Weekly Wellness Spotlight

Dear Julie,

In this week’s wellness spotlight, we would like to continue with the topic of intermittent fasting by highlighting one of our members who is a giant among us in nutritional medicine. Dr. Paul Chous has an Optometry practice in Tacoma, WA specializing in diabetes eye care and education. He is adjunct faculty at Western University of Health Sciences, past Vice President of OWNS, and serves as AOA liaison to the National Diabetes Education Program of the NIH. Dr.Chous lectures and writes frequently on topics related to diabetes and diabetic retinopathy.

Dr. Chous uses intermittent fasting frequently as an intervention for his patients in his practice. We asked him to provide us with a brief description of his experience using intermittent fasting clinically. His response is below:

I have been discussing alternate daily fasting with many of my patients presenting with “newly” diagnosed type 2 diabetes (< 5 years duration) and who are more than 40 lbs above their target body weight to achieve a non-obese BMI < 30 Kg/M2. Evidence suggests remission of T2DM is more likely within 5 years of Dx with bariatric surgery in severely obese patients, and ADF is both safer and less expensive than bariatric surgery.

I have presented the option to several hundred T2DM patients now and have had 8 of them agree to ADF for 3-6 months. Weight loss has ranged from 30-55 pounds, waist circumference reduction has ranged fro 4 to 7 inches, HbA1c reductions have ranged from 1.2% to 3%, and 7/7 patients on insulin therapy at baseline were able to discontinue it and maintain a glycosylated hemoglobin < 6.5 % with either metformin monotherapy or no anti-diabetes drugs whatsoever. I have had three of these patients break down and cry at follow-up and throw their arms around me in gratitude. A common refrain has been “why didn’t any other doctor even discuss this option with me?”

Although most obese patients presented with the option of ADF have shown little interest or adherence, a significant minority has.

Pearls:

1. Discuss ADF with good candidates; those with significant abdominal obesity, BMI > 35, short diabetes duration, high motivation to change; absent or well controlled cardiovascular disease

 2. Recommend a 1500-1800 calorie Mediterranean or Paleolithic type diet on ‘feeding days,’ and only water or unsweetened tea on fasting days

3. Let patients know that hunger is common the first week but largely dissipates by week two.
 
4. Write down the plan and give patients resources like books by Jason Fung, MD, a Canadian

5. Let patients know there is a light at the end of the tunnel – that ADF can be discontinued when BMI or waist circumference targets are met, with maintenance fasting 0-2 days per week and adoption of Mediterranean or Paleolithic, low refined carbohydrate diet for the long haul.

Thank you Dr. Chous for providing your valuable input. We gain strength as a society when we work together sharing our ideas and clinical pearls. If any of you have clinical pearls you would like to share, please reach out to us so that we can share your insights with other members. In closing, please see the article below that summarizes intermittent fasting.

https://www.medicalnewstoday.com/articles/319394.php

References: