Brand new clinical trial just came out looking at intermittent fasting in individuals with type 2 diabetes, and specifically they used this modality of intermittent fasting called 5:2 where you basically, five days out of the week you eat essentially normal and then two days out of the week you cut your calories a lot. So they took about 300 volunteers, so that's a pretty large scale trial, everybody had type 2 diabetes and everybody received standard healthy lifestyle advice that you give to anyone with type 2 diabetes, how to eat a healthy diet, how to stay active, and then they split the participants randomly into three groups. One group did this 5:2 protocol, and during those two days of the 5:2 where they're reducing calories, these guys ate about 800 calories a day give or take, so that's about a third of normal caloric intake for a day.
And that was from a meal replacement formula that was given to the participants, so things like shakes and bars, so it was all provided by the investigators and that's all the participants ate during those two days. So it's not really a fast per se in the sense that you're completely stopping your food intake for a prolonged period of time. They eat a lot less during those two days.
So intermittent caloric reduction, if you will. And this is often, not always, but often how 5:2works. So that was the first group.
Another group was put on a supervised exercise program. So two days a week they had to go to the research center and do this workout under supervision of trainers, and the workout consisted of both cardio and weights. The cardio was stationary bike, basically five minutes of warm-up, then four minutes pretty intense at 85 to 90 percent of maximum heart rate for their age and then five minutes of cool down.
And the weight training was four machine exercises, two sets of each, so things like chest press, shoulder press, leg extension etc. So those were the two intervention groups, the diet group that did the 5-2 and the supervised exercise, the third group was essentially served as a control group and they just had that standard healthy lifestyle advice that everybody received. After three months of the trial they looked at their hemoglobin A1c, their glycated hemoglobin, which is basically an average of glucose levels over the last three months, and the group doing 5:2 had significantly lower hemoglobin A1c than the control group.
On the other hand, there was no significant difference between the exercise and the control group. About 20% of the participants doing 5:2 achieved what's called remission. So basically they're no longer technically diabetic, and this means their hemoglobin A1c is under the threshold for diabetes without any glucose-lowering medication.
So if they were on any medication, they've already stopped it and their hemoglobin A1c is still under that threshold naturally. On the other hand, in the control and the exercise groups, the supervised exercise, about 10 to 11% of participants each achieved remission. There was no significant difference between the controls and the supervised exercise group.
So they both improved similarly, and then the diet group improved more. Just a reminder for people who have type 2 diabetes, especially if you are on diabetes medication, if you're going to do this type of diet or any dramatic dietary change, it's important to work with your doctor to have some supervision because you want to adjust your diabetes meds as your glucose levels come down. You don't want to become hypoglycemic.
A couple other things that were also reported in the trial, the folks doing the 5:2 also lost body weight in general, their BMI and their waist circumference was significantly reduced compared to controls, so all of the participants were either obese or overweight before the trial and the guys doing the diet intervention, the 5:2, lost about two and a half kilos average over the course of the trial. On the other hand, there was no significant difference between the exercise and the control group in these body metrics. Now, one obvious thing would be to combine, to do both the 5:2 and the exercise, so to have a combo group.
In this trial that's already a trial with three arms so they didn't have a fourth arm with the combo but obviously in general both attention to diet and exercise is recommended. They're not mutually exclusive. But I think so far this makes sense.
We're going to look at other results in a second but in terms of weight loss and glucose parameters, dietary changes are going to have a stronger impact than exercise alone. As people often say, you can't outrun a bad diet. Those guys doing 5:2, they're cutting between a thousand and sixteen hundred calories per day during those two days that they're calorie restricting so that's a lot, you're not going to lose sixteen hundred calories in a workout, in a trip to the gym, unless you're in a Rocky Balboa movie or something.
Of course there are many other benefits to exercise besides just weight loss and we'll look at those in a second. So that's the first of three major takeaways from this trial. Exercise is fantastic but for weight loss specifically, it's hard to lose meaningful weight without some substantial changes to diet.
Another result they reported was postprandial glucose, so glucose levels after eating, and they were also lowered on the folks doing 5:2. That tends to go hand in hand with weight loss. And no significant change in the folks doing supervised exercise compared to control.
Now, there was something that the exercise group was better at, and that was holding on to lean body mass. So the controls tended to lose a little bit of lean body mass over the course of the trial. The diet, the 5:2 group, was not significantly different from controls, so they also trended towards a little bit of loss, and the exercise group was significantly different from controls, so they were better, they tended to hold on to their lean mass better.
This makes sense, because the diet group lost more weight in general, and when we lose weight we lose some fat mass but we also tend to lose a little bit of lean mass, of muscle mass, and also because the exercise group is doing weight training, resistance training, so that helps reduce, minimize the loss of muscle. They also looked at body fat and both groups, both intervention groups, the diet and the supervised exercise groups, lost significant body fat compared to controls, and liver fat also, both groups significantly reduced their amount of liver fat, although the diet group seemed to lose more, about twice as much, which might explain the results with the hemoglobin a1c because we know that visceral fat, the fat that's accumulated around and inside the viscera, the abdominal organs like the liver and the pancreas, are particularly important for glucose metabolism. And finally, diastolic blood pressure was also significantly improved in both the diet and the supervised exercise group, although systolic blood pressure was not significantly better in either one, and neither was fasting glucose, insulin resistance, LDL cholesterol, or triglycerides.
Although, when they looked at the subset of participants that had completed the trial and that had good compliance with the instructions, with the diet or the exercise, then fasting glucose and insulin resistance were significantly improved in the folks doing 5:2. So my second takeaway to the trial is that even pretty modest lifestyle changes can have a pretty dramatic impact on health. Like, even just a couple of days a week.
So often we say, I don't have time to work out. I don't have time to eat healthy. I don't have time to prep meals.
These guys saw substantial benefits with just two days of dietary changes. One out of five was in remission from their diabetes. The guys doing the exercise also saw some significant benefits.
And that was only two days a week, like an hour a day. So two hours a week to get some health benefits, pretty doable. This is really cool because it gives us options.
Some people might prefer to do these lifestyle changes daily, consistently. Other people may have busier lives and just don't have time and prefer to do this intermittently, like on the weekend or something, a couple days a week. Both of these strategies, continuous or intermittent, can work.
Last thing they did on the trial was, after those three months of intervention, they continued to follow the participants for another nine months, so a total of one year of follow-up. And they're no longer providing the foods or supervising or telling them to do anything or looking over their shoulder. They're out of the trial, they broke out of Shawshank.
And perhaps not surprisingly, the weight did bounce back up and hemoglobin A1c also rose back. They're still lower than in the beginning of the trial, so they didn't go all the way back to baseline but they're no longer significantly different from the controls, presumably because they didn't keep up with the diet. So this is my third takeaway from this trial.
So often we think, man, if I could only lose the weight, if I could only reach that goal, then I'd be done. But it turns out that's actually the easy part, the hard part is not getting it done, it's keeping it done. So figuring out a lifestyle, diet and exercise program, that works for you so that it's doable, it's sustainable long term, it's enjoyable and you don't lose the gains right after you gain them.
If fasting helps you get there and stay there, whether it's 5:2 or some other modality, fantastic. If fasting is not for you, some people don't like it, doesn't work well for some people, there are other strategies to put diabetes in remission and we covered some of those in this video. And here's more on the best workouts for glucose control.
Check those out. I'll meet you over there. Bye.
