GI health and overall health depends on the choices you make in terms of food. That includes choosing when to eat and how much.

I am a big fan of cutting out meals and only eating when you are hungry. It works for my cat. Regular meals were not something that we humans have had for long (or animals ever), so I doubt the system is designed for regular eating. So, I am a fan of different “fasting” solutions, though honestly, I think that term is dumb. Let’s call it the “not eating on a regular schedule” solution.

In my review of the alternate-day fasting articles, I’m going to go out on a limb and say what a stupid idea.

• Trepanowski John F, Kroeger Cynthia M, Barnosky Adrienne, et al. Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults. JAMA Intern Med. July 1, 2017;177(7):930-938. doi:10.1001/jamainternmed.2017.0936.

In the paradigm, they made folks alternate starving one day (25% of normal intake) and then gorging as much as they could (125%) the following day. In other words, these people live in a miserable world alternating from extreme hunger to pigging out and feeling gross. A bad idea like that should fail and it did in every possible way. How did an IRB approve this? Perhaps we should try a diet where you lock yourself in a room without food and only water for 24 hours and then sit down as a Las Vegas Buffet for the next 24? Why not 2 days?

I understand that there are millions of different ways that people are investigating the value of fasting, but this has to be about the dumbest one I’ve ever imagined. How could you possibly succeed by going through such extremes on a daily basis? More logical fasting says that your caloric intake stays the same, but you try to limit your total number of meals per day. We know already that hunger is the enemy, so placing people in a state of extreme hunger seems the foolish approach. As expected, they didn’t see any benefit between such a miserable strategy. Telling people that they should not eat enough food so that they are hungry all the time? Crazy.

The end result is this furthers my opinion that the solution actually has nothing to do with dietary interventions, because dietary interventions seem to go off the rails with some ideas that are almost guaranteed to be miserable for the patient. Why not tell people to occasionally skip a meal if they’re not very hungry, and then when they get used to it, keep skipping meals so that their overall intake decreases? And why not tell people when they are hungry to not gorge themselves on food, but to eat a little bit and then wait 15 minutes, have some water, and see if they are still hungry since there’s a good chance that hunger will pass? Sometimes the hunger won’t pass. The goal is not to eliminate eating every time, but to slowly decrease the amount of food that people eat and to respond differently to hunger sensations that may or may not be real.

Overall, articles like this increase my compassion for people with overweight and obesity. We provide stupid solutions as “experts” that inevitably fail (or cost a lot of money or alter their anatomy for life). That failure further harms their sense of self-worth and confidence, which decreases the chance of success with the next intervention proposed.

They need a nice simple idea that they can implement slowly and regularly throughout the rest of their lives. Then, slow steady progress will give them the confidence that they can continue to pursue such a strategy and build confidence that it will be effective. We also need to find a way that exercise is added to this model, so that people can slowly increase their activity and decrease sitting and passive movement. Here, too, they would find a nice simple strategy to alter their activity levels in a way that’s sustainable and progressive over time.

Again, the solution is simple (I didn’t say easy). We just need to look at complicated solutions (that often are made to look easy, but are not) and say “why?”