Time-Restricted Eating Put to the Test

Time-Restricted Eating Put to the Test
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Are there benefits to giving yourself a bigger daily break from eating?

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

The reason many blood tests are taken before eating after an overnight fast is that meals can tip our system out of balance, bumping up certain biomarkers for disease such as blood sugars, insulin, cholesterol, and triglycerides. Yet fewer than 1 in 10 Americans may even make it 12 hours without eating. As evolutionarily unnatural as eating three meals a day is, most of us are eating even more than that. One study using a smartphone app to record more than 25,000 eating events found that people tended to eat about every 3 hours over an average span of about 15 hours a day. Might it be beneficial to give our bodies a bigger break?

Time-restricted feeding is “defined as fasting for periods of at least 12 hours but less than 24 hours.” This involves trying to confine calorie intake to a set window of time, typically 3–4 hours, 7–9 hours, or 10–12 hours a day, resulting in a daily fast lasting 12-21 hours. When mice are restricted to a daily feeding window, they gain less weight even when fed the exact same amount. Rodents have such high metabolisms, though, that a single day of fasting can starve away as much as 15 percent of their lean body mass. This makes it difficult to extrapolate from mouse models. You don’t know what happens in humans until you put it to the test.

The drop-out rates in time-restricted feeding trials certainly appear lower than most prolonged forms of intermittent fasting, suggesting it’s more easily tolerable. But does it work? If you have people even just stop eating between 7 p.m. and 6 a.m. for two weeks, they lose about a pound each week, compared to no time restriction. Note: no additional instructions or recommendations were given on the amount or type of food consumed; no gadgets, calorie counting, or record-keeping. They were just told to limit their food intake to the hours of 6 a.m. through 7 p.m., a simple intervention, easy to understand and implement.

The next logical step was to try putting it to the test for months instead of just weeks. Obese men and women were asked to restrict eating to the eight-hour window between 10 a.m. and 6 p.m. Twelve weeks later, they had lost seven pounds. This deceptively simple intervention may be operating from a number of different angles. People tend to eat more food later in the day, and higher-fat foods later in the day. By eliminating eating in the late evening hours, one removes prime-time snacking on the couch, a high-risk time for overeating. And indeed, during the no-eating-after-7-p.m. study, the subjects were inadvertently eating about 250 fewer calories a day. Then, there are also the chronobiological benefits of avoiding late-night eating.

I’m going to do a whole series of videos about the role our circadian rhythms have in the obesity epidemic, how the timing of meals can be critical, and how we can match meal timing to our body clocks. Just to give you a taste, the exact same number of calories at dinner is significantly more fattening than the same number of calories eaten at breakfast.

Calories in the morning cause less weight gain than the same calories given in the evening. A diet with a bigger breakfast causes more weight loss than the same exact diet with a bigger dinner. Nighttime snacks are more fattening than the same snacks in the daytime. Thanks to our circadian rhythms, metabolic slowing, hunger, carbohydrate intolerance, triglycerides, and a propensity for weight gain are all things that go bump in the night.

What about the fasting component of time-restricted feeding? There’s already the double benefit of fewer calories and avoiding night-time eating. Does the fact that you’re fasting for 11 or 16 hours a day play any role, considering the average person may only make it about 9 hours a day without eating? How would you design an experiment to test that? What if you randomized people into two groups, and forced both groups to eat the same number of calories a day and both to eat late into the evening, but with one group fasting even longer—20 hours? That’s exactly what researchers at the USDA and National Institute of Aging did.

Men and women were randomized to eat three meals a day, or to fit all those same calories into a four-hour window between 5 p.m.  and 9 p.m.  and fast the rest of the day. If the weight-loss benefits from the other two time-restricted feeding studies was due to the passive calorie restriction or avoidance of late night eating, then presumably both these groups should end up the same, because they’re both eating the same amount, and they’re both eating late. But that’s not what happened. After eight weeks, the time-restricted feeding group ended up with nearly five pounds less body fat. About the same number of calories, but they lost more weight. A similar study with an eight-hour window resulted in three pounds more fat loss. So, there does seem to be something to giving your body daily breaks from eating around the clock.

