It’s almost as if the proverbial “they” are fresh out of diet ideas and have now pivoted to marketing hunger itself.

IF restricts when people eat, and can sometimes restrict other aspects of eating as well, such as the amount and food choice (depending on the fast). There are several popular styles.

Is intermittent fasting a form of dieting?

Britannica.com describes “dieting” as regulating one’s food intake for the purpose of  improving one’s physical condition which includes “trying to lose body weight.” Cambridge Dictionary defines the noun “diet” as “the particular food and drink you are limited to when you cannot eat or drink whatever you want to.”

The rigidity behind fasting for a long period of time or for long stretches every day/week on an ongoing basis, and the shame when the physical hunger is fed outside of the rules, do not make anyone a happier, healthier version of themself. The mindset required for IF does not make room for mistakes, permission, or mindfulness. It also does not take into account how different every body and mind is from every other.

Diet or not, IF is a product of diet culture, not science, and that’s all most people need to know about it.

Tricky semantics at play! Interesting that most studies promoting IF health benefits such as increased longevity and reduced chronic inflammation have been done in “healthy” subjects to begin with and for only short periods of time. And the population most vulnerable to the pressures of diet culture, of which IF is part, are women.

Intermittent fasting throughout history

We can acknowledge and honor that IF has been practiced by religious communities throughout the world throughout all of history. From Buddhism to Islam to Judaism to Catholicism and on and on. These religious fasts have also been referred to as  “intermittent energy restriction” and “short-term starvation periods.” In some religions, fasting was also accompanied by reduced workload and long seated meditations or prayer. (These are activities, by the way, that do not require many calories.)

We also ought to acknowledge that there have been many times when fasting in the name of religion has gone way too far! Anorexia mirabilis, also known as holy anorexia, was practiced in Europe during the middle ages, and at other times throughout history, by women sometimes known colloquially as fasting girls or “Holy Anorexics.” Catholic nuns and other religious women used self-starvation as a way to purify themselves, imitate the suffering of Jesus, and experience hallucinations which were perceived as divine experiences.

Neither fasting nor associating food with impurity is new. And no kind of purification is possible so long as someone is abusing themselves, regardless of the name it is given. That includes calling “starvation” by manipulative names like “cleansing.”

Intention is everything

You already know my stance on dieting. But religion, on the other hand, can and should be part of a client’s recovery if they so desire, no question. When I work with clients, I encourage them to bring their spiritual selves into the healing process with them– their religion included. It’s part of meeting each individual where they are in their recovery. We help them untangle their religious beliefs from their food beliefs so they can consider exploring their faith from a place of fullness and respect for their vessel if and when they’re ready..

That said, I find it so interesting when religious fasting is held up as proof of IF’s merit. “If fasting is ok here, it must be ok there!” This view highlights something that is often misunderstood as it ignores one of the most important things that we as clinicians need to know if a client tells us they are choosing IF or any extreme feeding plan: What are your intentions behind doing this, and do you have a history with eating disorders and/or strong body dissatisfaction?

Intentionality is everything! What’s important is not the marketable or detestable label we slap on these diet culture products (which are all bug and no feature); what’s important are the intentionality behind extreme eating/restricting behavior and the dangerous consequences of blindly following misguided health advice.

The truth is, if I were to write out the signs and symptoms for Binge Eating Disorder cases, Bulimia cases, and those of individuals who practice various methods of IF and scramble them up, the average person would not be able to discern which are the benefits of fasting and which are the signs of starvation. I’m not saying IF is an eating disorder. What I’m saying is, that’s really not the point.

Higher-risk individuals

Even though they claim it can be practiced safely, those who swear by IF acknowledge that this “lifestyle” is not appropriate for people who have struggled with specific health issues, including eating disorders.

IF is also not recommended for:

• People with diabetes
• People with low blood pressure
• People who may be underweight
• Women pregnant or trying to conceive

IF is also not recommended for people who are on prescribed medication, which is to say, more than half of all adults in the United States. It seems that IF would be great for people with health issues…if fasting was advisable for those with health issues, which it is not.

Intermittent fasting has been shown to increase alertness in the short term, but when done over the long term, it does the opposite. In addition to decreased alertness, fatigue, difficulty concentrating (which is not ideal for students, working professionals, parents, or people who drive), increased stress and anxiety, irritability, and binge eating are common side effects of IF. And when you add these all up, over time they can damage more than someone’s physical health; IF and its side effects can hurt relationships, academia, job performance, etc.

Is Intermittent Fasting an Eating Disorder?

While IF is not classified as an eating disorder, it can trigger eating disorder behavior and/or become part of someone’s existing, maybe not-yet diagnosed, eating disorder.

Members of the wellness community claim IF can be practiced responsibly and in safe moderation. Working with clients struggling with mental illness, we know that moderation is not a magic cure. Actually, moderation is the most elusive place for some of our clients.

Imagine we are talking about something else- beer, for example.

Is beer good for you? It depends! I found several articles just now, quickly I might add, boasting the health benefits of beer. Of course, there are also some risks. For most of us, beer might be one of those “fine in moderation things.” But those who struggle with alcoholism will never be well if their approach to recovery is to drink in moderation. Similarly, people who struggle with eating/feeding disorders or body dissatisfaction will never be well if their approach to recovery is to sample harmful diet culture products like IF.

