Two weekends ago, my 52-year-old overweight, diabetic patient called me up frantically early in the morning and told me that he could not sustain his intermittent fasting or IF because it was giving him palpitations and profuse sweating, especially in the wee hours of the morning. He was feeling these symptoms at the time he called me.

He started doing IF after reading our column recommending it (“Skeptic tries intermittent fasting,” 11/03/20). He immediately went on a 16-hour fast and still continued the medicines he was taking for diabetes and high blood pressure at the same doses.

I asked him to check his blood pressure (BP), heart rate and blood sugar. The BP was well within normal limits. The pulse rate was fast at 110 per minute, and his blood sugar was quite low at 68 mg/dL. He was having hypoglycemia or low blood sugar, and his symptoms were related to it.

After drinking a glass of orange juice, he felt so much better and his blood sugar levels during the day were already within normal range. Of course, I asked him to stop his IF momentarily and adjusted the dose of his antidiabetic meds.

So for those with health issues like high BP, diabetes and heart disease, and those who are taking medicines for these health problems, they should get instructions from their physicians first on the dose adjustment of their maintenance medications, before starting IF.

For my patient, we tried IF again after several days, cutting his meds by almost half and monitoring his blood sugar regularly for the first several days. There are no more symptoms of hypoglycemia so far, and he says he’s getting adjusted to his new diet.

Dose adjustment

So the presence of diabetes or high BP is not a contraindication to IF. In fact, IF can help control the BP and blood sugar with fewer meds. Monitoring of blood sugar and BP is advised for a week or two after starting IF to determine the optimal adjusted dose. The dose adjustment needs to be individualized and tailor-fit for each patient.

IF alleviates the insulin resistance which is usually seen in diabetic patients. With IF, the body’s cells become more sensitive to insulin, allowing more efficient transport and use of the sugar in the bloodstream to the body cells. This, together with the blood sugar-lowering effect of fasting, helps control the blood sugar, and prevents the so-called yo-yo effect in diabetes, wherein the blood sugar spikes up then dives at other times.

However, the magnitude of this effect may differ from one person to another. Men and women also appear to respond differently. So it’s difficult to set guidelines on how much reduction in the dose of maintenance medicines we should prescribe. We just have to individualize the dose adjustments based on the monitoring of the BP and blood sugar.

My patient was told by his friend that because the brain cells are starved during the fasting state, IF might cause rapid deterioration of brain function and predispose one to developing Alzheimer’s disease or AD. Nothing is further from the truth.

Actually, IF can stave off the development of AD and other forms of dementia. Sugar is not really a very effective source of energy, but in a regularly fed state, it is the most convenient source, so all the cells of the body including the brain cells use sugar to generate energy. The shift of metabolism from sugar to fats can benefit the brain and other organs significantly.

IF also reduces oxidative stress, which is a very damaging process that can happen in the brain and other vital organs, including the heart, lungs, liver and kidneys. Furthermore, IF increases levels of a brain hormone called brain-derived neurotrophic factor, which is another probable reason for the enhancement in brain function with IF.

Metabolism shift

When we fast, as in IF, the body shifts its metabolism or manner of generating energy from sugar to fats, which is the more efficient source of energy. This mobilizes our fats instead of storing them in the fat depots. So our weight goes down and our areas where fat is stored, like the belly or midsection part, get trimmed down. In effect, we become leaner and develop a more toned body, rather than a fat-embellished one with hanging tissue accessories all over.

A beneficial effect on the arteries of the body and the organs they serve has been shown extensively in experimental animals, and there’s good reason to believe the same benefits can be expected in humans.

We may not realize it, but there’s a slow-burning inflammation insidiously taking place in the human body. This inflammation causes the arterial lining, called endothelium, to swell, leading to the progressive narrowing of these arteries.

When these arteries become significantly occluded, the blood supply to the vital organs is impaired, causing ischemia, and it can get progressively worse, leading to death of the tissues, called infarction.

When this happens in the heart, it’s called myocardial infarction, and when it happens in the brain, it’s called a cerebrovascular accident, or simply, a stroke.

So, again, researchers have shown in experimental animals that IF can help reduce this risk of inflammation and may help reduce the risk of complications like heart attack and stroke.

The reduction in inflammation can also affect favorably the immune system. And with this comes the possible reduction in other chronic or longstanding conditions like cancer and rheumatoid arthritis.

IF takes some getting used to, especially at the start. What is important is that one does not throw in the towel at the first experience of symptoms believed to be related to or caused by IF.

Just like in my patient, the symptoms or experienced side effects of IF can just be at the start, and could be easily managed with some adjustments in the duration of IF or the doses of the medicines one is taking.

Persist, persevere and reap the benefits of IF.