New research, published in Diabetologia today, indicates that people with type 2 diabetes may benefit from following a time-restricted eating (TRE) protocol that limits food intake to a 10-hour window.
Prof. Patrick Schrauwen, Charlotte Andriessen, and colleagues at Maastricht University Medical Center’s NUTRIM School of Nutrition and Translational Research in Metabolism carried out the research.
Our modern society, which is open 24 hours a day, is characterized by an endless supply of food and a messed-up day-night cycle caused by irregular sleep-wake cycles and a lot of exposure to artificial light. Additionally, people in Western countries frequently spread out their daily calorie intake over a minimum of 14 hours, which is likely to prevent them from experiencing a real nocturnal fast. The World Health Organization estimates that these factors together cause more than 1.5 million deaths annually from T2D, one of the most prevalent metabolic illnesses in the world.
TRE is a unique technique for enhancing metabolic health that aims to reverse the negative effects of eating during the day by restricting the duration of food intake (usually 12 hours or less) and restoring the cycle of daytime feeding and prolonged fasting throughout the evening and night.
Although these effects have not been well investigated, prior research indicates that TRE causes positive metabolic changes in overweight or obese individuals, including increased fat burning, lower blood sugar levels, and improved insulin sensitivity. Even though these results are promising, these studies used very short eating windows (6–8 h) and very controlled study settings, which makes it hard to use these protocols in real life. TRE has been shown to improve metabolic health without causing weight loss, which suggests that additional mechanisms are at play when restricting caloric intake has a metabolic health-improving effect.
The authors hypothesize that a disturbed fed-fasting cycle contributes to the abnormalities in metabolic rhythms observed in people with impaired metabolic health when compared to healthy, lean individuals. To improve metabolic health, they recommend restricting meal intake to the daytime and increasing the length of the overnight fast.
For the study, the team included 14 people with T2D who were between the ages of 50 and 75 (7 men and 7 women, with an average age of 67.5 years) and had a body mass index (BMI) of less than 25 kg/m2. The trial was divided into two 3-week TRE and CON intervention periods, with a washout interval of at least 4 weeks in between. Participants were given a body weight assessment at the beginning of each session, as well as a continuous glucose monitoring (CGM) device that took blood sugar readings every 15 minutes. They were told to stick to their typical sleeping and exercise routines and to maintain a constant weight. For the second intervention, a food and sleep diary was used to make sure that both the quantity and quality of the diet were consistent.
Participants in the TRE were given the instruction to finish eating within a 10-hour window during the daytime and no later than 1800H. Outside of this window, they could drink water, plain tea, or black coffee. They could also drink zero-calorie soft drinks in the evening, but only in small amounts. During CON, subjects were just asked to consume their normal diet over a minimum of 14 hours, with no extra restrictions.
The eating window for TRE was 9.1 hours on average as opposed to 13.4 hours for CON, and both groups had similar sleep-wake patterns with mean sleep duration of 8.1 and 8.0 hours, respectively. Mean body mass at the start of TRE and CON was similar, however, TRE led to a slight but statistically meaningful weight decrease while CON did not.
TRE was observed to reduce 24-hour glucose levels, mostly due to reduced nighttime blood sugar, and the average time spent with blood glucose in the normal range increased to 15.1 hours, compared to 12.3 hours during the CON phase.
The TRE group consistently had lower morning fasting glucose than those following the control diet, which might be the result of long-lasting modifications in nocturnal glucose regulation.
An eating window of approximately 10 hours is a safe and effective lifestyle intervention for adults with T2D, as shown by the fact that TRE did not significantly increase the amount of time spent in hypoglycemia (low blood sugar) and that no serious adverse effects were reported as a result of the protocol.
Approximately halfway through each intervention, liver glycogen levels were evaluated in the morning after a 10 h or 14 h night-time fast, and again at the end of each research period after an 11 h fast for both TRE and CON. In both cases, there was no significant difference in liver glycogen between TRE and CON, and an examination of liver fats revealed no variation in quantity or composition between therapies.
Unlike a prior investigation studying TRE, this one found no effect on insulin sensitivity; however, the previous study had a significantly shorter 6 h food consumption window, with the last meal consumed at 15:00 h.
This resulted in a longer fasting time, which may have been more effective but was deemed impractical for the majority of persons with type 2 diabetes.
“Future studies will be needed to reveal whether the duration of the fasting period is indeed crucial in determining positive effects on insulin sensitivity,” advise the authors.
“Mechanisms underlying the improvement in glucose regulation upon TRE remain unclear. Our results show,” the authors write, “that TRE did not improve peripheral and liver insulin sensitivity, skeletal muscle mitochondrial function, energy metabolism or liver fat content, all of which are known to be affected in T2D.”
They suggest that additional research be done on the effects’ underlying processes and their ramifications, with an emphasis on learning more about nocturnal glucose metabolism.
This research is limited by its extremely brief length and the fact that some, but not all, participants were using the glucose-lowering medication, which may have diminished the benefit of TRE. A 3-week intervention time, however, was shown to be sufficient for affecting the variables being studied, and the authors stress the reduction in the study’s relevance to the broader T2D population if only volunteers who were not on medication were recruited.
According to the scientists, spreading daily calorie consumption over at least 14 hours results in lower glucose levels and longer periods of time spent in the normal blood sugar range in persons with T2D. These findings demonstrate the potential value of TRE in T2D.
“A daytime 10 h TRE regimen for 3 weeks decreases glucose levels and prolongs the time spent in the normal blood sugar range in adults with T2D as compared with spreading daily food intake over at least 14 h. These data highlight the potential benefit of TRE in T2D,” they conclude.
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