It is no more likely for someone struggling with substance abuse to heal while still consuming that substance with the intention of doing so moderately than it is for someone struggling with an eating disorder to heal while practicing another restrictive diet plan.

IF impacts sexes differently

So how do women compare to men when following the IF “lifestyle” diet? Is there a difference in how a woman’s body, and mind, respond to IF compared to a man’s body and mind? Current research is limited; however, a few recent headlines have indicated that women may not respond to IF as “favorably” as men. The first claim is that women’s glucose response to a meal after 22 days of IF was not as positive as men’s response. A closer look? The study, reported in 2005, tested only 16 “nonobese subjects” divided equally between men and women (Obes Res. 2005 Mar;13(3):574-81).

The study goal was to examine the effects of 3 weeks of alternate-day fasting on “glucose tolerance and skeletal muscle expression of genes involved in fatty acid transport/oxidation, mitochondrial biogenesis, and stress response.” In other words, a short three weeks of alternate fasting to see the differences in blood sugar response, indicators of fat metabolism, presence of new mitochondria, and response to stress in general between a small group of “nonobese” men and women.

Women’s glucose response was “slightly impaired” after three weeks with NO change in insulin response. Men had NO change in glucose response and a “significant reduction” in insulin response. The problem here? Too few subjects, too few days, and too few health variations reflect any significance for those following IF for the overwhelming majority of people.

Another recent study reflected on the IF influence on women’s fertility. It is a known and accepted scientific fact that weight loss and inadequate nutrition have a direct negative effect on healthy menstruation and levels of reproductive hormones over time.

Although there are no human studies for comparison, female rat studies have shown that 3-6 months of alternate-day fasting reduces ovary size and disrupts reproductive cycles (PLoS One. 2013;8(1):e52416. doi: 10.1371/journal.pone.0052416. Epub 2013 January 29.) Because of these results, recent headlines encourage women to modify their approach to IF, using shorter fasting periods and fewer total days of fasting. A closer look? ANY diet plan that provides inadequate nutrition consistently and disrupts normal social functions such as the freedom to eat daily meals and snacks to meet your physical, social, and mental needs of the day is a risk. Risk of disruption of normal healthy reproductive functioning over time, a significant risk of disruption of a normal healthy relationship with food and body, and an even more significant risk of disruption of quality of life and relationships in general.

Is IF superior to any other latest-greatest diet trend? According to a 2015 study, the answer may surprise you. NO.  “Intermittent fasting thus represents a valid–albeit not superior–option to continuous energy restriction for weight loss” (Mol Cell Endocrinol. 2015 December 15;418 Pt 2:153-72. doi: 10.1016/j.mce.2015.09.014. Epub 2015 September 16.) Add this statement to “several studies suggest that intermittent fasting (from a randomized trial in “young overweight women”) is as effective as traditional calorie-restricted diets for short-term weight loss” (Int J Obes (Lond). 2011 May;35(5):714-27. doi: 10.1038/ijo.2010.171. Epub 2010 Oct 5.). And how effective is SHORT-TERM weight loss, over the LONG-term? The dieting industry would not be the $72 billion-dollar industry today if short-term weight loss from any kind of diet plan was working over the long term. What if that formula is just the secret to the DIET INDUSTRY’S success – keep attention focused on short-term “results” with long-term promises that aren’t supported by significant research? Business will always be booming. Scary, and heart-breaking, for the millions who support it whether they realize it or not.

A critical yet underplayed effect of IF on disordered eating behaviors deserves a closer look before conclusions can be made. A recent study in which 59 “obese subjects” participated in an eight-week alternate-day fasting trial reports that despite side effects of constipation, water retention, dizziness, general weakness and the ever-popular bad breath, positive results included a decrease in body weight, depression, and binge eating behaviors. However, and an important “however,” “purgative behavior (purging by vomiting, laxatives, over-exercise for example) and fear of fatness remained unchanged.” This report concludes, “therefore, ADF (alternate day fasting) produces minimal adverse outcomes and has either benign or beneficial effects on eating disorder symptoms” (Nutr J. 2015 May 6;14:44. doi: 10.1186/s12937-015-0029-9). May I translate this for you?

A slight improvement in depression and binge eating behaviors without any change in purging behaviors and a deep-rooted fear of fatness is neither benign OR beneficial to any clinician who understands how significant and damaging purging and fear of fatness can be to the physical and emotional health of anyone, male or female. The purging and fears that continue will inevitably trigger the depression and binge eating behaviors that may have subsided during the 8-week “honeymoon stage” created by temporary weight changes in this study.

Although this study did not differentiate between women and men, it is known that disordered eating patterns are more common in women today, although men are not immune, and the numbers are rising in all genders with no significant signs of slowing.

What are clients actually telling us when they say they want to try IF?

What are clients hoping to achieve through fasting? The idea that this rigid ritual of denying one’s body of life-giving fuel somehow cleanses it and makes it well suggests something unfortunate about many of our clients’ relationships with food.

We know from history that wellness fads don’t just go away;  unless something fundamental changes in our culture, IF will be replaced by something entirely different, and yet completely the same. Therefore, the focus must remain on intentionality when it comes to eating, and not on considering each variation of the same diet culture trap.

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