Because that four-hour window was at night, though, they suffered the chronobiological consequences—significant elevations in blood pressures and cholesterol levels—despite the weight loss. The best of both worlds was demonstrated in 2018: early time-restricted feeding, eating with a narrow window earlier in the day, which we’ll cover next.

Please consider volunteering to help out on the site.

Image credit: Monoar Rahman Rony via pixabay. Image has been modified.

Video includes graphics from Vecteezy.com

Motion graphics by Avocado Video

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

The reason many blood tests are taken before eating after an overnight fast is that meals can tip our system out of balance, bumping up certain biomarkers for disease such as blood sugars, insulin, cholesterol, and triglycerides. Yet fewer than 1 in 10 Americans may even make it 12 hours without eating. As evolutionarily unnatural as eating three meals a day is, most of us are eating even more than that. One study using a smartphone app to record more than 25,000 eating events found that people tended to eat about every 3 hours over an average span of about 15 hours a day. Might it be beneficial to give our bodies a bigger break?

Time-restricted feeding is “defined as fasting for periods of at least 12 hours but less than 24 hours.” This involves trying to confine calorie intake to a set window of time, typically 3–4 hours, 7–9 hours, or 10–12 hours a day, resulting in a daily fast lasting 12-21 hours. When mice are restricted to a daily feeding window, they gain less weight even when fed the exact same amount. Rodents have such high metabolisms, though, that a single day of fasting can starve away as much as 15 percent of their lean body mass. This makes it difficult to extrapolate from mouse models. You don’t know what happens in humans until you put it to the test.

The drop-out rates in time-restricted feeding trials certainly appear lower than most prolonged forms of intermittent fasting, suggesting it’s more easily tolerable. But does it work? If you have people even just stop eating between 7 p.m. and 6 a.m. for two weeks, they lose about a pound each week, compared to no time restriction. Note: no additional instructions or recommendations were given on the amount or type of food consumed; no gadgets, calorie counting, or record-keeping. They were just told to limit their food intake to the hours of 6 a.m. through 7 p.m., a simple intervention, easy to understand and implement.

The next logical step was to try putting it to the test for months instead of just weeks. Obese men and women were asked to restrict eating to the eight-hour window between 10 a.m. and 6 p.m. Twelve weeks later, they had lost seven pounds. This deceptively simple intervention may be operating from a number of different angles. People tend to eat more food later in the day, and higher-fat foods later in the day. By eliminating eating in the late evening hours, one removes prime-time snacking on the couch, a high-risk time for overeating. And indeed, during the no-eating-after-7-p.m. study, the subjects were inadvertently eating about 250 fewer calories a day. Then, there are also the chronobiological benefits of avoiding late-night eating.

I’m going to do a whole series of videos about the role our circadian rhythms have in the obesity epidemic, how the timing of meals can be critical, and how we can match meal timing to our body clocks. Just to give you a taste, the exact same number of calories at dinner is significantly more fattening than the same number of calories eaten at breakfast.

Calories in the morning cause less weight gain than the same calories given in the evening. A diet with a bigger breakfast causes more weight loss than the same exact diet with a bigger dinner. Nighttime snacks are more fattening than the same snacks in the daytime. Thanks to our circadian rhythms, metabolic slowing, hunger, carbohydrate intolerance, triglycerides, and a propensity for weight gain are all things that go bump in the night.

What about the fasting component of time-restricted feeding? There’s already the double benefit of fewer calories and avoiding night-time eating. Does the fact that you’re fasting for 11 or 16 hours a day play any role, considering the average person may only make it about 9 hours a day without eating? How would you design an experiment to test that? What if you randomized people into two groups, and forced both groups to eat the same number of calories a day and both to eat late into the evening, but with one group fasting even longer—20 hours? That’s exactly what researchers at the USDA and National Institute of Aging did.

