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Along with tobacco avoidance, a monthly day of fasting could help avert coronary artery disease (CAD) risk, indicates a recent study. Abstainers with diabetes showed the same CAD reduction, according to the study of a largely Mormon population, among whom 24-hour monthly fasting is a common religious practice. However, lead researcher Benjamin Horne, PhD, MPH, is quick to caution the findings are no indication that diabetes patients should skip meals.
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More data are needed on fasting effects, generally, and in diabetes, specifically, says Horne. He notes that, at present, diabetes patients are advised against skipping meals to prevent destabilization of blood glucose and compensatory overeating.
However, further research on fasting is worth conducting, he says, given this study's compelling finding of a 40% CAD reduction among people who abstain from food and drink for 1 day each month.
Why might fasting offer a heart benefit?
Horne, who reported the results at the American Heart Association's 2007 Scientific Sessions, held Nov. 4–7 in Orlando, Fla., finds one possibility especially intriguing: "Fasting for 24 hours—foregoing not just food but drinks as well—may allow the body to rest and reset metabolism, increasing the body's sensitivity to glucose and insulin," says Horne, director of cardiovascular and genetic epidemiology at Intermountain Medical Center in Salt Lake City. "This hypothesis is supported by animal research findings of an association between fasting and increased longevity. Fasting may aid expression of genes related to glycogen, a molecule that seems to increase storage of glucose." 1,2
OTHER EXPLANATIONS?
But there are other possible explanations for the fasting benefit, says Horne. For instance, people who fast may be more vigilant about what they eat day to day. The study did not assess this possibility, he says, noting it's tricky to track exactly what—and how much—people eat each day.
Horne and his colleagues' interest in Mormons' reduced CAD risk stems from analyzing 1994–2002 health records of 4,629 patients (average age 64). That analysis revealed that 61% of Mormon patients had CAD, compared with 66% of non-Mormon patients. When the researchers looked at nonsmokers alone, CAD rates remained lower for Mormons.
The researchers then investigated what factors not related to smoking but possibly involving religious practice—including abstaining from coffee, tea, and alcohol; fasting; observing a weekly day of rest; donating time, goods, or money to charity; and attending worship services—could explain the disparity in a second sample of 515 recipients (average age 64) of coronary angioplasty during 2004–2006.
Fasting emerged as the strongest predictor of reduced CAD risk. When the researchers excluded diabetes patients from the analysis, the fasting-associated lower risk held.
UNKNOWNS
Horne cautions the findings on fasting do not extend to random skipping of meals. "This study looked at total cessation of intake for 24 hours," he says. "We didn't ask about skipping meals, binging, and such."
Horne also warns the findings are preliminary, and that people should not act on them until and unless further research backs them up. "These are interesting initial findings, but we're not suggesting people go out there and fast."
What he does want to see is research on the long-term effect of fasting on glucose and lipid levels. He's also curious how fasting might affect levels of C-reactive protein (CRP), which is associated with inflammation and heart disease in people with type 2 diabetes.
In addition to such biomarkers, he plans to assess the dietary habits of
those who fast versus those who don't, despite the challenges of tracking food
intake. 
References
2. Anson RM, Guo Z, de Cabo R, et al.: Intermittent fasting
dissociates beneficial effects of dietary restriction on glucose metabolism
and neuronal resistance to injury from calorie intake. Proc Natl
Acad Sci 100:6216–6220, 2003.
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