Two recent papers, building on small but interesting areas of focus for health management are featured in this article. Stretching and balance as indicators of life expectancy and dry fasting as a method of metabolic health and weight management.
Dry fasting, which involves abstaining from both food and water, has gained popularity on platforms like TikTok and YouTube. Proponents claim various health benefits, but at this stage in the understanding of its effects, it is wise to advise caution, particularly for individuals with diabetes, to avoid potential harm.
The alleged benefits and risks of dry fasting depend on the duration and the individual following the practice. Advocates on social media assert that dry fasting can enhance intuition and boost autophagy, but there is little scientific evidence to support these claims. Some medical professionals have warned of serious risks, including dehydration, kidney stones, and the possibility of overeating after fasting, which can undermine weight loss efforts.
For people with type 2 diabetes, the risks are even more pronounced. Dehydration can worsen hyperglycaemia and increase the risk of complications like diabetic ketoacidosis (DKA). Additionally, electrolyte imbalances and nutrient deficiencies can occur, further complicating diabetes management.
The concept of dry fasting is often misunderstood, with varying definitions and interpretations. According to the first international consensus on fasting terminology, dry fasting is defined as the voluntary abstinence from all foods and beverages, including water, for a certain period. This is distinct from other forms of fasting, such as water-only fasting[1].
The Evidence
Evidence from small studies suggests that dry fasting might have short-term benefits, such as reducing inflammation[2]. However, these findings are not yet supported by larger, long-term studies. For example, a small study at Baylor College of Medicine found that 30 days of dawn-to-dusk dry fasting reduced inflammatory cytokines in participants with high body mass index[3]. Another study observed that dry fasting during Ramadan led to varying changes in fasting blood glucose levels among individuals with type 2 diabetes[4].
Despite some positive findings, the overall health effects of dry fasting remain unclear and vary among individuals. A study on healthy volunteers in Germany suggested that a 19-day dry fasting regimen was safe and had no negative effects on hydration, but these results need further validation[5].
Alternative approaches
For patients considering fasting for weight loss or diabetes management, experts recommend alternative approaches that are safer and more sustainable. Intermittent fasting methods that allow fluid intake, such as the 16:8 or 5:2 methods, can improve insulin sensitivity and metabolic health[6]. Other strategies include caloric restriction with a balanced diet, low-carbohydrate diets, and the Mediterranean diet, which emphasises whole foods and healthy fats.
Mindful eating, which focuses on being present during meals and paying attention to hunger cues, can also be beneficial. Mindful eating is associated with reduced BMI and weight loss. Combining mindful eating with moderate energy restriction may enhance weight loss. Mindful eating improves eating attitudes, reduces emotional and uncontrolled eating, and decreases food cravings[7].
Mindful Eating
Mindful eating is an intentional approach to consuming food that involves paying attention to the physical and emotional sensations experienced during eating. It emphasises developing awareness of one’s hunger and fullness cues, savouring each bite, and recognising the sensory properties of food.
According to Dr. Jan Chozen Bays, a pioneer in the field of mindful eating, “mindful eating is the practice of paying attention to our experiences, moment by moment, without judgment” [Mindful Eating: A Guide to Rediscovering a Healthy and Joyful Relationship with Food” by Jan Chozen Bays].
This definition highlights two key components of mindful eating: intentionality and non-judgmental acceptance.
Intentionality refers to the deliberate decision to focus on the experience of eating, rather than engaging in automatic or distracted behaviour. Non-judgmental acceptance means acknowledging and accepting one’s emotions, thoughts, and bodily sensations without evaluating or criticising oneself.
Some common characteristics of mindful eating include:
- Paying attention: Focusing on the taste, texture, smell, colour, and temperature of food.
- Savouring: Enjoying each bite slowly and thoroughly.
- Recognising hunger and fullness cues: Noticing when you feel hungry or satisfied, rather than relying on external signals such as meal times or portion sizes.
- Eating slowly: Taking time to chew and swallow each mouthful before taking another bite.
- Avoid distractions: Eating away from screens, conversations, or other activities that might divert attention from the eating process.
- Noticing emotions: Recognising how emotions influence food choices and eating behaviours.
- Practicing self-compassion: Treating yourself kindly and understandingly, especially when faced with challenging emotions or situations around food.
More research is needed to fully understand the relationship between mindful eating and weight loss.
Clinicians are encouraged to help patients find a weight-loss plan that suits their preferences and lifestyle, emphasising the importance of hydration and balanced nutrition. While dry fasting may appeal to some, experts generally recommend fasting regimens that include fluids to minimise risks and support overall health.
Living Longer – Healthier
Whilst lifestyle, food and environment are recognised factors in aging associated health determination, the findings, published in the Scandinavian Journal of Medicine & Science in Sports, in August 2024 analysed data from 2087 men and 1052 women who underwent medical-functional evaluations at CLINIMEX an Exercise Medicine Clinic in Rio de Janeiro. Each participant received a body flexibility score, known as the Flexindex (watch to learn more and calculate your own score), which was determined by assessing the range of motion in 20 movements across seven joints. Scores ranged from 0 to 80.
Among the 3139 participants, 302 deaths (9.6%) occurred over an average follow-up period of 12.9 years, with cardiovascular disease being the leading cause of death in men and cancer in women.