Men and women were randomized to eat three meals a day, or to fit all those same calories into a four-hour window between 5 p.m.  and 9 p.m.  and fast the rest of the day. If the weight-loss benefits from the other two time-restricted feeding studies was due to the passive calorie restriction or avoidance of late night eating, then presumably both these groups should end up the same, because they’re both eating the same amount, and they’re both eating late. But that’s not what happened. After eight weeks, the time-restricted feeding group ended up with nearly five pounds less body fat. About the same number of calories, but they lost more weight. A similar study with an eight-hour window resulted in three pounds more fat loss. So, there does seem to be something to giving your body daily breaks from eating around the clock.

Because that four-hour window was at night, though, they suffered the chronobiological consequences—significant elevations in blood pressures and cholesterol levels—despite the weight loss. The best of both worlds was demonstrated in 2018: early time-restricted feeding, eating with a narrow window earlier in the day, which we’ll cover next.

Please consider volunteering to help out on the site.

Image credit: Monoar Rahman Rony via pixabay. Image has been modified.

Video includes graphics from Vecteezy.com

Motion graphics by Avocado Video

Doctor's Note

Isn’t that mindblowing about the circadian rhythm stuff? Calories in the morning count less, and are healthier, than calories in the evening. So if you’re going to skip a meal to widen your daily fasting window, skip dinner instead of breakfast. I’ll get to the best-of-both worlds study next in The Benefits of Early Time-Restricted Eating.

If you missed any of the previous 12 videos in this fasting series, here they are:

If you missed my last video of the day, it’s the exciting announcement that How Not to Diet is hitting shelves on December 10. Check out the book trailer here, and you can still pre-order the book to get it right when it comes out.

If you haven’t yet, you can subscribe to my videos for free by clicking here.

81 responses to “Time-Restricted Eating Put to the Test

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  1. This is probably for people not eating whole food plant-based diets? I continually eat throughout the day because if I don’t I will probably lose more weight and my BMI is around 21. I don’t think I could comfortably get enough calories in a Time restricted window.

    1. Might it be that your are eating mainly the plant components of the Acheulian diet (nuts, seeds, cooked plants, little tubers etc) form 800ka years ago and not the Homo Sapiens diet (mainly cooked starches), from 300ka-100ka ago:

      From the article “Earliest evidence of the cooking and eating of starches”:

      “Starch diet isn’t something that happens when we started farming, but rather, is as old as humans themselves,” says Larbey. Farming in Africa only started in the last 10,000 years of human existence. Humans living in South Africa 120,000 years ago formed and lived in small bands. “Evidence from Klasies River, where several human skull fragments and two maxillary fragments dating 120,000 years ago occur, show that humans living in that time period looked like modern humans of today. However, they were somewhat more robust,” says Wurz.

      https://www.sciencedaily.com/releases/2019/05/190517115142.htm

    2. DavidW,

      I too eat all throughout the day, but small meals and even smaller snacks. I consider it as about 3 normal meals, but spread out. And my weight is fine — right in the middle of the BMI (because I’m shrinking! Worsening scoliosis doesn’t help.) Oh, and I eat whole plant foods, avoiding animal products and most processed foods, as well as added sugar, oil, and salt.

      In fact, I don’t do fasting blood tests, and haven’t for years. Because I think I’m slightly hypoglycemic, as well as needle phobic — a wicked combination early in the morning for blood tests! But, routine fasting blood tests are no longer recommended. There is apparently very little difference, at least for the lipid panels (as I recall), between fasting and non-fasting results. Fasting blood tests are done if any abnormalities are observed. So I’m surprised to see Dr. Greger mentioning them as routine. But then again, as he himself has frequently noted, it takes about 17 years from lab results to clinical practice, and these results are only a few years old.

    3. I’m pretty sure this article is for people who need to lose weight, rather than people not on a PBD. Even on a plant-based diet, weight loss is hard. Personally, I’ve lost only 20 lbs after being on PBD for a year. If I found something that worked with my schedule and I lost even just one pound a week, I would lose what I need to in 10 months. Maybe then, I’ll start to ‘worry’ about your point.

    4. I don’t eat past 7pm typically because I do feel better, but I eat when I get up when I feel like it. (In fact, I feel much better on an earlier schedule in general). I felt awful when doing the intermittent thing and basically needing to force myself to eat (in order to get proper servings in, such as in the daily dozen) when I wasn’t hungry. Contrary to feeling cleaner, I felt overwhelmed and more backed up. It really felt very unnatural and caused a lot of physical as well as psychological stress. I personally do not believe it is mentally healthy or particularly sustainable to make eating that complicated and “perfect.”

