Athletes and active individuals often seek to improve their body composition by increasing muscle mass with minimal fat gain or by decreasing body fat while maintaining existing muscle mass. A combination of exercise and nutritional interventions is typically recommended to pursue these goals (12). Within athletic populations, achieving a low body fat percentage is particularly important for those competing in weight-restricted or “body composition sensitive” sports such as mixed martial arts, boxing, wrestling, gymnastics, rock climbing, and figure skating. For combat athletes trying to lose weight, the most common dietary strategy is limiting daily caloric intake so that caloric consumption is less than the amount needed to maintain existing body weight (9,37). To achieve this goal of daily caloric restriction, several dietary strategies are commonly used by individuals in an attempt to lose weight such as eating smaller and more frequent meals throughout the day, limiting carbohydrate consumption, limiting fat intake, and increasing protein intake. However, daily caloric restriction can be difficult to maintain over long periods of time.
In weight-restricted combat sports such as boxing and mixed martial arts, it is not uncommon for athletes to lose relatively large amounts of body weight before competition (9). After competition, significant amounts of weight are often regained because of the difficulty of maintaining a particular dietary strategy. If this happens, combat athletes may attempt to rely on more rapid, and potentially life-threatening, weight loss strategies to prepare for subsequent competitions. This may involve losing large amounts of “water weight” in the days before their official “weigh-in” or competition, which can adversely affect performance and well-being (9). Thus, combat athletes in particular may benefit from a dietary strategy that could theoretically be maintained throughout the year and potentially minimize large perturbations in weight between competitions. This may mitigate the need to lose as much “water weight” leading up to competition, thereby allowing a potentially less difficult and safer weight cut.
Intermittent fasting (IF) is one potential strategy of interest to weight-restricted athletes. IF uses regular short-term fasts with the goal of improving body composition and overall health. Although IF is a broad term that encompasses a number of specific programs, most forms can be divided into the following categories: time-restricted feeding (TRF), alternate-day fasting (ADF), whole-day fasting (WDF), and Ramadan IF. It is important to note that many IF programs use modified fasting rather than true fasting. True fasting requires abstinence from all caloric intake, but modified fasting allows small amounts of caloric intake. Even during modified fasting, the total energy consumed is drastically lower than weight maintenance energy needs. Modified fasting can be viewed as following a very low–calorie diet but only on certain days or parts of days.
Time-restricted feeding (e.g.,Warrior Diet (26) and Leangains method [The Leangains Guide, Intermittent fasting diet for fat loss, muscle gain and health. Available from: http://www.leangains.com/2010/04/leangains-guide.html]) typically consists of following the same eating pattern each day, with certain hours comprising the fasting period (12–20 hours) and the remaining hours comprising the feeding window. There is variability between programs in the placement of the fasting and feeding periods during the day, but it is most common to place the feeding period in the evening. Alternate-day fasting alternates between ad libitum feeding days (i.e., unrestricted eating) and pseudofasting days that allow 1 meal containing ∼25% of daily calorie needs. Whole-day fasting (e.g., Eat Stop Eat (42)) consists of 1–2 days of fasting per week and ad libitum eating on the other days.
Ramadan IF is primarily a religious fast rather than a fasting regimen used specifically to enhance body composition and health. The effects of Ramadan on body composition and athletic performance have been previously summarized (1,13,14,47) and will not be the focus of this review. It is important to note that both food and fluid intake are restricted during Ramadan. The potential impact of dehydration and altered sleep schedules during Ramadan make interpretation and application of these studies more difficult.
Although the majority of the research to date has not been conducted with an athletic population, the current body of evidence demonstrates potential benefits and concerns of IF programs and sets the stage for future studies in athletes. The purpose of this review is to discuss the existing research in the realm of IF, particularly effects on body weight and composition, and to discuss its potential applicability as an alternative dietary strategy for athletes competing in weight-restricted sports.
