Intermittent fasting is an Interventional strategy where in individuals are subjected to varying periods of fasting. It doesn’t specify which foods you should eat but rather when you should eat them. Intermittent fasting (IF) is an eating pattern that cycles between periods of fasting and eating. It’s currently very popular in the health and fitness community. Recently attracted attention because: 1- Its Evidence-Based Health Benefits 2- Its potential for correcting metabolic Abnormalities 3- Better adherence than other methods

1. Intermittent
Fasting
Dr. Fathi Neana, MD
Chief of Orthopaedics
Dr. Fakhry & Dr. A. Al-Garzaie Hospital
January, 02 - 2019

3. Cut of this metabolic switch:
1- Mitochondrial Biogenesis
2- Hyperbaric oxygen
3- Cut the Sugar off

4. 1- Diet: High fat – adequate protein – cut off the sugar
(ketone bodies unlike sugar are non fermentable fuel – Low protein inhibit
mTOR)
A- Ketogenic diet (KD) - Mitochondrial Metabolic Therapy (MMT) – low carb
High fat Diet Regime (LCHF)
B- Intermittent fasting
Fat burner less ROS (like KD) – low calorie intake - Autophagy
C- Avoid stress – sugar – obesity
Hypothalamus – sugar burning mode
2- Exercise and physical activity
Regular – endurance - PGC 1-alpha – ROS fission – mTOR like protein
3- Feeding Your Mitochondria
CoQ10 or ubiquinol (the reduced form) - L-Carnitine, which shuttles fatty acids to the mitochondria
- D-ribose, which is raw material for ATP molecule – Magnesium - Omega-3 fatty acids - All B
vitamins, including riboflavin, thiamine, and B6 - Alpha-lipoic acid (ALA) – Thiotacid.
Get as many micronutrients as you can from whole foods
4- Avoid Environmental Toxins
Oxidative stress
Mitochondrial Biogenesis

5. Autophagy
The housekeeper
in every cell
Dr. Fathi Neana, MD
Chief of Orthopaedics
Dr. Fakhry & Dr. A. Al-Garzaie Hospital
December, 27 - 2018

6. Major health benefits of Autophagy
Defective
Damaged cell parts
Intracellular
pathogens
Misfolded proteins
Amyloid deposits (toxic)
Alzheimer
Parkisonian
Diabetic angiopathy
Cataract
Mitochondrial damage
(Oxidant stress)
(Hyper insulinemia)
Stimulate
Inhibit
Autophagy
(Lysosome
Recycler)
Fasting
Intermittent fasting
Low caloric diet
AMPK
mTOR
High caloric diet
High protein diet
AMPK
mTOR
Neuro protective
Cardio protective
Immune system
Anti aging
The main regulator of autophagy is:
1- The mammalian target of rapamycin
(mTOR) kinase.
When mTOR goes up, it shuts down
autophagy.
mTOR is exquisitely sensitive to dietary
amino acids (protein).
2- The other main regulator is 5' AMP-
activated protein kinase (AMPK). This is
a sensor of intracellular energy
(adenosine triphosphate or ATP).
Free fatty acids
Amino acids
Cell remodeling
+
Fuel

7. Practical interventions to promote
autophagy
Fasting activates Autophagy
caloric restriction affects 5 molecular pathways
that activate autophagy
Sunlight, Vitamin D and Klotho activate
Autophagy – there are three ways through which
UV light, Vitamin D, and the Klotho pathway
activate autophagy via inhibiting the
insulin/IGF-1 pathway
Rapamycin activates Autophagy – there are two
ways through which mTOR inhibitors activate
autophagy – TORC1 and TORC2 mechanisms
Caffeine activates Autophagy – Caffeine can
activate autophagy via an mTOR-dependent
mechanism
Green tea activates Autophagy – ECGC can
activate autophagy via an mTOR-dependent
mechanism
Metformin activates Autophagy – metformin
can activate autophagy via AMPK activation –
mTOR-dependent and mTOR-independent
mechanisms
Lithium activates Autophagy – lithium and other
compounds can activate autophagy by inhibiting
inositol monophosphate and lower IP3 levels – an
mTOR-independent mechanism –
(grains, vegetables, mustard,
kelp, pistachios, dairy, fish, and meat.)
Resveratrol activates Autophagy – there are four 4
ways through which Resveratrol can activate
autophagy – via mTOR-dependent and mTOR-
independent mechanisms –
(peanuts, pistachios, grapes, blueberries, cranberries,
and even cocoa and dark chocolate.)
Spermidine activates Autophagy – how Spermidine
activates autophagy via histone protein
deacetylation – mTOR-independent mechanism –
(dry soy bean, chicken liver, green peas, corn, shell fish,
blue cheese, most of the meat products (like sausages,
chicken, and turkey), some vegetables (like pumpkin))
Hypoxia activates Autophagy – intermittent hypoxia
can increase autophagy via HIF-1a (anaerobics)
Phytosubstances which activate the Nrf2
pathway can activate Autophagy. These are many
and include soy products and hot chili peppers.