  2. This is the video I’ve been waiting for. I’ve been doing time restricted eating (noon to 6 pm) for so long that my body is totally used to it. I don’t get hungry until noon. I feel cleaner eating this way and find it’s easier to sleep when you’re not loaded down with food. Looking forward to the next video.

  3. What about restricted time eating for athletes who train twice per day, for example from 6:30 am to 8:30 am, and 7:30 pm to 9 pm?
    Is it benificial to keep fasting after training? Or is it more important to reload, even if it is later at night?

    1. Aiman I heard that working out while fasting leads to better results. I would personally eat afterwards. You need to fuel up. I would repeat the same thing with you
      Next workout. Hopefully dr. Greger can answer that.

    2. I would look to WFBP authors who have been professional athletes for advice on the issue: Joel Furhman or the Esselstyns. I would suspect that fasting after a workout is probably a bad idea. I am not sure how much of an authority Valter Longo is, but he said it is important to have most of your protein for the day within an hour or two following your workout. I believe he suggested 30g. You might look for ways to get this from easily digested protein foods for your evening post workout meal/snack.

    3. https://www.nomeatathlete.com › intermittent-fasting

      Training while Intermittent Fasting

      We have enough glucose stored in our liver to support moderate intensity activity for 90 minutes or so, and 30-60 minutes for high intensity. You can do these workouts without fueling. Keep in mind, however, that not fueling may impact your performance. If you find that’s the case, try doing your workout during your eating window or on non-fasting days. …If you are a marathon or ultramarathon runner or a distance cyclist, and your workouts last several hours, you will almost certainly need to fuel during those workouts. In that case, try to workout during your eating window, or don’t fast on the days when you do your long run. If that seems impossible to coordinate, then maybe intermittent fasting is not for you.

  4. I’m fasting from 7 pm until 11 am 16 – 8 I really gives your body the time to clean up an digest all of that food. I’m really interested in the new videos with the circadian rhythms. I do believe that fasting disrupts sleep.

  5. Dr. Greger, will all this fasting/circadian rhythm information be in “How not to Diet?” If so, I’m really looking forward to having it all put together! Pre-ordered on my Kindle –

  6. How could we possibly state as a fact that eating 3 meals a day is evolutionarily unnatural? And what happened to the theory of our ancestors eating fruit and foliage all day long? I don’t care how many feces fossils are collected and how many ideas make promising theories, it just seems impossible to factually know how many times a day our collective—as in throughout the globe—ancestors ate.

    1. I wouldn’t take too much notice of what our ancestors ate. The most important findings are of modern day science and biological markers from randomized tests.
      We are all human and can make our own choices. I eat PBD and fast 16 to 20 hours a day. I have more energy than when I was 20 years younger. Currently 56 with a young family.

      1. We do not know how they ate, but we have indications of what they ate. Also, we have acquired genetic modifications related to starch digestion (salivary amylase) about 300ka ago, indicating more cooked starches into the diet.

      2. I’m glad that works so great for you, David, those are some really cool results. For me, when I tried intermittent fasting two separate and fairly long term times in my life, I felt substantially worse than how I do on my non-intermittent WFPB diet. I do like to stop eating past 7 or at least 8 on a regular basis (with some exception), though, because I find that I feel my best when I do.?typically that leaves about 11 hours of not eating (I do drink tea) on average sometimes more sometimes maybe a little less but I don’t worry about it which in and of itself is a healthy act for me.

        The thing is, is there are actually very few studies showing how fasting and other controlled diets compare to a whole foods plant based diet. So even if improved markers in health are shown in studies of people doing intermittent fasting, it can’t be said how it would look side-by-side to a non faster, WFPB person or even a fasting WFPB person.