METABOLIC CHANGES OF FASTING
During short-term fasting, a transition in substrate utilization occurs, which decreases reliance on carbohydrate and increases reliance on fatty acids (49). Although blood glucose levels decline, whole body lipolysis and fat oxidation increase throughout the first 24 hours of food deprivation (32,44,49). The time period between 18 and 24 hours of fasting has shown an ∼50% decrease in glucose oxidation and an ∼50% increase in fat oxidation (32). It is thought that increased sympathetic nervous system activity, higher concentrations of growth hormone, and reduced insulin concentrations may contribute to this shift in substrate utilization (36,49).
One concern associated with fasting is that muscle will be catabolized to provide substrate for gluconeogenesis. It is known that humans adapt to prolonged starvation by conserving body protein (10,45), but increased proteolysis has been seen during short-term fasting studies (21,41,43,56). However, the majority of these studies compared measurements taken after an overnight fast with those taken 60+ hours later (21,41,43). Because the duration of fasts during popular IF protocols is much shorter than 60 hours (e.g., up to 24 hours), it is possible that muscle mass loss does not occur to the same extent during shorter fasts.
Early literature examining complete fasting reported that protein catabolism did not begin to increase until the third day of fasting (5), and Soeters et al. (48) found that 2 weeks of ADF (alternating between 20-hour fasting and 28-hour feeding) did not alter whole-body protein metabolism in lean healthy men. Although these metabolic changes are interesting, it should be noted that the effects of habitual short-term fasts may be different than brief periods of short-term fasting in individuals who typically follow a normal eating pattern. Studies that specifically examine IF protocols and track changes in body composition are the best evidence regarding the effectiveness of these programs.
Alternate-day fasting is one of the more commonly studied forms of IF. Alternate-day fasting consists of alternating between ad libitum feeding days and modified fasting days that typically allow 1 meal containing ∼25% of daily calorie needs. This meal is usually consumed midday. Studies have consistently shown body weight reductions of ∼3–8% (6,16,17,24,25,28,34,58–60) and decreases in fat mass of ∼4–15% (6,16,17,24,25,34,57,58,60). The majority of studies have reported these results in obese (6,16,17,25,28,34,58,59) and overweight subjects (18,25,59,60); however, this has been demonstrated in normal weight subjects as well (24,60). Table 1 presents an overview of the methods and results of ADF studies. The majority of studies used both male and female subjects but did not specifically examine or report sex differences.
Results regarding changes in fat-free mass have been mixed: no change was reported in several studies (34,58,60), whereas others reported a decrease (6,16,24,25), and some did not report fat-free mass changes (17,28,59). Varady (57) stated that it appears that a lower proportion of lean mass is lost during intermittent caloric restriction (∼10% of weight loss as lean mass) compared with daily caloric restriction (∼25% of weight loss as fat mass), but no ideas concerning the potential mechanisms behind this observation were provided. These percentages were based on comparing only 3 studies of IF with 11 studies of daily caloric restriction. There were also differences in body composition assessment (i.e., dual energy x-ray absorptiometry [DXA] versus bioelectrical impedance analysis [BIA]) and study design (e.g., level of caloric deficit) that should be considered. Without further research, it cannot be said whether IF leads to a lean mass-sparing effect.
Whole-day fasting typically consists of 1 or 2 days of complete or modified fasting each week. Whole-day fasting studies (3,23,27,33,54,55,65) have reported reductions of ∼3–9% in body weight, as well as decreased body fat mass. No change in lean mass was observed in 3 of the studies (23,33,55), but Teng et al. (54) reported a ∼1% decrease after 12 weeks of WDF. Two studies did not report changes in lean mass (27,65). A limitation of these studies is that only one used DXA to evaluate changes in body composition (33), whereas the remainder used BIA. Table 2 presents an overview of the methods and results of WDF studies. Contrary to ADF, most WDF studies have examined solely male (27,54,55) or female (23,33) subjects, rather than a combination. However, based on the differences between experimental design and subjects used (i.e., normal weight and overweight males versus obese females), it is not possible to determine sex differences in the responses to these programs at this time.