9. Co-occurrence of several known
cardiovascular risk factors
Type 2 Diabetes
Central Obesity
Atherogenic dyslipidemia
Hypertension
These conditions are interrelated
and share underlying mediators,
mechanisms and pathways
The metabolic syndrome
Insulin Resistance syndrome
Syndrome X - Deadly quartet - Reaven’s syndrome

10. Definition according to The
International Diabetes Federation
1- Abdominal obesity
Plus two other components
2- Elevated BP
2- Low HDL
3- Elevated TG
4- Impaired fasting glucose (Diabesity)
The metabolic syndrome
Insulin Resistance syndrome
Syndrome X - Deadly quartet - Reaven’s syndrome

11. Sedentary Lifestyle
Caloric overload, High Carb-Sugar, Inactivity, Stress, Sleep, Obesity, Drugs, etc
5- 83% Type 2 diabetes
Insulin, Not Cholesterol, Is the True Culprit in Heart Disease
February 18, 2017 | 6,928 views - Dr. Joseph Mercola
Reaven GM. Physiol Rev. 1995;75:473-486
Clauser, et al. Horm Res. 1992;38:5-12.
10- polycystic Ovary
Syndrome
(PCOS)
Insulin Resistance syndrome
Hyper insulinemia - Insulin toxicity
1- Direct damage blood vessels
Intima –neoangiogenesis –plaque -
3- High blood pressure
Mg loss in urine –> spasm of blood
vessels – salt water retention
Sympathetic nervous system
4- Heart disease & failure
Endothelial dysfunction, coagulopathy,
Hypertension , coronary heart disease.
6- Obesity (abdominal),
Lipogenesis - Dyslipidemia
9- Osteoporosis
8- Certain types of cancer
as colon, breast & prostate
INSULIN
RESISTANCE
(Toxicity)
12- Ch. Inflammation
Glucose - NEFA -Triglycerides
7- Insulin-Leptin-Ghrelin
(Hunger pain)2- Coagulation & fibrinolysis
disorders
11- Higher risk of
Alzheimer, Nephropathy,
etc

12. Signs and symptoms of chronically
elevated insulin:
1- Fatty liver
2- Unexplained Weight Gain
3- abdominal obesity
4- Hunger and cravings
5- Elevated blood sugar
6- Acne and pores on the face
testosterone
7- Menstrual Irregularities
8- Polycystic ovarian syndrome
9- Hirsutism
10- Scalp hair loss in women
as in male pattern
11- Acanthosis nigricans
12- Skin tags
13- Increased risk of gout.
fructose convert too uric acid
14- High blood pressure
15- Puffy swollen ankles
sodium and water
Vascular & heart disease Fatty liver
Polycystic ovarian disease (PCOS)
Acanthosis nigricans -
Acne - large pores - faceSkin tags
Do You Know Your Insulin Level ?
October 23, 2013 by David Spero, BSN, RN
Hirsutism
Abdominal obesity

13. Manifestations
(No Cure)
Traditional mainstream
thinking
Insulin
(Hyperinsulinemia)
Drugs
Low fat diet
(The big lie>40y)
Root cause
(Cure)
1- Bariatric surgery
(Enforced fasting)
Vs.
2- Bariatric Lifestyle
(Intentional fasting)
3- Very low carb diet
Metabolic
syndrome
The metabolic syndrome
Insulin Resistance syndrome
Syndrome X - Deadly quartet - Reaven’s syndrome

14. ADF (75% restriction on day 1, 25% surplus on day 2) (Klempel et al., 2013)
They tested this with low fat and high fat versions (all food was provided and both diets worked, with a modest advantage of HF over LF):
Fat mass declined slightly more on HF, and muscle actually increased in both groups, slightly more on HF. The changes in muscle mass are surprising,
as there was no exercise intervention and protein was held at 15% in both groups (but varied between 19 & 94 grams/d).

16. What is
intermittent
fasting
(IF)

17. What is intermittent fasting
Interventional strategy where in individuals are subjected to
varying periods of fasting.
It doesn’t specify which foods you should eat but
rather when you should eat them.
Intermittent fasting (IF) is an eating pattern that
cycles between periods of fasting and eating.
It’s currently very popular in the health and fitness
community.
Recently attracted attention Because:
1- Its Evidence-Based Health Benefits
2- Its potential for correcting metabolic Abnormalities
3- Better adherence than other methods

18. It’s not a diet in the conventional sense but more accurately
described as an eating pattern.
Common intermittent fasting methods involve daily 16-hour fasts
or fasting for 24 hours, twice per week.
Fasting has been a practice throughout human evolution. Ancient
hunter-gatherers didn't have supermarkets, refrigerators or food
available year-round.
Sometimes they couldn't find anything to eat. As a result, humans
evolved to be able to function without food for extended
periods of time.
In fact, fasting from time to time is more natural than always
eating 3–4 (or more) meals per day.
Fasting is also often done for religious or spiritual reasons,
including in Islam, Christianity, Judaism and Buddhism.
What is intermittent fasting (IF)?