  7. The various parts of the body need differing periods of R&R. The gut lining cells, which together with skin are exposed to the outside world, take a beating. The gut lining cells only live a couple of days before they are replaced. While the brain gets R&R while sleeping, the gut cells get R&R between meals, first they do their job digesting the food. Then it best to give the gut some recovery time before you hit it with another meal. That is why between meal snacking is not good for digestive health, and a long overnight fast is healthy for the gut.

    1. “That is why between meal snacking is not good for digestive health”

      Evidence, please.

      I have never had digestive problems from snacking between meals on a healthy plant diet. I only had digestive issues occur on this diet when I ate when I wasn’t hungry in trying to do intermittent fasting. As far as snacks go, I would guess that an apple between meals will be beneficial to digestion, for example, vs a corn dog. As far as digestion goes, it seems dependent on what you eat more than anything else.

      1. that’s great, but just because this hasn’t caused problems for you doesn’t mean that’s the case for the majority of people. I had a viral infection that made my digestion very poor for 6 months, and it made it even worse when I ate frequently. however both of our cases are nothing but anecdotes. everyone is different. the digestive system (and the rest of the body) generally benefit from having breaks from working on digestion so energy can be allocated to other cleanup and recovery, this is simply what the research currently shows.

        1. “that’s great, but just because this hasn’t caused problems for you doesn’t mean that’s the case for the majority of people“

          Likewise, angelacatalano. Just because it has caused problems for you, does not mean it causes problems for the majority of people. Yes, anecdotes indeed, which is why I requested evidence for the statement made above. And the same goes for your statement that such evidence does exist… What evidence? What evidence exists that shows that eating more frequently or snacking between meals as opposed to solely eating meals with no snacking or as opposed to intermittent fasting, healthy food (this can mean anything but I assume most of us here understand what real healthy food is), causes problems with digestion?

          Obviously if someone snacks more frequently on refined foods and/or animal products, their digestion would likely suffer. You would need controlled studies evaluating the more frequent consumption of whole plant foods (between meals or more frequent smaller meals) compared to a group on the same diet with no snacking.

          I know people with digestive problems who can only eat small amounts at once and get sick from large meals. I’m sure there are many variables and many right ways to do a healthy thing. Much fewer wrong ways, though.

          1. I also hypothesize based on my personal experience but mostly on the work of Elizabeth Blackburn and Elissa Epel, that worrying or obsessing to a degree that many do now with timing, etc, etc, is very harmful to health. Again, my own hypotheses.

    2. I have been eating between 8am and 5pm,approximately, for the past few months now. Three meals, on the small side, and sometimes just two, no snacks. I was just trying to cut down on eating out of habit vs being hungry. I feel much better, sleeping better, and manage to schedule around gym time comfortably.

      1. Am happy to hear you’ve been keeping it up, Barb. *thumbs up*

        But you’re stronger than I am. I still like to have my three squares. And those meals aren’t so “small.”

  8. In 2009, when I was unemployed, I fell into a 10am and 4pm meal pattern. It was the happiest meal pattern for my body. Too bad it is so difficult to follow that schedule while working full-time. I should try to work out a compromise that comes close.

  9. Funny thing: non-American cultures have known this for centuries. Relatives who live in Germany have always had a moderate breakfast. The “big” meal of the day is at noontime. In the evening, dinner was very light: some fruit, cheese, maybe sliced meats and then shut the mouth for a 10-12 hour fast. In parts of Mexico even today, the big meal is lunch followed by a siesta – what a nice way to live.

    1. Why would it be different? I’ve been doing intermittent-fasting for more than 6 months. I try to quit eating between 5pm-7pm & then eat at around 11am. It takes 12 hours of fasting, water is okay, coffee & tea are NOT, & then your body begins to cannibalize defective fat cells, including senescent cells in the brain, which have been related to cognitive disorders. I think this is a much more important reason to engage in intermittent-fasting, regardless of your work schedule. Your body gets very used to it. The only time it’s weird for me is Friday night dinner which is late, but I still try to finish eating by 8p or 9p, so even if I eat the next morning at 10:30am or 11am, I’ve still got my 12 hrs plus 1.5-2 of cannibalizing defective fat cells.

          1. It seemed to me that she was addressing two separate questions 1). black coffee 2). amino acid supplements

            Admittedly, coffee does contain trace amounts of some amino acids but the amount is so small as to be negligible.