When Ramadan IF studies are excluded, there is very little research examining TRF programs. Stote et al. (50) conducted a study of TRF, which used daily 20-hour fasts in male and female participants (age: 45.0 ± 0.7; mean ± SEM). The study used a randomized cross-over design with two 8-week periods of eating either 1 meal per day or 3 meals per day. These 2 phases were separated by an 11-week washout period, and all food was provided to the subjects throughout the study. During the 1 meal per day phase, participants consumed all their calories within a 4-hour window of time in the evening. After eating 1 meal per day, as compared with 3 meals per day, lower-body weight (65.9 ± 3.2 kg versus 67.3 ± 3.2 kg) and fat mass (14.2 ± 1.0 kg versus 16.3 ± 1.0 kg) were reported. Although both treatments were designed to be isocaloric, the subjects ate ∼65 fewer calories per day during the 1 meal per day phase of the study because of “extreme fullness” and difficulty eating all the food in the allotted time window (50). It is possible that individuals would have eaten even less if they had been free to choose when to stop eating, and a lower level of energy intake could have led to even greater weight loss. The ability to adhere to this type of eating pattern is questionable, as indicated by higher ratings of hunger and desire to eat in the 1 meal per day group. The severity of these phenomena increased throughout the study, indicating that the subjects did not grow adequately accustomed to the eating pattern.
Stote et al. (50) also reported a trend (p = 0.06) for greater fat-free mass after consuming 1 meal per day (50.9 ± 0.4 kg) than after consuming 3 meals per day (49.4 ± 0.4 kg). It should be noted that body composition was assessed using BIA, which has been previously questioned in regard to fat-free mass measurements during fasting. Faintuch et al. (18) examined nonobese individuals undergoing a complete fast for 43 days (subjects only ingested water, vitamins, and electrolytes). During the later stages of fasting (between the 31st and 43rd day), BIA reported unrealistic increases in fat-free mass, and the authors stated that these findings must be rejected because of questionable plausibility. However, the fasting protocols used by Stote et al. (50) and Faintuch et al. (18) varied considerably. Subjects in the study by Stote et al. (50) did not undergo complete fasting for even 1 entire day, and the dietary changes made were not nearly as extreme as those in the study by Faintuch et al. (18). Taken together, these studies may demonstrate that BIA is not the optimal tool for measuring lean mass changes during such fasting protocols, and the trend for greater fat-free mass reported by Stote et al. (50) should be interpreted cautiously.
No exercise intervention was used in the study by Stote et al. (50), and no changes in physical activity were found throughout the course of the study. It should be noted that there was a 28.6% withdrawal rate from the study, indicating that some individuals may not be able to adhere to this pattern of eating. However, there is limited long-term success of maintaining weight loss induced by a daily hypocaloric diet (7,64).
INTERMITTENT FASTING AND EXERCISE
To our knowledge, only one study has examined combining an IF protocol with an exercise program (6). The study examined 4 groups: ADF, ADF plus exercise, exercise alone, and control. Twelve weeks of supervised endurance exercise on stationary bikes and elliptical machines was implemented in the 2 exercising groups. Subjects exercised 3 times per week, beginning with 25 minutes at 60% of their age-predicted maximum heart rate (HRmax) and progressing to 40 minutes at 75% HRmax over the course of the study. It was not reported whether subjects exercised on modified fasting days or on ad libitum feeding days, as well as whether subjects exercised in a fasted or fed state.
The ADF plus exercise group lost more weight and fat mass than any other group. The ADF and exercise alone groups both lost weight and fat mass but did not differ in the amount lost. There were no differences between groups for fat-free mass changes, although the ADF did exhibit a small decrease in fat-free mass. Lean mass was retained in the group that exercised and followed ADF, and the authors reported that the exercise program may have been responsible. A limitation of this study is that BIA was used to measure body composition.
REDUCING MEAL FREQUENCY
Meal frequency is often a polarizing topic, and many fitness practitioners recommend a relatively high meal frequency. Although the number of studies specifically examining different IF protocols is limited, investigations of meal frequency alterations can provide some additional information about effects of decreasing meal frequency.