19. Intermittent fasting (IF)
Better adherence with all varieties than other methods
1- ‘Alternate day fasting’ (ADF)
Alternate Day Fasting – 75% restriction on day 1; 25% surplus on day 2.
2- Every other day (EOD) fasting
eat only Every Other Day. 36 hour fasts – from dinner on day 1
until breakfast on day 3.
3- ‘Fasting two non-consecutive days per week’
Skip breakfast.
4- ‘Modified fasting regimes’
(allow water - coffee or tea. limiting caloric intake < 20% - > 500 calories)
5- The Warrior diet
(1 large meal per day) Skip breakfast & lunch)
6- Variations
(different combinations of EOD and the Warrior diet)
‘Normal eating’ resumed on non-fasting days

20. Timeline of Tissue Breakdown
36-48 hours before significant amounts of protein start being broken down

22. Timeline of Tissue Breakdown
Intermittent fasting
Fasting Period
(8 h glucose & glycogen) -- fat -- (36 - 48 hours protein)
Fasting for 14+ hours force the body to
burn body fat when blood sugar or
carbs drop
Rapid loss of fat by fasting 14 to 20
hours per day
(even without ex & dietary regimes)
Progress slowly, don’t jump straight
into 24-36 hour fasts
36-48 hours before significant amounts of
protein start being broken down

23. Intermittent fasting (IF)
The most popular methods
•The 16/8 method: Also called the Leangains protocol, it involves skipping
breakfast and restricting your daily eating period to 8 hours, such as 1–9 p.m. Then
you fast for 16 hours in between.
•Eat-Stop-Eat: This involves fasting for 24 hours, once or twice a week, for example by not
eating from dinner one day until dinner the next day.
•The 5:2 diet: With this methods, you consume only 500–600 calories on two non-consecutive
days of the week, but eat normally the other 5 days.
Many people find the 16/8 method to be the simplest, most sustainable and
easiest to stick to. It’s also the most popular.
SUMMARY There are several different ways to do intermittent fasting. All of them split the day
or week into eating and fasting periods.
All ways of which involve splitting the day or week into eating and fasting periods.
During the fasting periods, you eat either very little or nothing at all.
don't compensate by eating much more during the eating periods.
By reducing calorie intake, all of these methods should cause weight loss

24. Intermittent fasting
(IF)

25. How does
intermittent
fasting work?

26. How does intermittent fasting work?

27. Simplified View of Insulin Action
Graphic originally published at http://weightology.net/weightologyweekly/?page_id=319
How does intermittent fasting work?

28. 1- Fat burning as KD
More energy – less Reactive oxygen ROS.
2- Calorie restriction (+ increase metabolic rate)
Less ROS with fasting
Increase your antioxidants (not exhausted)
Avoid eating several hours before going to sleep
3- Autophagy
Remove damaged cells and mitochondria known as mitophagy
4- Triggering the Immune System for Cancer Patients
5- Reducing Cancer Recurrence and Mortality Rates
Interventional strategy
where in individuals are subjected to
varying periods of fasting.
Sources
•https://news.usc.edu/103972/fasting-like-diet-turns-the-immune-system-against-cancer/
•https://www.osher.ucsf.edu/patient-care/self-care-resources/cancer-and-nutrition/frequently-asked-questions/cancer-
and-fasting-calorie-restriction/
•https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3680567/
•https://health.clevelandclinic.org/2015/10/interested-fasting-health-get-facts-first/
How does intermittent fasting work?

29. How does intermittent fasting work?
How It Affects The Cells and Hormones
•Human Growth Hormone (HGH):
The levels of growth hormone skyrocket, increasing as much as 5-fold. This has benefits for fat
loss and muscle gain, to name a few (4, 5, 6, 7).
•Insulin:
Insulin sensitivity improves and levels of insulin drop dramatically. Lower insulin levels make
stored body fat more accessible (8).
•Cellular repair:
When fasted, your cells initiate cellular repair processes. This includes autophagy, where cells
digest and remove old and dysfunctional proteins that build up inside cells (9, 10)
•Gene expression:
There are changes in the function of genes related to longevity and protection against
disease (11, 12).
These changes in hormone levels, cell function and gene expression are
responsible for the health benefits of intermittent fasting.

30. How does intermittent fasting work?
A Very Powerful Weight Loss Tool
Weight loss is the most common reason for people to try intermittent fasting (13).
Intermittent fasting can lead to:
1- An automatic reduction in calorie intake.
2- Changes hormone levels to facilitate weight loss.
3- Lowering insulin and increasing growth hormone levels,
3- It increases the release of the fat burning hormone norepinephrine (noradrenaline).
4- May increase your metabolic rate by 3.6–14% (14, 15).
Intermittent fasting causes weight loss by changing both sides of the calorie equation.
Less intake & more burning
Studies show that intermittent fasting can be a very powerful weight loss tool.
A 2014 review study found that this eating pattern can cause 3–8% weight loss over 3–24 weeks, which is a
significant amount, compared to most weight loss studies (1).
According to the same study, people also lost 4–7% of their waist circumference, indicating a significant loss
of harmful belly fat that builds up around your organs and causes disease (1).
Another study showed that intermittent fasting causes less muscle loss than the more standard method of
continuous calorie restriction (16).
However, keep in mind that the main reason for its success is that intermittent fasting helps you eat fewer
calories overall. If you binge and eat massive amounts during your eating periods, you may not lose any
weight at all.
SUMMARY: Intermittent fasting may slightly boost metabolism while helping you eat fewer calories. It’s a
very effective way to lose weight and belly fat.