    1. It’s absolutely not cheating to fast while you sleep! i usually fast 7 pm to 10 or 11 AM and have found it really helps me control my appetite. Feeling hungry is normal and we don’t have to eat every time we feel it a little. the problem is eating too close to bed and having your body not digest before it slows down to sleep.

  10. Why did the video at 5:00 mention significant elevations in blood pressure, but then list ~116/70 for the blood pressures in the group? That’s a very healthy blood pressure.

    1. Yes but it was higher than the 110/66 in the non TRF group.

      “Significant’ here means statistically significant (not ‘big’)

  11. I have more difficulty sleeping well than maintaining my weight. Does anyone find that Time Restricted Eating helps with insomnia, particularly sleep maintenance? I feel if I don’t have a light snack two hours before bed, I wake up hungry in the middle of the night. I often am awake in the middle of the night much of the time, regardless.

    1. Yes, but I have the opposite problem – I sleep badly if I eat too close to my bedtime. I need at least three hours without food before bed. I know he’s Oprah-trendy (Oprendy?), but Dr. Breus’s ideas about sleep have helped me considerably. He’s not a good person to listen to about nutrition, but on circadian patterns and related sleep issues, he is helpful. The animal chronotypes sound goofy, but for me, the description and suggestions were spot-on.

  12. Watching what David Sinclair has been discussing on various YT channels, he’s implying that with various nutraceuticals/drugs you could reverse ageing and eat a high fat diet. Some of the nutraceuticals include metformin, niacinimide mononucleotide and nicotinamide riboside, trans-resveratrol. It’s a little out there but with the vegan diet you have to take b-12 tablets so it’s not that much different. Except for the cost.

  13. Wonderful information! I’ve never needed to lose weight and am plant-based and gluten free. I have noticed that when I follow this method I have less hormonal acne and I sleep a lot better. I’m a seventh day Adventist and we have been into health for over a century and we have generally advocated a early time restricted diet for general health.

    1. That’s really interesting, Rae Mora! I knew that Seventh Day Adventists have many good health habits, but I didn’t know they advocated time restriction. Can you give us the general guidelines?

    2. Thanks for your comment. Great that you are having plant based and gluten free diet that is working for you. The Adventist Health Study (AHS-2), which involved more than 96,000 Adventists and looked for links between diet, disease, and lifestyle found that those who followed a vegetarian diet had a significantly lower risk of obesity, high blood pressure, and high blood sugar — all of which are strong risk factors for heart disease. I wish you good health.

    3. ‘The reason health professionals don’t want to see people on gluten-free diets unless absolutely necessary is that for the 98% of people that don’t have gluten issues, whole grains—including the gluten grains wheat, barley and rye—are health promoting, linked to the reduced risk of coronary heart disease, cancer, diabetes, obesity and other chronic diseases.’
      https://nutritionfacts.org/video/gluten-free-diets-separating-the-wheat-from-the-chat/

  14. Re: carbohydrate intolerance in the sentence: “Thanks to our circadian rhythms, metabolic slowing, hunger, carbohydrate intolerance, triglycerides, and a propensity for weight gain are all things that go bump in the night.”

    I thought that humans are supposed to eat carbohydrates, the more, the better. Like DavidW I eat a starch-based plant diet very successfully as do others that I know personally. I even know people who have been sick for years while eating a whole-food plant diet who turned that around by tweaking it with McDougall’s Starch Solution.

    That’s why I was shocked at the mention of carbohydrate intolerance. Could that be a typo? Or does it only refer to Twinkies and such?

    1. It just means that we don’t deal with carbohydrates as well later in the evening than we do earlier in the day. Definitely whole food plant based carbs are the way to go, and eating them before 7 pm (or earlier) allows our body to metabolize them easier. I would assume that this also applies to fats and protein.

      However, one caveat not mentioned in the video is we seem to also have more insulin resistance early in the morning because our higher cortisol levels (to wake us up) also cause insulin resistance. https://www.todaysdietitian.com/newarchives/111609p38.shtml and https://adrenalfatiguesolution.com/cortisol-levels-change-throughout-day/

      So I’m guessing that best times to eat range between 10 AM and 7 PM.