In 1997, Bellisle et al. (4) critically examined the literature to assess whether there are benefits of increasing meal frequency to reduce body weight. They concluded that epidemiological evidence for these benefits is very weak. They also identified 2 major issues with observational studies of meal frequency and weight gain: post hoc changes in meal frequency after weight gain and misreporting of energy intake (4). The post hoc changes occur when individuals skip meals to maintain or lose weight after weight gain has already occurred (4,51), generating an artificial inverse relationship between meal frequency and body weight. Misreporting of energy intake is well documented, and data from NHANES I Epidemiological Follow-Up Study point to widespread underreporting of food intake, particularly by those who are overweight and reported low meal frequencies (4,29). In the NHANES data, reported energy intake shows an inverse relationship with body mass index and skinfold thickness that appears to be inexplicable apart from underreporting of energy intake (4).
The conclusions reached by Bellisle et al. (4) were largely echoed in 2011 through an updated review on meal frequency by La Bounty et al. (35) who concluded that although some observational studies support an inverse relationship between body weight and meal frequency, the majority do not support this (in normal weight, overweight, and obese subjects). In addition to the mixed results and potential problems with observational studies, it was concluded that the majority of the experimental studies fail to find any consistent improvements in body weight or body composition through higher meal frequencies (8,11,19,20,22,35,50,62,66). It also appears that the thermic effect of feeding is unchanged by alterations in meal frequency (4,31,35), although some studies have shown increases (39,52) or decreases (38) in response to lower meal frequencies. More importantly, the evidence indicates that there is no change in 24-hour energy expenditure after alterations in meal frequency ranging from 2 to 7 meals per day (15,22,53,61–63,66).
Recently, Schoenfeld et al. (46) conducted a meta-analysis evaluating experimental research of meal frequency as it relates to body composition. Although the initial results of the analysis seemed to favor increased meal frequency for improvements in body composition, a sensitivity analysis revealed that a single study was responsible for this result. The authors concluded that if any benefits to higher or lower meal frequencies exist, they are likely to be negligible in terms of practical significance, and personal choice should largely dictate the selection of a meal frequency to enhance compliance.
It should be noted that the line between decreased meal frequency and IF protocols is somewhat blurred. Intermittent fasting, by definition, is a systematic reduction in meal frequency. However, IF emphasizes extending periods of fasting or modified fasting, which is not necessarily the case when meal frequency is otherwise reduced. For example, a diet that reduces meal frequency may include meals at breakfast and dinner, which leads to a significantly shorter daytime fasting window (∼6–10 hours) than most of the IF protocols use. As discussed, this prolonged fasting window may have beneficial effects on lipolysis and lipid oxidation, which could potentially lead to improved fat loss.
The lack of research specifically examining the effects of implementing IF programs in athletes makes it difficult to provide concrete recommendations for the use of these programs in athletes. However, several points are worth considering. Intermittent fasting can be an effective means of reducing calorie intake, body weight, and body fat in nonathletes. Intermittent fasting programs can be designed to allow adequate nutrient consumption before and after physical activity (i.e., exercise does not have to be performed in a fasted state when an IF program is implemented). Some IF programs are as simple as abstaining from food after dinner and not eating again until breakfast or lunch the next day. These milder TRF programs lead to a period of fasting that is ∼12–16 hours in duration.
Most forms of IF could be modified to fit an athlete's training schedule. In ADF and WDF, the modified fasting days consisting of very low-energy intake could be used less frequently or placed on rest days or days with lighter training activities. A TRF schedule could be developed that allows the athlete to eat at the most critical times (e.g., before and after training sessions and competition). Even using a single day per week of modified fasting could help an athlete achieve a negative energy balance for the week while not disturbing the usual pattern of food intake on heavier training and competition days. Although there is scant evidence to demonstrate the ability to adhere to these types of dietary interventions long term, IF may provide an alternative strategy for athletes who are trying to lose weight or prevent weight gain.
Intermittent fasting protocols may be particularly applicable for athletes competing in weight-restricted sports such as mixed martial arts, boxing, and wrestling. These sports often require athletes to lose significant amounts of weight before competition. After competition, it is not uncommon for these athletes to quickly regain the weight, creating a “yo-yo” pattern of weight loss and weight gain—a cycle that is relatively common in combat sports. Intermittent fasting protocols may provide the athletes in these sports an alternative method in which they could not only achieve weekly caloric deficits and weight loss but also maintain adequate intake needed to provide energy for strenuous training days.