31. Leptin, Ghrelin, and weight loss
Normally Insulin 8 Leptin (satiety) 7 Ghrelin (huger)
Obesity Hyperglycemia
Hyperinsulinemia
Insulin Resistance
Hyperleptinemia
Leptin Resistance
TG
Ghrelin
Unsuppressed
->> Hunger ->> More eating ->> Obesity
Hyperinsulinemia
Insulin Resistance
Hyperleptinemia
Leptin Resistance
Ghrelin
Unsuppressed
->> Hunger ->> More eating ->> Obesity
HyperglycemiaObesity

32. How does intermittent fasting work?
Leptin, Ghrelin, and weight loss
• Cortisol
– Stress hormone
• Leptin
– controls satiety
• Ghrelin
– Sparks hunger
• Thyroid
– Controls metabolic rate
Intermittent Fasting
eliminates hunger & cravings
IT reduces or normalizes Ghrelin (the
hunger hormone) -> less appetite
EAT PROTEIN BEFORE CARBS
We know the amount of certain nutrients
But the order in which you eat them matters too
Blood sugar levels were about 29 percent lower after 30 minutes, 37 percent lower
after 60 minutes, and 17 percent lower after 120 minutes after starting their meal
High Sugar (esp fructose) turning off the body's appetite-control system (insulin and leptin signaling)
-> huger -> more eating -> gaining weight

33. Evidence-Based
Health Benefits

34. •Improved mental clarity and concentration
•Weight and body fat loss
•Reduction of inflammation
•Lowered blood insulin and sugar levels
•Reversal of type 2 diabetes
•Increased energy
•Improved fat burning
•Increased growth hormone
•Lowered blood cholesterol
•Prevention of Alzheimer’s disease (potential)
•Longer life (potential)
•Activation of cellular cleansing (potential) by stimulating autophagy
(a discovery that was awarded the 2016 Nobel Prize in medicine)
Some of the purported physical benefits of
fasting include

35. Intermittent Fasting Changes The Function of Cells, Genes and Hormones
When you fast, insulin levels drop and human growth hormone increases. Your cells also initiate
important
cellular repair processes and change which genes they express.
Intermittent Fasting Can Help You Lose Weight and Belly Fat
Intermittent fasting helps you eat fewer calories, while boosting metabolism slightly. It is a very
effective tool to lose weight and belly fat.
Intermittent Fasting Can Reduce Insulin Resistance, Lowering Your Risk of Type 2 Diabetes
Intermittent fasting can reduce insulin resistance and lower blood sugar levels, at least in men.
Intermittent Fasting Can Reduce Oxidative Stress and Inflammation in The Body
Studies show that intermittent fasting can reduce oxidative damage and inflammation in the
body. This should have benefits against aging and development of numerous diseases.
Intermittent Fasting May be Beneficial For Heart Health
Studies show that intermittent fasting can improve numerous risk factors for heart disease such
as blood pressure, cholesterol levels, triglycerides and inflammatory markers.
10 Evidence-Based Health Benefits of Intermittent Fasting
Written by Kris Gunnars, BSc on August 16, 2016

36. 10 Evidence-Based Health Benefits of Intermittent Fasting
Written by Kris Gunnars, BSc on August 16, 2016
Intermittent Fasting Induces Various Cellular Repair Processes
Fasting triggers a metabolic pathway called autophagy, which removes waste material from
cells.
Intermittent Fasting May Help Prevent Cancer
Intermittent fasting has been shown to help prevent cancer in animal studies. One paper in
humans showed that it can reduce side effects caused by chemotherapy.
Intermittent Fasting is Good For Your Brain
Intermittent fasting may have important benefits for brain health. It may increase growth of new
neurons
and protect the brain from damage
Intermittent Fasting May Help Prevent Alzheimer's Disease
Studies in animals suggest that intermittent fasting may be protective against neurodegenerative
diseases
like Alzheimer's disease
Intermittent Fasting May Extend Your Lifespan, Helping You Live Longer
Given the known benefits for metabolism and all sorts of health markers, it makes sense that
intermittent fasting could help you live a longer and healthier life.

37. Effect of intermittent fasting and refeeding on insulin action in healthy men
Nils Halberg, Morten Henriksen, Nathalie Söderhamn, Bente Stallknecht, Thorkil Ploug, Peter
Schjerling, Flemming Dela
Journal of Applied Physiology Published 1 December 2005 Vol. 99 no. 6, 2128-
2136 DOI: 10.1152/japplphysiol.00683.2005
We mimicked the fluctuations in eight healthy young men [25.0 ± 0.1 yr (mean ± SE); body
mass index: 25.7 ± 0.4 kg/m2] by subjecting them to intermittent fasting every second day
for 20 h for 15 days.
This study was undertaken to test the hypothesis that 14 days of intermittent fasting and
refeeding improves insulin-stimulated glucose disposal.
Intermittent fasting 20h every second day for 15 days. :
Increased the insulin sensitivity 7 folds (2)
Decreased the incidence of diabetes (32).
Decrease in circulating leptin after 8–20 h of fasting

