Type 2 diabetes mellitus: individualizing the dietary plan: When to choose a ketogenic diet versus intermittent fasting?

Abstract

The intermittent fasting (IF) eating pattern arises from ancient traditions, practiced by different communities for cultural or religious reasons. Hippocrates wrote: “Eating when you are sick is to feed your illness” and Plutarch suggests: “Instead of using medicines, it is better to fast today.” AI differs from calorie restriction (RC) and although in the short term it was shown to improve different cardiovascular risk factors, maintaining it for prolonged periods is difficult and causes weight gain.

Intermittent fasting (IF) eating pattern is becoming more accepted. It arises from very ancient traditions and has been practiced by different communities, whether for cultural or religious reasons. Hippocrates once wrote: “Eating when you are sick is to feed your illness.” The ancient Greeks believed that fasting improves cognitive abilities and even Plutarch suggests: “Instead of using medicines, it is better to fast today.”

IF differs from calorie restriction (CR) in which caloric intake is decreased without generating risk of malnutrition. Although short-term calorie restriction has been shown to improve different cardiovascular risk factors, most people have difficulty maintaining it for long periods and gain weight. IF consists of a pattern of time periods from 12 hours to several days with little or no calorie consumption. There are different types of IF with fasting hours or days and the rest of the hours or days with isocaloric or hypocaloric intake. This therapeutic proposal must be agreed upon with the patient and is considered to imitate human eating patterns of intake and intermittency. The literature shows data supporting the benefits regarding weight loss and cardiometabolic health as time-restricted feeding resulted in a decrease in energy intake and body weight, as well as body fat mass, blood pressure as well as glycemia, triglycerides, glucose tolerance and inflammatory markers.

IF is indicated in people living with type 2 diabetes, it improves insulin sensitivity and glucose homeostasis by reducing adiposity and insulin resistance, reducing caloric intake and therefore insulin production, increases AMPK levels and metabolic reprogramming in relation to the circadian system that intervenes in the regulation of energy homeostasis in the context of day/night cycles and in turn directs genetically encoded molecular clocks, brain and other organs, developed in evolution and whose function is to align the metabolism with the time of day.