Currently, there is a paucity of literature on the effects of IF protocols on exercise performance. Thus, it cannot be decisively concluded if these types of dietary strategies hinder or enhance exercise performance, if they affect performance at all. However, if this type of dietary strategy is used in a conservative fashion as described here (i.e., fasting one select day of the week or on nontraining days), it could theoretically play a very minor role in exercise performance because of the limited impact on most training days. However, more research and empirical data are needed to make more definitive conclusions in this area.
It should also be noted that there are data showing the importance of regularly consuming dietary protein to maintain lean muscle tissue, which is an item of concern for many athletes(31). Thus, this should be considered when using longer duration fasts. Moore et al. (40) and Areta et al. (2) have reported that ingesting 20 g of whey protein at regular intervals every ∼3 hours may be superior in regard to net protein balance and protein synthesis when compared with consuming the same total amount of protein (∼80 g) in larger, less frequent or in smaller, more frequent doses. The benefit of eating protein in this quantity and frequency may be due to the “leucine threshold” that is needed to optimize protein synthesis above baseline levels. Thus, if an athlete uses an IF protocol, he or she may choose to modify it and consume whey protein or another protein source at metered points throughout the fasting window, particularly if lean mass preservation is a major concern.
Future research specifically examining IF programs in athletes should be conducted, particularly in athletes competing in weight-restricted sports. The temporal relationship between nutrient intake and athletic activities should be considered, and any IF program implemented in athletic populations should take into consideration the specific requirements of the sport as well as individual variation and preferences.
1. Alkandari JR, Maughan RJ, Roky R, Aziz AR, Karli U. The implications of Ramadan fasting
for human health and well-being. J Sports Sci 30: S9–S19, 2012.
2. Areta JL, Burke LM, Ross ML, Camera DM, West DWD, Broad EM, Jeacocke NA, Moore DR, Stellingwerff T, Phillips SM, Hawley JA, Coffey VG. Timing and distribution of protein ingestion during prolonged recovery from resistance exercise alters myofibrillar protein synthesis. J Physiol 591: 2319–2331, 2013.
3. Ash S, Reeves MM, Yeo S, Morrison G, Carey D, Capra S. Effect of intensive dietetic interventions on weight and glycaemic control in overweight men with type II diabetes: A randomised trial. Int J Obes 27: 797–802, 2003.
4. Bellisle F, McDevitt R, Prentice AM. Meal frequency and energy balance. Br J Nutr 77(Suppl 1): S57–S70, 1997.
5. Benedict FG, Goodall HW, Ash JE, Langfeld HS, Kendall AI, Higgins HL. A Study of Prolonged Fasting
. Washington, DC: Carnegie Institution, 1915.
6. Bhutani S, Klempel MC, Kroeger CM, Trepanowski JF, Varady KA. Alternate day fasting
and endurance exercise combine to reduce body weight and favorably alter plasma lipids in obese humans. Obesity (Silver Spring) 21: 1370–1379, 2013.
7. Blomain ES, Dirhan DA, Valentino MA, Kim GW, Waldman SA. Mechanisms of weight regain following weight loss
. ISRN Obes 2013: 2013. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3901982/
. Accessed December 2014.
8. Bortz WM, Wroldsen A, Issekutz B Jr, Rodahl K. Weight loss
and frequency of feeding. N Engl J Med 274: 376–379, 1966.
9. Brito CJ, Roas AFCM, Brito ISS, Marins JCB, Córdova C, Franchini E. Methods of body mass reduction by combat sport athletes. Int J Sport Nutr Exerc Metab 22: 89–97, 2012.
10. Cahill GF Jr. Starvation in man. N Engl J Med 282: 668–675, 1970.
11. Cameron JD, Cyr MJ, Doucet E. Increased meal frequency does not promote greater weight loss
in subjects who were prescribed an 8-week equi-energetic energy-restricted diet. Br J Nutr 103: 1098–1101, 2010.
