It can be an enormous struggle to take and keep weight off. Now, more than a month into 2020, many of us have been frustrated that our New Year’s resolutions have eluded us.  Like that song in your head that you just can’t get rid of, we are reminded of those few extra holiday pounds each time we look into the mirror.

“Intermittent fasting” has become a popular trend; it’s all over social media. There are several different approaches to intermittent fasting and they can be very powerful and effective, not just in terms of weight control, but for overall healthy aging and disease prevention. Many people lose considerable weight with intermittent fasts, but for others, an additional approach may be required. In my practice, I have found that adding selected peptide therapies to an intermittent fasting program can really make a difference and lead to substantial weight loss.

The benefits of fasting extend beyond the obvious notion that if you aren’t taking in calories, then you will lose weight. Of course, it is true that those who participate in fasts will consume fewer calories, but fasting also results in powerful physiologic changes in the body that not only lead to burning stored fat but that turn on genes that regulate metabolism, improve insulin sensitivity and metabolic efficiency and promote cellular housekeeping. The normal process of metabolism within our cells results in waste products that need to be discarded or recycled by the body. This cellular cleansing is associated with health and longevity. Fasting turns on the genes that regulate these cellular mechanisms.  With constant eating, these restorative mechanisms are reduced. Our primitive ancestors lived in times when food was at times scarce. We evolved with genetic tools to survive lean times. This is similar to hibernating mammals, who store fat during the summer so that they can use the stored energy and regenerate through the winter months.

Let’s discuss various fasting programs and why this approach is so popular. “Intermittent fasting” really means that there is a substantial period of time at least 24 hours or more-in which one takes in zero (or nearly) calories. One example is the “5-2” program, in which one eats ad libidum (meaning whatever you want) for 5 days per week and selects 2 days, usually not consecutive, for a 36 hour fast. For example, after dinner Sunday night, no eating again until breakfast on Tuesday and then repeat that from Thursday dinner until Saturday’s breakfast.

A more ambitious fasting schedule is 3 or even 5 days of consecutive fasting, performed once or twice monthly.

During the fasts, one consumes water, tea or coffee ( without sugar) to ensure hydration. Many recommend the consumption of limited quantities  of bone broth or consume soup, allowing for a very small amount of calories.

The “Fasting mimicking diet” is a 5 day limited fast, developed by Dr. Valter Longo1, in which some intake of specialized foods is permitted in order to make an extended fast more tolerable. Despite the intake of some calories, the body is “tricked” into thinking that there is an ongoing fast, which allows for the metabolic changes we seek. This program is repeated periodically, either monthly, quarterly, or less often, depending upon the goals.

Arguably, the most practical and sustainable approach is the “time-restricted” eating program, in which each day, food is only consumed during a limited portion-time. Usually, a 16/8 schedule is planned, in which calories are only taken in within an eight-hour period each day. For example, food is only consumed between noon and 8 pm. That means no snacking after dinner and breakfast is skipped. It does not matter which 8-hour period is selected. Some people, for example, prefer to eat early in the day, enjoy breakfast and lunch and choose to skip the dinner meal. So, they may be eating between 8am – 4pm. Many people ease into this program by starting with a 14/10 schedule and gradually shortening the feeding window.

Time-restricted eating programs are not really intermittent fasts, since in order for the body to shift into “fasting metabolism”, one really needs to do without caloric intake for 36 hours or more. But the time-restricted eating program remains quite effective, probably as a result of reduced total caloric intake and the avoidance of late-night eating and may, to a lesser extent encourage additional desired metabolic changes.

Note that these eating schedules focus much less on the types of foods one should eat and instead emphasize feeding times. This is one reason that fasting programs are so popular. When it is eating time, you can enjoy your foods and do not have to worry as much about dietary restrictions. That said, proper nutrition is still essential. Eat whole foods, avoid added sugars and processed foods, and limit refined carbohydrates. That means limit your sweets and no “junk” food. And try not to eat too much during the feeding period! But if you prefer a Paleo approach, are a vegetarian or vegan, or if you follow a low fat, whole grain diet, it doesn’t matter much. Any of these approaches work well with intermittent fasting programs.

Where Do Peptides Come In?

Intermittent fasting is not easy, and some people simply cannot participate in prolonged fasts. Most people can find a way to eat on a time-restricted schedule, even if it is a 14/10 program. And despite the benefits, some people don’t lose as much weight as they seek with intermittent fasting alone. It is also important to try to lose fat, not muscle, which is often challenging, especially with calorie restriction. That is where peptides come in. (To learn more about peptides, in general, check on my blog HERE).

There are several peptides that can be a great addition to an intermittent fasting program.

Growth hormone stimulating peptides, such as Ipamorelin, CJC1295, Sermorelin, and Tesamorelin are excellent options. As we age, our growth hormone(GH) levels naturally diminish. This leads to a loss of muscle mass, increase in fat deposition, loss of bone density, skin and hair integrity and other changes associated with aging. GH is made in our pituitary gland. While taking hGH is unsafe and discouraged, peptides that stimulate pituitary GH production are safe and effective alternatives. These peptides are analogues of naturally occurring peptide hormones that are involved in the pituitary production of GH.

By themselves, GH stimulating peptides lead to improvements in body composition, with a loss of fat and an increase in muscle mass, but overall weight loss is limited. But when combined with an intermittent fasting program, they can really enhance the success and help to maintain muscle mass and strength.

Liraglutide (trade name Victoza) is a peptide that has been used as a diabetes drug since 2010. Along with several other similar diabetes drugs (Trulicity, Ozempic, Bydureon, Byetta) these peptide products act as “incretin analogues” which are intestinal hormones that regulate carbohydrate metabolism, appetite, metabolism, and intestinal function. These medications not only treat Type 2 diabetes but were known to result in significant weight loss in treated patients. Later, liraglutide was demonstrated as an effective agent for weight loss in non-diabetic patients and was approved as Saxenda in 2014.   Liraglutide is taken as a daily injection and is a great addition to intermittent fasting (or for that matter, any weight loss dietary regimen). It does not cause hypoglycemia but reduces appetite and promotes early satiety (feeling of fullness, thus reducing overeating). Published studies in non-diabetics demonstrated that patients on liraglutide lost an average of 8% body weight.

If you would like to learn more about intermittent fasting programs or are interested in discussing these or other peptide therapy options, give us a call for an appointment. We’d love to see you!

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