I often say things to patients like “Just try fasting without losing weight” or “If you are not having success with weight-loss try turning things up to level two, it’s very unlikely you don’t lose weight.” And this is true. Fasting regimens are by far the most effective and healthiest path to weight loss I have found.
But what if you would like to try a fasting regimen for some reason other than weight-loss and you don’t actually need to lose weight? Perhaps you are seeking improvement in a GI disorder, looking for an alternative practice to improve mental health and focus, trying to improve blood pressure or improve your sports performance. Perhaps you are intrigued by potential longevity benefits of fasting. Maybe you just want to try it out and see if you feel better.
Approaching fasting can be more direct for those who are over-weight. You don’t have to worry about losing too much weight. That is often the point. If you are already of a normal weight there are a few additional considerations. Being underweight is not desired and I list this as one of the primary contraindications to fasting.
Keeping it Simple…
When counseling for weight-loss I almost never encourage people to count calories. I keep a very high-level view on making sure there are healthy food choices and as strict an adherence to the fasted interval as can be done without stressing about it. As long as people are eating reasonably healthy meals I encourage them not to change much about the meals they are eating. Even at level 1 this is an aggressive practice that is often successful.
When weight-loss is not the goal I change this perspective. As a starting point I encourage people to keep a close eye on their weight to make sure weight-loss is not happening or is at least minimal. I also generally encourage people to focus on increasing the quantity of food consumed in the meals that are eaten. As a starting point this can also be done without focusing on calories too much. “More” might be enough to focus on within reason.
…But Monitoring as Needed
However some broad strokes regarding calories may be helpful. I may recommend a more detailed calorie analysis if there is ongoing unwanted weight-loss but fasting is helping and there is desire to continue. If someone was eating 1800 calories per day prior to the fasting trial in three meals this would typically be an average of 600 calories per meal. It is reasonable to consider a 50% increase in average calories per meal and have 900 calorie meals twice a day on level one. It is generally difficult to get 1800 calories in only one meal per day although it can be done. I don’t encourage this. People usually do not want to eat more than 1300 calories or so in any one meal if it is healthy food and I don’t want people to focus on overeating. I generally titrate a regimen between level one and level two to even out the total calories on a weekly basis to a sustainable pattern that maintains weight. Such as a level 2 day every third day if that remains stable.
A Few Examples:
GI disorder: An individual with severe microscopic colitis was having 15 diarrhea stools per day and was having difficulty maintaining weight due to malabsorption. They had been eating six small meals throughout the day per standard counseling. One month into a Level 1 regimen they had lost 5 pounds but stool frequency was down to 8/day. We increased to Level 2 at one large healthy meal per day. Over the subsequent 2 months diarrhea resolved and the 5 pounds came back on. Condition and weight stable over one year with this practice.
Fitness: A lean individual interested in gaining muscle as part of a plan to bulk up a bit. Weight lifting three days per week in the morning in the fasted state. Eating 2 meals per day ~1100 calories each within 6 hours + snack in the middle. Able to gain 10 lb over 6 months through muscle growth while decreasing body-fat at the same time.
Longevity: An older individual with a BMI of 24 who has a family history of dementia and is interested in practicing one level 3 day per week for possible neurological/longevity benefit. They are fasting one full day per week with no specific purposeful change in other days eating. Has felt better and maintained weight eating three meals per day the rest of the week.