12. Centers for Disease Control and Prevention. Healthy weight: Losing weight—DNPAO—CDC. Available at: http://www.cdc.gov/healthyweight/losing_weight/index.html?s_cid=govD_dnpao_082
. Accessed December 2014.
13. Chaouachi A, Leiper JB, Chtourou H, Aziz AR, Chamari K. The effects of Ramadan intermittent fasting
on athletic performance: Recommendations for the maintenance of physical fitness. J Sports Sci 30: S53–S73, 2012.
14. Chaouachi A, Leiper JB, Souissi N, Coutts AJ, Chamari K. Effects of Ramadan intermittent fasting
on sports performance and training: A review. Int J Sports Physiol Perform 4: 419–434, 2009.
15. Dallosso HM, Murgatroyd PR, James WP. Feeding frequency and energy balance in adult males. Hum Nutr Clin Nutr 36C: 25–39, 1982.
16. Donahoo W, McCall K, Brannon S, Melanson EL, Gozansky WS. Effect of 8 weeks of intermittent fasting
on weight loss
, body composition
, and insulin sensitivity in obese individuals. Obesity 17: S258, 2009.
17. Eshghinia S, Mohammadzadeh F. The effects of modified alternate-day fasting
diet on weight loss
and CAD risk factors in overweight and obese women. J Diabetes Metab Disord 12: 4, 2013.
18. Faintuch J, Soriano FG, Ladeira JP, Janiszewski M, Velasco IT, Gama-Rodrigues JJ. Changes in body fluid and energy compartments during prolonged hunger strike. Rev Hosp Clin Fac Med Sao Paulo 55: 47–54, 2000.
19. Farshchi HR, Taylor MA, Macdonald IA. Decreased thermic effect of food after an irregular compared with a regular meal pattern in healthy lean women. Int J Obes Relat Metab Disord 28: 653–660, 2004.
20. Finkelstein B, Fryer BA. Meal frequency and weight reduction of young women. Am J Clin Nutr 24: 465–468, 1971.
21. Fryburg DA, Barrett EJ, Louard RJ, Gelfand RA. Effect of starvation on human muscle protein metabolism and its response to insulin. Am J Physiol 259: E477–E482, 1990.
22. Garrow JS, Durrant M, Blaza S, Wilkins D, Royston P, Sunkin S. The effect of meal frequency and protein concentration on the composition of the weight lost by obese subjects. Br J Nutr 45: 5–15, 1981.
23. Harvie MN, Pegington M, Mattson MP, Frystyk J, Dillon B, Evans G, Cuzick J, Jebb SA, Martin B, Cutler RG, Son TG, Maudsley S, Carlson OD, Egan JM, Flyvbjerg A, Howell A. The effects of intermittent or continuous energy restriction on weight loss
and metabolic disease risk markers: A randomized trial in young overweight women. Int J Obes 35: 714–727, 2011.
24. Heilbronn LK, Smith SR, Martin CK, Anton SD, Ravussin E. Alternate-day fasting
in nonobese subjects: Effects on body weight, body composition
, and energy metabolism. Am J Clin Nutr 81: 69–73, 2005.
25. Hoddy KK, Kroeger CM, Trepanowski JF, Barnosky A, Bhutani S, Varady KA. Meal timing during alternate day fasting
: Impact on body weight and cardiovascular disease risk in obese adults. Obesity (Silver Spring) 22: 2524–2531, 2014.
26. Hofmekler O, Holtzberg D. The Warrior Diet. St. Paul, MN: Dragon Door Publications, 2001.
27. Hussin NM, Shahar S, Teng NIMF, Ngah WZW, Das SK. Efficacy of Fasting
and Calorie Restriction (FCR) on mood and depression among ageing men. J Nutr Health Aging 17: 674–680, 2013.
28. Johnson JB, Summer W, Cutler RG, Martin B, Hyun D-H, Dixit VD, Pearson M, Nassar M, Tellejohan R, Maudsley S, Carson O, John S, Laub DR, Mattson MP. Alternate day calorie restriction improves clinical findings and reduces markers of oxidative stress and inflammation in overweight adults with moderate asthma. Free Radic Biol Med 42: 665–674, 2007.