38. Intermittent Fasting
vs.
Bariatric Surgery
vs.
Dieting regime

39. Obesity epidemic. Search for dietary strategies that:
(i) prevent weight gain (ii) promote weight loss (iii)
prevent weight regain
There is some long-term success with gastric
surgical options
But
1- Invasive interventions
2- Post-operative risk of death
due to early complications
3- Long term late complications
SO
there is still a requirement for effective
dietary interventions
1- Promote long-term adherence
2- Sustained beneficial effects
Such dietary interventions need to be
1- Palatable and satiating
2- Meet minimal nutritional requirements
3- Promote loss of fat and preserve lean body mass
4- Ensure long-term safety
5- Simple to administer and monitor
6- Widespread public health utility
(Intermittent fasting)
Is that option, achieving weight loss and
maintenance
International Journal of Obesity
Fasting for weight loss: an effective strategy or latest dieting trend?
A Johnstone - (26 December 2014)

40. Intermittent Fasting vs. Dieting regime
Alternating periods of eating & not eating vs. Regular eating less than normal
Better adherence than other methods :
1- Instead of trying to create a deficit of 300-500
kcal/day (dieting regime), you are making deficits of
1500-2000 kcal a couple days a week (intermittent
fasting)
2- Type of food does not matter with fasting

41. Bariatrics is Surgically Enforced Fasting
All of the benefits of bariatric surgery accrue because of the fasting.
Patients scheduled for bariatric surgery underwent a period of fasting immediately prior. This would burn a lot
of the liver fat. The smaller liver makes surgery easier, especially with the newer laparoscopic techniques.
Comparing the effects of the fasting with the surgery right after, fasting was clearly superior in terms of weight
lost (7.3kg vs 4kg) and reduction in blood sugars.
Studies show that fasting is actually superior to surgery in both weight loss and reduction in blood sugars.
Diabetes Care. 2013 Sep;36(9):2741-7. doi: 10.2337/dc12-2316. Epub 2013 Mar 25.
Rapid improvement in diabetes after gastric bypass surgery: is it the diet or surgery?
Lingvay I1, Guth E, Islam A, Livingston E.

42. Likelihood of Complications: 10% For Early Complications, 15.3% For Late Complications
List of Potential Complications: All 20 Possible
Complications
vary widely depending on the experience of your
surgeon and your behavior before and after surgery.
•Bleeding (also called “Hemorrhage”)
•Blood clots or blood clot symptoms (also called
“thrombus”)
•Bowel function changes
•Bowel obstruction (also called an “internal hernia”)
•Dumping syndrome
•Dehydration
•Dyspepsia (indigestion)
•Gallstones
•Gastro esophageal reflux disease (GERD)
•Hypoglycemia (low blood sugar)
•Incision(al) hernia
•Intolerance to certain foods
•See our Bariatric Diet section for details.
•Kidney stones
•Leaks ( including gastrointestinal leaks and staple
line leaks )
•Nausea and vomiting
•Nutritional deficiency, especially iron and calcium.
•See our Bariatric Vitamins .
•Organ injury during surgery
•Stenosis/Stricture
•Marginal Ulcer
•Wound infection
For a complete list and comparison of
complications relating to all types of bariatric
surgery, see our Bariatric Surgery
Complications page
Complications of Gastric Bypass Surgery – 22 Potential Problems
REVIEWED BY: Peter F. Rovito, MD, FACS
LAST UPDATED: 10/14/2018

43. Frequently asked
questions

44. 1. Can I Drink Liquids During the Fast?
Yes. Water, coffee, tea and other non-caloric beverages are fine. Do not add sugar to your coffee. Small amounts of
milk or cream may be okay.
Coffee can be particularly beneficial during a fast, as it can blunt hunger.
2. Isn't It Unhealthy to Skip Breakfast?
No. The problem is that most stereotypical breakfast skippers have unhealthy lifestyles. If you make sure to eat healthy
food for the rest of the day then the practice is perfectly healthy.
3. Can I Take Supplements While Fasting?
Yes. However, keep in mind that some supplements like fat-soluble vitamins may work better when taken with meals.
4. Can I Work out While Fasted?
Yes, fasted workouts are fine. Some people recommend taking branched-chain amino acids (BCAAs) before a fasted
workout.
You can find many BCAA products on Amazon.
5. Will Fasting Cause Muscle Loss?
All weight loss methods can cause muscle loss, which is why it’s important to lift weights and keep your protein
intake high. One study showed that intermittent fasting causes less muscle loss than regular calorie restriction (16).
6. Will Fasting Slow Down My Metabolism?
No. Studies show that short-term fasts actually boost metabolism (14, 15). However, longer fasts of 3 or more days
can suppress metabolism (36).
7. Should Kids Fast?
Allowing your child to fast is probably a bad idea.
Intermittent fasting (IF)
Frequently asked questions

45. • Is it dangerous to go without food?
• Won’t health suffer if we aren’t eating
regular meals?
• I need to eat regularly otherwise my body
goes into starvation mode
Intermittent fasting (IF)
Frequently asked questions

46. Fasting
Religious Reasons
Ramadan
a 4-week period of food and fluid
abstinence between the hours
from sunrise to sunset
the length of the fast may vary from
10 to 19 hours each day
Fasting
Recall History
Human history
we were not regular meal eaters.
We followed a more episodic pattern of
intake (intake does not refer to a set period
of time, as habitual pattern )