The likelihood of death over nearly 13 years of follow-up was around 1% for men with Flexindex scores above 49 and women with scores above 56. However, for those in the lowest 10% of Flexindex scores, the death rates were significantly higher, at 26.9% for men and 18.2% for women. Men with the poorest flexibility were nearly twice as likely to die over the follow-up period than men with high flexibility. Women with the poorest flexibility were almost five times more likely to die than those with high flexibility.
The lead author Claudio Gil Araújo, MD, PhD has published two previous studies on flexibility. The first showed that the ability to rise from a sitting position on the floor is a strong predictor of longevity[8], and the second demonstrated that the inability to stand on one leg for at least 10 seconds is linked to an increased risk for death over 7 years[9]. After accounting for age and many other risk factors, such as diabetes, body mass index, and a history of heart disease, people who were unable to complete the standing test were 84% more likely to die from any cause over the study period than their peers with better one-legged static balance (95% CI: 1.23 – 2.78; P < .001).
Whilst there are certain limitations to the various data sources, it is clear that being more flexible, maintaining leg strength and balance, might actually improve long-term survival or outcomes. Regardless of its impact on survival, flexibility enhances quality of life, improves balance, and reduces the risk of falls. These benefits make flexibility deserving of greater recognition and appreciation from both the public and clinicians.
References
[1] Koppold DA, Breinlinger C, Hanslian E, Kessler C, Cramer H, Khokhar AR, Peterson CM, Tinsley G, Vernieri C, Bloomer RJ, Boschmann M, Bragazzi NL, Brandhorst S, Gabel K, Goldhamer AC, Grajower MM, Harvie M, Heilbronn L, Horne BD, Karras SN, Langhorst J, Lischka E, Madeo F, Mitchell SJ, Papagiannopoulos-Vatopaidinos IE, Papagiannopoulou M, Pijl H, Ravussin E, Ritzmann-Widderich M, Varady K, Adamidou L, Chihaoui M, de Cabo R, Hassanein M, Lessan N, Longo V, Manoogian ENC, Mattson MP, Muhlestein JB, Panda S, Papadopoulou SK, Rodopaios NE, Stange R, Michalsen A. International consensus on fasting terminology. Cell Metab. 2024 Aug 6;36(8):1779-1794.e4
[2] A. Mähler, C. Jahn, Lars Klug, Caroline Klatte, A. Michalsen, D. Koppold-Liebscher and M. Boschmann. “Metabolic Response to Daytime Dry Fasting in Bahá’í Volunteers—Results of a Preliminary Study.” Nutrients, 14 (2021).
[3] Al Lami Z, Kurtca M, Atique MU, Opekun AR, Siam MS, Jalal PK, Najafi B, Devaraj S, Mindikoglu AL. Dawn-to-dusk dry fasting decreases circulating inflammatory cytokines in subjects with increased body mass index. Metabol Open. 2024 Feb 7;21:100274.
[4] Jarrar Y, Abdul-Wahab G, Mosleh R, Abudahab S, Jarrar Q, Hamdan A, Qadous SG, Balasmeh R, Abed AF, Ibrahim Y, Al-Doaiss AA, AlShehri MA. Does Ramadan Intermittent Fasting Affect the Fasting Blood Glucose Level among Type II Diabetic Patients? J Clin Med. 2023 Oct 18;12(20):6604.
[5] Koppold-Liebscher DA, Klatte C, Demmrich S, Schwarz J, Kandil FI, Steckhan N, Ring R, Kessler CS, Jeitler M, Koller B, Ananthasubramaniam B, Eisenmann C, Mähler A, Boschmann M, Kramer A, Michalsen A. Effects of Daytime Dry Fasting on Hydration, Glucose Metabolism and Circadian Phase: A Prospective Exploratory Cohort Study in Bahá’í Volunteers. Front Nutr. 2021 Jul 29;8:662310.
[6] Obermayer A, Tripolt NJ, Pferschy PN, Kojzar H, Aziz F, Müller A, Schauer M, Oulhaj A, Aberer F, Sourij C, Habisch H, Madl T, Pieber T, Obermayer-Pietsch B, Stadlbauer V, Sourij H. Efficacy and Safety of Intermittent Fasting in People With Insulin-Treated Type 2 Diabetes (INTERFAST-2)-A Randomized Controlled Trial. Diabetes Care. 2023 Feb 1;46(2):463-468.
[7] Pepe RB, Coelho GSMA, Miguel FDS, Gualassi AC, Sarvas MM, Cercato C, Mancini MC, de Melo ME. Mindful eating for weight loss in women with obesity: a randomised controlled trial. Br J Nutr. 2023 Sep 14;130(5):911-920. doi: 10.1017/S0007114522003932. Epub 2022 Dec 19. PMID: 36529854.
[8] Brito LB, Ricardo DR, Araújo DS, Ramos PS, Myers J, Araújo CG. Ability to sit and rise from the floor as a predictor of all-cause mortality. Eur J Prev Cardiol. 2014 Jul;21(7):892-8.
[9] Araujo CG, de Souza E Silva CG, Laukkanen JA, Fiatarone Singh M, Kunutsor SK, Myers J, Franca JF, Castro CL. Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals. Br J Sports Med. 2022 Sep;56(17):975-980.