29. Kant AK, Schatzkin A, Graubard BI, Ballard-Barbash R. Frequency of eating occasions and weight change in the NHANES I Epidemiologic Follow-up Study. Int J Obes Relat Metab Disord 19: 468–474, 1995.
30. Kerksick C, Harvey T, Stout J, Campbell B, Wilborn C, Kreider R, Kalman D, Ziegenfuss T, Lopez H, Landis J, Ivy JL, Antonio J. International society of sports nutrition position stand: Nutrient timing. J Int Soc Sports Nutr 5: 17, 2008.
31. Kinabo JL, Durnin JV. Effect of meal frequency on the thermic effect of food in women. Eur J Clin Nutr 44: 389–395, 1990.
32. Klein S, Sakurai Y, Romijn JA, Carroll RM. Progressive alterations in lipid and glucose metabolism during short-term fasting
in young adult men. Am J Physiol 265: E801–E806, 1993.
33. Klempel MC, Kroeger CM, Bhutani S, Trepanowski JF, Varady KA. Intermittent fasting
combined with calorie restriction is effective for weight loss
and cardio-protection in obese women. Nutr J 11: 98, 2012.
34. Klempel MC, Kroeger CM, Varady KA. Alternate day fasting
(ADF) with a high-fat diet produces similar weight loss
and cardio-protection as ADF with a low-fat diet. Metabolism 62: 137–143, 2013.
35. La Bounty PM, Campbell BI, Wilson J, Galvan E, Berardi J, Kleiner SM, Kreider RB, Stout JR, Ziegenfus T, Spano M, Smith A, Antonio J. International society of sports nutrition position stand: Meal frequency. J Int Soc Sports Nutr 8: 4, 2011.
36. Lafontan M, Langin D. Lipolysis and lipid mobilization in human adipose tissue. Prog Lipid Res 48: 275–297, 2009.
37. Langan-Evans C, Close GL, Morton JP. Making weight in combat sports
. Strength Cond J 33: 25–39, 2011.
38. LeBlanc J, Mercier I, Nadeau A. Components of postprandial thermogenesis in relation to meal frequency in humans. Can J Physiol Pharmacol 71: 879–883, 1993.
39. Molnár D. 36 the effect of meal frequency on postprandial thermogenesis in obese children. Pediatr Res 28: 283, 1990.
40. Moore DR, Areta J, Coffey VG, Stellingwerff T, Phillips SM, Burke LM, Cleroux M, Godin J-P, Hawley JA. Daytime pattern of post-exercise protein intake affects whole-body protein turnover in resistance-trained males. Nutr Metab 9: 91, 2012.
41. Nair KS, Woolf PD, Welle SL, Matthews DE. Leucine, glucose, and energy metabolism after 3 days of fasting
in healthy human subjects. Am J Clin Nutr 46: 557–562, 1987.
42. Pilon B. Eat Stop Eat. Ontario: Strength Works, Inc. 2007.
43. Pozefsky T, Tancredi RG, Moxley RT, Dupre J, Tobin JD. Effects of brief starvation on muscle amino acid metabolism in nonobese man. J Clin Invest 57: 444–449, 1976.
44. Romijn JA, Godfried MH, Hommes MJ, Endert E, Sauerwein HP. Decreased glucose oxidation during short-term starvation. Metabolism 39: 525–530, 1990.
45. Saudek CD, Felig P. The metabolic events of starvation. Am J Med 60: 117–126, 1976.
46. Schoenfeld BJ, Aragon AA, Krieger JW. Effects of meal frequency on weight loss
and body composition
: A meta-analysis. Nutr Rev 73: 69–82, 2015.
47. Shephard RJ. The impact of Ramadan observance upon athletic performance. Nutrients 4: 491–505, 2012.
48. Soeters MR, Lammers NM, Dubbelhuis PF, Ackermans M, Jonkers-Schuitema CF, Fliers E, Sauerwein HP, Aerts JM, Serlie MJ. Intermittent fasting
does not affect whole-body glucose, lipid, or protein metabolism. Am J Clin Nutr 90: 1244–1251, 2009.