47. Fasting
Logical thinking
Observe & read the natural life
Why no metabolic syndrome in
wild animals

48. Fasting was a regular part of the
Messenger's life.
He would fast every Monday and
Thursday.
He would also fast the 13th, 14th and
15th of each month
When the Messenger (peace and
blessings be upon him)
was not fasting he was on
“intermittent fasting”
eating only once a day
“The Warrior diet ”
The Prophetic Diet: The Perfect New Year’s Resolution
Moutasem Atiya
30 December 2013
‫الطعام‬ ‫في‬ ‫وسلم‬ ‫عليه‬ ‫هللا‬ ‫صلى‬ ‫النبي‬ ‫عادة‬
‫الثالث‬ ‫الوجبات‬ ‫تقسيم‬ ‫السنة‬ ‫في‬ ‫ليس‬:‫والغ‬ ، ‫الفطور‬‫داء‬
‫والعشاء‬
‫من‬ ‫أكثر‬ ‫تناول‬ ‫وسلم‬ ‫عليه‬ ‫هللا‬ ‫صلى‬ ‫عادته‬ ‫من‬ ‫يكن‬ ‫لم‬ ‫بل‬
‫والليلة‬ ‫اليوم‬ ‫في‬ ‫وجبتين‬‫التى‬‫فيها‬ ‫اليصوم‬
ْ‫ت‬َ‫ل‬‫ا‬َ‫ق‬ ‫عنها‬ ‫هللا‬ ‫رضى‬ َ‫َة‬‫ش‬ِ‫ئ‬‫َا‬‫ع‬ ْ‫َن‬‫ع‬( :َ‫ك‬َ‫أ‬ ‫ا‬َ‫م‬‫هللا‬ ‫صلى‬ ٍ‫د‬َّ‫م‬َ‫ح‬ُ‫م‬ ُ‫ل‬‫آ‬ َ‫ل‬
ْ‫ح‬ِ‫إ‬ َّ‫ال‬ِ‫إ‬ ٍ‫م‬ ْ‫و‬َ‫ي‬ ‫ي‬ِ‫ف‬ ِ‫ْن‬‫ي‬َ‫ت‬َ‫ل‬ْ‫ك‬َ‫أ‬ ‫وسلم‬ ‫عليه‬ٌ‫ر‬ْ‫م‬َ‫ت‬ ‫ا‬َ‫م‬ُ‫ه‬‫َا‬‫د‬)‫البخاري‬ ‫رواه‬
6455
.
‫هللا‬ ‫رحمه‬ ‫حجر‬ ‫ابن‬ ‫الحافظ‬ ‫يقول‬" :‫رب‬ ‫أنهم‬ ‫إلى‬ ‫إشارة‬ ‫فيه‬‫ما‬
‫فإح‬ ‫أكلتين‬ ‫وجدوا‬ ‫فإن‬ ، ‫واحدة‬ ‫أكلة‬ ‫إال‬ ‫اليوم‬ ‫في‬ ‫يجدوا‬ ‫لم‬‫داهما‬
‫تمر‬"‫انتهى‬.
"‫الباري‬ ‫فتح‬”11/292
‫طعامه‬ ‫في‬ ‫ورد‬ ‫مما‬‫وسلم‬ ‫عليه‬ ‫هللا‬ ‫صلى‬
‫اللبن‬ ‫الشعير‬ ‫الزيتون‬ ‫زيت‬ ‫الخل‬ ‫التمر‬ ‫العسل‬

49. Intermittent
fasting Safety
and Limitations

50. A 2014 review have shown
fasting improves indicators of
health
Blood pressure
Insulin sensitivity
Inflammation
Cellular responses to stress
Reduce the risk of chronic
diseases
cancer
Limitations
Intermittent fasting not studied
in children
the elderly
the underweight
and could be harmful in this population
fast for periods of time greater than 24 hours
should be monitored by a physician, as changes
to the gastrointestinal system or circadian
rhythm can occur
. fasting is unlikely to have much effect on
conditions other than obesity, such as aging or
other chronic condition
unless combined with moderate calorie
restriction and plant-based diet such as the
Mediterranean diet.[7]
Intermittent fasting Safety and Limitations

51. Who Should Be Careful Or Avoid It?
Intermittent fasting is certainly not for everyone.
If you’re underweight or have a history of eating disorders, you should not fast without
consulting with a health professional first.
In these cases, it can be downright harmful.
Should Women Fast?
There is some evidence that intermittent fasting may not be as beneficial for women as it is for
men.
For example, one study showed that it improved insulin sensitivity in men, but worsened blood
sugar control in women (33).
Though human studies on this topic are unavailable, studies in rats have found that intermittent
fasting can make female rats emaciated, masculinized, infertile and cause them to miss cycles
(34, 35).
There are a number of anecdotal reports of women whose menstrual period stopped when
they started doing IF and went back to normal when they resumed their previous eating
pattern.
For these reasons, women should be careful with intermittent fasting.
They should follow separate guidelines, like easing into the practice and stopping immediately if
they have any problems like amenorrhea (absence of menstruation).
If you have issues with fertility and/or are trying to conceive, consider holding off on intermittent
fasting for now. This eating pattern is likely also a bad idea if you’re pregnant or breastfeeding.

