Metabolisk
Faste og blodsukker, insulin og lipider
Markørerne forbedres. Det svære spørgsmål er, om de forbedres mere, end de ville gøre ved det samme vægttab opnået på en anden måde.
Hvad de bedste oversigter siger
Cochrane-oversigten om periodisk fasten for voksne med overvægt eller fedme [1] og BMJ's systematiske oversigt over fastestrategier [2] er de to synteser, man bør læse, hvis man kun læser to. Begge finder reelle effekter på vægt og tilknyttede kardiometaboliske markører, og begge er omhyggelige med at angive størrelsen og sikkerheden af disse effekter.
Det gennemgående forbehold: markørerne forbedres nogenlunde proportionalt med den tabte vægt. Forsøg, der sammenligner periodisk fasten med kontinuerlig energirestriktion ved type 2-diabetes, fandt sammenlignelige resultater [4], hvilket er, hvad man ville forvente, hvis mekanismen er underskuddet.
Glykæmisk forbedring
Diabetesforsøgene
EARLY-forsøget er det klinisk mest interessante: en 5:2-periodisk fasten-måltidsersætningsdiæt blev testet for glykæmisk kontrol hos voksne med diabetes, med HbA1c som endepunkt [6]. Måltidsersætning fjerner en stor del af efterlevelsesproblemet, hvilket kan være grunden til, at resultatet var positivt.
En randomiseret sammenligning af 16:8 mod 14:10 og en kontrolgruppe rapporterede om både vægtreduktion og metaboliske parametre [8], hvilket understøtter, at vinduets længde ikke er den aktive ingrediens.
Alder spiller en rolle
En oversigt, der specifikt undersøger risici og fordele ved periodisk fasten for det aldrende kardiovaskulære system [3], er værd at læse, hvis du er over 60. Ældre voksne har mindre fedtfri masse at tabe, flere lægemiddelinteraktioner og en større sandsynlighed for, at en periode med reduceret indtag giver problemer, som ville være trivielle i 30-årsalderen. Et Cell Metabolism-forsøg, der målte hjernens respons på periodisk fasten versus en sund levevis-diæt hos ældre voksne [7], er et af de få studier designet til denne population.
Hvad der ikke holder
- "Fasten vender insulinresistens uafhængigt af vægttab." Ikke dokumenteret. Forsøg, der matchede vægtændring, viser ikke en klar uafhængig effekt.
- "Fasten fixer dit kolesterol." Lipider ændrer sig med vægt og kostsammensætning. Fasten i sig selv har ingen dokumenteret lipidspecifik effekt.
- "Fasten sænker inflammation." Inflammatoriske markører falder ved fedttab. At tilskrive dette fastemønstret kræver en kontrolgruppe, som de fleste forsøg ikke har.
- "Du bliver fedtadapteret og forbrænder fedt hele dagen." Substratforbruget skifter under en fasteperiode og skifter tilbage efter måltider. Fedtoxidationen over 24 timer styres af energibalancen.
Ofte stillede spørgsmål
Kan fasten reversere min prædiabetes?
Betyder det, at det ikke virker, hvis mine fasteblodsukkerværdier stiger?
Er fasten godt for kolesterolet?
Kan jeg faste med type 2-diabetes?
References
Every citation below links to the original peer-reviewed record on PubMed or via DOI. Nothing here is a substitute for medical advice.
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