49. Soeters MR, Soeters PB, Schooneman MG, Houten SM, Romijn JA. Adaptive reciprocity of lipid and glucose metabolism in human short-term starvation. Am J Physiol 303: E1397–E1407, 2012.
50. Stote KS, Baer DJ, Spears K, Paul DR, Harris GK, Rumpler WV, Strycula P, Najjar SS, Ferrucci L, Ingram DK, Longo DL, Mattson MP. A controlled trial of reduced meal frequency without caloric restriction in healthy, normal-weight, middle-aged adults. Am J Clin Nutr 85: 981–988, 2007.
51. Summerbell CD, Moody RC, Shanks J, Stock MJ, Geissler C. Relationship between feeding pattern and body mass index in 220 free-living people in four age groups. Eur J Clin Nutr 50: 513–519, 1996.
52. Tai MM, Castillo P, Pi-Sunyer FX. Meal size and frequency: Effect on the thermic effect of food. Am J Clin Nutr 54: 783–787, 1991.
53. Taylor MA, Garrow JS. Compared with nibbling, neither gorging nor a morning fast affect short-term energy balance in obese patients in a chamber calorimeter. Int J Obes Relat Metab Disord 25: 519–528, 2001.
54. Teng NIMF, Shahar S, Manaf ZA, Das SK, Taha CSC, Ngah WZW. Efficacy of fasting
calorie restriction on quality of life among aging men. Physiol Behav 104: 1059–1064, 2011.
55. Teng NIMF, Shahar S, Rajab NF, Manaf ZA, Johari MH, Ngah WZW. Improvement of metabolic parameters in healthy older adult men following a fasting
calorie restriction intervention. Aging Male 16: 177–183, 2013.
56. Tsalikian E, Howard C, Gerich JE, Haymond MW. Increased leucine flux in short-term fasted human subjects: Evidence for increased proteolysis. Am J Physiol 247: E323–E327, 1984.
57. Varady KA. Intermittent versus daily calorie restriction: Which diet regimen is more effective for weight loss
? Obes Rev 12: e593–e601, 2011.
58. Varady KA, Bhutani S, Church EC, Klempel MC. Short-term modified alternate-day fasting
: A novel dietary strategy for weight loss
and cardioprotection in obese adults. Am J Clin Nutr 90: 1138–1143, 2009.
59. Varady KA, Bhutani S, Klempel MC, Kroeger CM. Comparison of effects of diet versus exercise weight loss
regimens on LDL and HDL particle size in obese adults. Lipids Health Dis 10: 119, 2011.
60. Varady KA, Bhutani S, Klempel MC, Kroeger CM, Trepanowski JF, Haus JM, Hoddy KK, Calvo Y. Alternate day fasting
for weight loss
in normal weight and overweight subjects: A randomized controlled trial. Nutr J 12: 146, 2013.
61. Verboeket-van de Venne WP, Westerterp KR. Influence of the feeding frequency on nutrient utilization in man: Consequences for energy metabolism. Eur J Clin Nutr 45: 161–169, 1991.
62. Verboeket-van de Venne WP, Westerterp KR. Frequency of feeding, weight reduction and energy metabolism. Int J Obes Relat Metab Disord 17: 31–36, 1993.
63. Verboeket-van de Venne WP, Westerterp KR, Kester AD. Effect of the pattern of food intake on human energy metabolism. Br J Nutr 70: 103–115, 1993.
64. Wadden TA, Butryn ML, Byrne KJ. Efficacy of lifestyle modification for long-term weight control. Obes Res 12(Suppl): 151S–162S, 2004.
65. Williams KV, Mullen ML, Kelley DE, Wing RR. The effect of short periods of caloric restriction on weight loss
and glycemic control in type 2 diabetes. Diabetes Care 21: 2–8, 1998.
66. Wolfram G, Kirchgessner M, Müller HL, Hollomey S. Thermogenesis in humans after varying meal time frequency [in German]. Ann Nutr Metab 31: 88–97, 1987.