52. Safety and Side Effects
Hunger is the main side effect of intermittent fasting.
You may also feel weak and your brain may not perform as well as you're used to.
This may only be temporary, as it can take some time for your body to adapt to the new
meal schedule.
If you have a medical condition, you should consult with your doctor before trying
intermittent fasting.
This is particularly important if you:
•Have diabetes.
•Have problems with blood sugar regulation.
•Have low blood pressure.
•Take medications.
•Are underweight.
•Have a history of eating disorders.
•Are a woman who is trying to conceive.
•Are a woman with a history of amenorrhea.
•Are pregnant or breast feeding.
All that being said, intermittent fasting has an outstanding safety profile. There is nothing
dangerous about not eating for a while if you’re healthy and well-nourished overall.
SUMMARY: The most common side effect of intermittent fasting is hunger. People with
certain medical conditions should not fast without consulting with a doctor first.

53. Intermittent Fasting safety and Limitations was answered
>1400 y
Intermittent fasting not studied
in children
the elderly
the underweight
and could be harmful in this population
fast for periods of time greater than 24
hours
should be monitored by a physician, as
changes to the gastrointestinal system
or circadian rhythm can occur
. fasting is unlikely to have much effect
on conditions other than obesity, such
as aging or other chronic condition
unless combined with moderate calorie
restriction and plant-based diet such as
the Mediterranean diet.[7]

54. Intermittent Fasting safety and Limitations
was answered >1400 y
‫الصوم‬ ‫وصال‬ ‫وكراهة‬ ‫عن‬ ‫النهي‬
‫قال‬ ‫وسلم‬ ‫عليه‬ ‫هللا‬ ‫صلى‬ ‫النبي‬ ‫أن‬ ‫هريرة‬ ‫أبي‬ ‫عن‬" :‫والوصال‬ ‫إياكم‬"-‫ثالث‬ ‫قالها‬
‫مرات‬-‫قالوا‬:‫قال‬ ‫هللا؟‬ ‫رسول‬ ‫يا‬ ‫تواصل‬ ‫فإنك‬:"‫أبيت‬ ‫إني‬ ،‫مثلي‬ ‫ذلك‬ ‫في‬ ‫لستم‬ ‫إنكم‬
‫يطعمني‬(2)،‫ويسقيني‬ ‫ربي‬‫تطيقون‬ ‫ما‬ ‫االعمال‬ ‫من‬ ‫فاكلفوا‬"‫البخاري‬ ‫رواه‬
‫ومسلم‬.
‫وسلم‬ ‫عليه‬ ‫هللا‬ ‫صلى‬ ‫قوله‬:(َ‫د‬َ‫ب‬َ ْ‫اْل‬ َ‫م‬‫ا‬َ‫ص‬ ْ‫ن‬َ‫م‬ َ‫م‬‫ا‬َ‫ص‬ َ‫ال‬)‫البخاري‬ ‫رواه‬(1977)‫ومسلم‬
(1159)
‫وسلم‬ ‫عليه‬ ‫هللا‬ ‫صلى‬ ‫هللا‬ ‫رسول‬ ‫سأل‬ ‫أنه‬ ‫عنه‬ ‫هللا‬ ‫رضي‬ ‫الخطاب‬ ‫بن‬ ‫عمر‬ ‫وعن‬( :
َ‫ل‬‫ا‬َ‫ق‬ ‫؟‬ ُ‫ه‬َّ‫ل‬ُ‫ك‬ َ‫ر‬ْ‫ه‬َّ‫د‬‫ال‬ ُ‫م‬‫و‬ُ‫ص‬َ‫ي‬ ْ‫ن‬َ‫م‬ِ‫ب‬ َ‫ف‬ْ‫ي‬َ‫ك‬:َ‫ط‬ْ‫ف‬َ‫أ‬ َ‫ال‬َ‫و‬ َ‫م‬‫ا‬َ‫ص‬ َ‫ال‬َ‫ر‬)‫مسلم‬ ‫رواه‬(1162)
ِ‫ه‬‫َّللا‬ َ‫ول‬ ُ‫س‬َ‫ر‬ ‫ه‬‫ن‬َ‫أ‬ ‫ا‬َ‫هم‬ْ‫ن‬َ‫ع‬ ‫هم‬‫ه‬‫ل‬‫ال‬ ‫ي‬ ِ‫ض‬َ‫ر‬ ‫و‬ٍ‫ر‬ْ‫م‬َ‫ع‬ ِ‫ن‬ْ‫ب‬ ِ‫ه‬‫َّللا‬ ِ‫د‬ْ‫ب‬َ‫ع‬ ْ‫ن‬َ‫ع‬َ‫ال‬َ‫ق‬ َ‫م‬‫ه‬‫ل‬ َ‫س‬َ‫و‬ ِ‫ه‬ْ‫ي‬َ‫ل‬َ‫ع‬ ‫هم‬‫ه‬‫ل‬‫ال‬ ‫ى‬‫ه‬‫ل‬ َ‫ص‬
ُ‫ه‬َ‫ل‬:
:‫إني‬ ‫قلت‬ ‫السالم‬ ‫عليه‬ ‫داود‬ ‫صيام‬ ‫وهو‬ ‫الصيام‬ ‫أعدل‬ ‫وهو‬ ‫يوما‬ ‫وأفطر‬ ‫يوما‬ ‫صم‬
‫وسلم‬ ‫عليه‬ ‫هللا‬ ‫صلى‬ ‫هللا‬ ‫رسول‬ ‫فقال‬ ‫ذلك‬ ‫من‬ ‫أفضل‬ ‫أطيق‬:‫ذلك‬ ‫من‬ ‫أفضل‬ ‫ال‬

