabetes.
The new research, led by Vicky Pavlou, RDN, doctoral student at the University University of Illinois at Chicagoinvolved 75 obese adults with obesity, who had type 2 diabetes. Participants between the ages of 18 and 80 were divided into three groups: control, calorie restriction or time-restricted diet.
Those in the control group continued to eat as usual, and those who began calorie restriction reduced their maintenance calorie intake (the amount needed to maintain their current weight) by 25%. They could eat at any time of the day.
Meanwhile, the time-restricted eating group was not given an assigned calorie goal and did not track their calorie intake – but could only eat between noon and 8 p.m. each day.
For help, participants in both groups met with a dietitian once a week for the first three months of the study and every two weeks for the remaining three months.
“The dietitian helped them through all the diet challenges and gave them general nutritional advice,” Pavlou told Healthline — including “the importance of reading labels and understanding calories.”
The participants followed the diets for six months. After this time, the calorie restriction group experienced no weight loss compared to the control group. On the other hand, compared to the control group, the time-restricted feeding group lost an average of 3.55% body weight.
“I was surprised that the [calorie restriction] group didn’t lose more weight,” Pavlou said. “In most studies, the [time-restricted eating] and calorie restriction groups lose the same amount of weight.
Additionally, the time-restricted eating and calorie-restriction groups demonstrated a decrease in mean blood sugar as measured by HbA1c compared to those in the control group.
The findings are important, Pavlou said, because they offer another potential weight loss strategy for people with type 2 diabetes.
“Some people have trouble counting calories,” she said. “Others don’t have weekly or monthly support and need a simple diet to follow, like watching the clock.”
There are several reasons why intermittent fasting or time-restricted eating may have been more effective in encouraging weight loss.
After analyzing the data, it was noted that “the [time-restricted eating] group was more faithful to its diet than the [calorie restriction] group,” Pavlou explained.
But why could that have been? “Most participants in the [time-restricted eating] group reported that the diet was easy to follow,” she said. Meanwhile, “at least half of the participants in the [calorie restriction] group reported that the diet was difficult to follow.
Another main factor is the difference in calorie reduction between the two groups. Even though the researchers told the time-restricted eating group not to reduce or track their calorie intake, they “reduced their intake by 313 kcal per day,” Pavlou revealed.
Yet despite actively working to reduce calories, the calorie restriction group only saw their average intake drop by an average of 197 kcal per day.
“THE [time-restricted eating] The group only had 8 hours to eat their calories, so they naturally reduced their intake (no breakfast or post-dinner snacks/drinks),” Pavlou said. “I thought the [calorie restriction] group would do better, but I don’t think they followed very precisely or consistently enough.
Kelsey CostaMS, a registered dietitian and health research specialist at the National Coalition on Healthcare (NCHC), who was not involved in the study, agreed that tracking calories can be difficult for some.
“Traditional methods of counting calories and tracking food intake can be time-consuming,” she shared with Healthline.
“Even with the help of calorie-tracking apps, meticulously planning and monitoring daily meals can feel overwhelming, especially for people with busy lives.”
Time-restricted eating is a type of intermittent fasting in which meals are eaten in a shorter amount of time, usually between 4 and 12 hours.
By creating alternating phases of eating and fasting, “the underlying idea is that this pattern can positively affect nutrient metabolism, hormone regulation and physiological processes, thereby improving cardiometabolic health,” Costa said.
During periods of “fasting”, your body depends on its fat stores for energy. “This metabolic process promotes weight loss by using internal resources,” Costa told Healthline.
But time-restricted meals are thought to encourage weight loss in other ways as well, such as reducing snacking opportunities.
This approach to fasting “may also help regulate hormones associated with hunger and satiety, leading to decreased calorie intake,” Costa said.
Additionally, she added, “research suggests that time-restricted eating may help improve insulin sensitivity and reduce inflammation, which may improve glycemic control and weight loss.”
While intermittent fasting or time-restricted eating is thought to have benefits, there are also risks and side effects to be aware of, especially for people with diabetes.
For starters, “incorrect implementation or lack of guidance can lead to nutrient deficiencies, electrolyte imbalances, and dehydration,” Costa explained.
Another key consideration is the impact of time-restricted eating on medications taken to help control diabetes.
“Some diabetes medications require food to be absorbed and will not be absorbed if fasting,” said Doctor. Pouya Shafipourboard-certified physician in family medicine and obesity at Providence Saint John’s Health Center.
Additionally, “some diabetes medications lower blood sugar rapidly,” Shafipour told Healthline. “Fasting will put a person at risk of hypoglycemia, which can be life threatening.”
If a diabetic patient begins to undertake a time-restricted diet, it is recommended that they work with a doctor to closely monitor their blood sugar levels, said Dr. Revital Gorodeski BaskinAssistant Professor of Medicine at Case Western Reserve University and Director of the Obesity Program at the Diabetes and Metabolic Center, University Hospitals.
She explained that the medications can then be quickly adjusted (if necessary) to counter any hypoglycemic effects.
It’s also crucial to note that committing to a time-restricted diet doesn’t mean you can eat all the treats and chips you might like.
“The quality of food choices is important when it comes to [time-restricted eating,]said Costa. “Eating unhealthy processed foods and high calorie snacks will likely counteract the weight loss benefits associated with this dietary approach.”
When adopting a new diet tactic, it is essential to consult your doctor before doing so.
Costa shared that many factors can complicate weight loss for people with type 2 diabetes, such as the body’s insulin response, mental health issues often associated with diabetes (such as depression), and medications.
Still, maintaining a modest weight is crucial for people with this metabolic disorder because it helps manage blood sugar levels and reduces the risk of health-related complications.
The good news is that you don’t have to drop multiple dress sizes to reap the health benefits.
“With even small percentages of weight loss, insulin resistance improves, as does diabetes,” Gorodeski Baskin said.
The new study supports the role of time-restricted eating or intermittent fasting in weight loss – although Gorodeski Baskin believes calorie restriction still has a role to play.
“I recommend a [calorie restriction] to most patients, and often encourage [time-restricted eating] too,” she said. “I think the combination of the two measures helps improve diabetes.”
What you eat is as important as how much you eat.
“Consuming a significantly lower amount of simple starches, sugar and preservatives” can aid weight loss in diabetics, Shafipour said.
Instead, he continued, try following a “low-carb Mediterranean diet high in vegetable fats, legumes, fiber, colorful vegetables, whole seasonal fruits and fish.”
But watching food intake (or the clock) isn’t the only approach that can help with weight loss.
Gorodeski Baskin noted that “strength training helps increase metabolic rate, and therefore often aids in weight loss.”
Additionally, not eating three hours before bed, exercising daily and optimizing sleep are all ways to encourage weight loss and improve diabetes, Shafipour said.
New study findings indicate that traditional calorie restriction is not the most effective way for people with type 2 diabetes to shed excess pounds. Instead, experts suggest that time-restricted eating, also known as intermittent fasting — consuming food only within an eight-hour window — is a more beneficial approach for those looking to lose weight.