    1. ‘Just saw this – it might be of interest’

      Proof reading before posting – rather then after posting – might be the way to go?

  15. People for years have pointed to front-loading meals and suggesting an early cutoff time at night may be beneficial. But, as many of us know, assumptions are often foolish.

    This is going to be a great video series by Dr. G since he’s presenting the theories that have actually been put to the test. Thanks always, Dr. G!!

  16. Hi, I am posting a paragraph from Bottomline Health, Jul 2019 Vol 33/No 7, p. 3, “Heard by our Editors” section. “Skipping breakfast and eating a late dinner hinders heart attack recovery, we hear from Marcos Minicucci, MD. New Study: heart attack sufferers with these eating habits were four to five times more likely to die, have another heart attack or suffer from angina within 30 days of hospital discharge. Each habit alone was also linked to these outcomes. Marcos Minicucci, MD, professor of medicine, Sao Paulo State Unversity, Brazil.”

  17. ps – I have found only one real article on this by the cited author,
    European Journal of Preventive Cardiology, Skipping breakfast concomitant with late-night dinner eating is associated with worse outcomes following ST-segment elevation myocardial infarction.
    Article first published online: April 17, 2019. https://doi.org/10.1177/2047487319839546. PMID: 30995859
    Guilherme Neif Vieira Musse, Tayná Moreira, Maisa Ayumi Kimura, Filipe Welson Leal Pereira, Katashi Okoshi, Silmeia Garcia Zanati, Paula Schmidt Azevedo, Bertha Furlan Polegato, Sergio Alberto Rupp de Paiva, Leonardo Antonio Mamede Zornoff, Marcos Ferreira Minicucci
    Internal Medicine Department, Botucatu Medical School, Brazil

    Corresponding Author:

    Marcos Ferreira Minicucci, Internal Medicine Department, Botucatu Medical School, UNESP, Rubião Júnior s/n, Botucatu, SP, Brazil. Email: minicucci@fmb.unesp.br
    ————————-
    The article seems less general than implied by the paragraph I posted. The article indicates, “Epidemiological and interventional studies suggest that skipping breakfast and late-night dinner eating (LNDE) are associated with a greater risk of obesity, insulin resistance and cardiovascular diseases.6–9 Thus the objective of this study was to evaluate the association between skipping breakfast concomitant with LNDE and the primary composite endpoint of death, reinfarction and postinfarction angina within 30 days after hospital discharge following ST-segment elevation myocardial infarction (STEMI).”

    In total, 126 patients were evaluated, but eight were excluded because of the need for mechanical ventilation and five because of altered mental status. Thus 113 patients with a mean age of 59.9 ± 11.1 years were included in the analysis. Among these patients, 73% were men, 5.3% died, 17.7% had reinfarction or postinfarction angina and 23.0% experienced the primary composite endpoint within 30 days after hospital discharge. The eating behaviour skipping breakfast was observed in 57.5% and LNDE in 51.3%. Concomitant behaviours were present in 40.7% of the patients.

    The demographic, clinical, laboratory and echocardiographic data are shown in Table 1. Patients who smoked and had the concomitant behaviours of skipping breakfast and LNDE had more primary outcomes. Importantly, the patients of both groups received adequate treatment. The patients who died or had reinfarction or postinfarction angina within 30 days after hospital discharge had lower levels of total and low-density lipoprotein (LDL) cholesterol and higher values of left ventricular diastolic diameter. It is important to observe that there were significantly more patients using statins before hospital admission in the group with unhealthy eating habits (yes 76.2% vs. no 34.5%; P < 0.001) and with worse outcome (yes 72% vs. no 45.8%; P = 0.028). Despite that, Johal et al. showed that statin users were less likely to consume high levels of saturated fat than non-users. 10

    In the multiple logistic regression analysis, concomitant skipping breakfast and LNDE, when adjusted by age, gender, CK-MB, and ejection fraction (odds ratio (OR) 4.229, 95% confidence interval (CI) 1.602–11.159; P = 0.004) and when adjusted by tobacco smoke, LDL-cholesterol and left ventricular diastolic diameter (OR 5.050, 95% CI 1.699–15.004; P = 0.004) was associated with the primary composite endpoint.