55. SUMMARY

56. Metabolic Syndrome reaches an epidemic in MENA
No cure by insulin, drugs, low fat diet
Can be Cured by bariatric surgery, fasting, very low
carb diet
SUMMARY
Our bodies are very well equipped to go without
food for 1-2 days at a time.
There is no significant detriment to our health.
We can survive many weeks without food!
Intermittent Fasting offers
1- Fasting Benefits
2- Health Benefits

57. SUMMARY
Fasting Benefits:
Rules are easy to understand
(not necessarily follow)
Did you eat something? Yes/No
Less emphasis on weighing/measuring
Not as important to consider low Carb vs.
low fat
Dramatic calorie cuts (in a single day,
followed by regular eating)
may make it tougher for metabolism to
down-regulate
Less food prep and eating time
Cheaper than other diets
Removing entire meals as opposed
to buying less calorie dense foods
Health Benefits of Intermittent Fasting:
1- fat-burning maintain a healthy body weight
2- Rise of human growth hormone (HGH)
The only other thing that can compete in terms of
dramatically boosting HGH levels is high-intensity interval
training
3- Normalizing insulin and leptin sensitivity
which is key for optimal health
4- Normalizing Ghrelin levels
also known as "the hunger hormone
5- Lowering triglyceride levels
6- Improving biomarkers of disease
7- Reducing inflammation and lessening free
radical damage
8- Preserving memory functioning and learning

58. SUMMARYHealth Benefits of Intermittent Fasting:
Reduced
blood lipids
blood pressure
markers of inflammation
oxidative stress
Cancer
Increased
cell turnover and repair
fat burning
growth hormone release
metabolic rate.
Improved
appetite control
blood sugar control
cardiovascular function
neuronal plasticity

59. Intermittent Fasting vs Dieting regime
Instead of trying to create a deficit of 300-500 kcal/day
(dieting regime)
you are making deficits of 1500-2000 kcal
a couple of days a week
Intermittent Fasting vs Bariatric
surgery
Studies show that fasting is actually
superior to surgery in both weight loss
and reduction in blood sugars.
SUMMARY

60. Intermittent fasting Makes Your Healthy
Lifestyle Simpler
Eating healthy is simple, but it can be
incredibly hard to maintain.
One of the main obstacles is all the work
required to plan for and cook healthy
meals.
Intermittent fasting can make things
easier, as you don't need to plan, cook or
clean up after as many meals as before.
For this reason, intermittent fasting is very
popular among the life-hacking crowd, as
it improves your health while simplifying
your life at the same time.
SUMMARY: One of the major benefits of
intermittent fasting is that it makes
healthy eating simpler. There are fewer
meals you need to prepare, cook and clean
up after.
Fasting offers many important unique
advantages that are not available in typical
diets.
Where diets complicate life, fasting simplifies.
Where diets are expensive, fasting is free.
Where diets can take time, fasting saves time.
Where diets are limited, fasting is available
anywhere.
Where diets have variable efficacy, fasting has
unquestioned efficacy.
There is no more powerful method for
lowering insulin and decreasing body weight.

61. Should You Try It?
Intermittent fasting is not something that anyone needs to do.
It’s simply one of many lifestyle strategies that can improve your health.
Eating real food, exercising and taking care of your sleep are still the most
important factors to focus on.
The best diet for you is the one you can stick to in the long run.
Intermittent fasting is great for some people, not others. The only way to find
out which group you belong to is to try it out.
If you feel good when fasting and find it to be a sustainable way of eating, it
can be a very powerful tool to lose weight and improve health.

62. Getting Started
You've already done many intermittent fasts in your life. Simply by skip meals
from time to time when you're not hungry or don't have time to cook
If you skip ‘breakfast , then you've probably already fasted for 16+ hours.
Some people instinctively eat this way. They simply don't feel hungry in the
morning.
It's recommended to start with the 16/8 method,
.
If you find it easy and feel good during the fast, then may be try moving on to
more advanced fasts like 24-hour fasts 1–2 times per week (Eat-Stop-Eat)
or only eating 500–600 calories 1–2 days per week (5:2 diet).
There is no need to follow a structured intermittent fasting plan to derive at
least some of the benefits.
Experiment with the different approaches and find something that you enjoy,
fits your schedule and works for you.

63. Fasting Tricks and Tips
1. Food choices matter.
2. Be patient. It can take 3-6 weeks to get
comfortable with it
3. Exercise helps
4. Timing is everything, you need to figure out your
optimal fasting length
5. Progress slowly, don’t jump straight into 24-36
hour fasts
6. Don’t overdo it: fasting daily is called an eating
disorder
7. Eat protein
8. It’s still a lifestyle: you can’t do it for a month, then
stop
9. Some shouldn’t do it: if you have a history of
disordered eating. if you have a really fast
metabolism.

64. Patient Compliance and Willpower
POP cast
vs.
Patient Education
Intermittent fasting
vs.
Beriatric surgery