    In conclusion, the association between skipping breakfast concomitant with LNDE increases four to fivefold the likelihood of death, reinfarction and postinfarction angina within 30 days after hospital discharge.
    ———————–
    I am not a statistician but it seems to me there are a number of important additional factors involved and there are no details here indicating to me how the "adjustments" were made or whether I should put stock in them.

    1. rickh4136, thank you for the article cite, I’m off to read it. This is a subject I will be spending time within the upcoming year – I have much room for improvement in meal timing. I haven’t been able to face breakfast in the early morning since puberty, which from conversations is fairly common among us females – maybe this is related to the same thing that causes morning sickness in pregnancy? Anyway, I eat breakfast, but not until 9:30. One of the other apparent advantages of eating breakfast is good sleep patterns. Apparently, eating in the morning starts our chronological clock. I hope Dr. Greger will keep revisiting the circadian aspect of eating well.

  18. Hi guys! Just need some clarity. Considering that calories in the evening contribute more to body fat that calories in the morning, should I still mind this even if I am on a plant based diet? My usual dinner is made up of whole foods just a splash of oil for sautéing. Since I get off work late, will my dinner contribute to my body fat even if it is mostly whole food plant based? Thank you in advance!

    1. Hi, hopefully this goes to the blog as well. I am not a nutritionist, but eating more calories than you need will generally go to fat stores. (I guess there is some nutritional content relation to exactly what proportion may find its way to muscle.) Eating late at night will apparently raise the bar re the calorie content that gets burned, i.e. it will be easier to overeat. None of this answers the question of whether or not you are overeating, which depends on your BMI, weight, metabolic rate, etc. I hope that makes some sense.

    2. You are doing a good job in eating a plant based diet, but you cannot ignore the research that states we do better eating early. Since you work late, following a schedule that allows you to eating earlier may not work for you and stressing about that will not help. You could see if you can still eat more before you work and have a lighter meal or snack later. You could perhaps explore how many of us have learned to get away from using oil which would be one way to minimize risk of body fat. Here are two resources for that.https://www.forksoverknives.com/plant-based-cooking-how-to-cook-without-oil/#gs.q5s74y
      https://www.ornish.com/zine/cooking-without-oil/
      Hope this helps. .

    3. Nadine, this is just personal and anecdotal, but when I moved to working late and ate most of my calories during my evening dinner, I gained weight – on exactly the same WFPB food I’d been eating before. It was very frustrating. I don’t work as late in my current job, but it still makes dinner late when I work until 6pm and have a 30-minute commute. I pack breakfast to eat on my morning break and a large lunch. My husband and I have a light dinner when I get home (or at least that’s the plan). I used to take a half-hour lunch and leave at 5:30, but traffic made my commute slower and it didn’t help much. Now I take an hour lunch that includes both a walk and eating. I’m lucky to have a certain amount of flexibility in my schedule, but maybe there’s some room for adjustments in yours?

      1. Something else that might work is shifting some of the dinner calories to lunch and/or breakfast. Also committing to not eating anything after dinner is very helpful for us but sometimes takes more discipline than we like. Of course sometimes we fail. (:

  19. Here are some of the questions that remain unanswered even from the studies cited by Dr. Gregor.

    Time restricted or intermittent fasting works.
    Whole Food Plant Based Diets work.
    Is eating a WFPD diet better if you follow it all day as compared to four hours?
    If your feeding window is four hours you will lose more fat by eating in the morning than at night. Probably?
    What about if your eating window during the day is eight, ten or twelve hours but your window at night is four hours?
    What if your nightime snacks are blueberries and apples?
    Is eating between 10AM and 6PM really better than eating between 4PM and 8PM?
    What about weightlifting or running at night before I eat?
    What if I break my fast with Apples and Carrots and start to become full?

    The big benefit of intermittent fasting is BEHAVIORAL. I get up and go to work keep busy and food really is not on my mind.
    When we think of dinner we think of being with family sitting down for dinner etc.

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