There’s been a lot of discussion about the benefits of intermittent fasting (IF) in the paleo community lately. Paul Jaminet mentions it’s role in boosting the immune system in his book, The Perfect Health Diet, and IF can also be helpful for those trying to lose weight and tune their metabolism.
From an evolutionary perspective, intermittent fasting was probably the normal state of affairs. There were no grocery stores, restaurants or convenience stores, and food was not nearly as readily available or easy to come by as it is today. Nor were there watches, schedules, lunch breaks or the kind of structure and routine we have in the modern world. This means it’s likely that our paleo ancestors often did go 12-16 hours between meals on a regular basis, and perhaps had full days when they ate lightly or didn’t eat at all.
So, while I agree that IF is part of our heritage, and that it can be helpful in certain situations, I don’t believe it’s an appropriate strategy for everyone.
Why? Because fasting can elevate cortisol levels. One of cortisol’s effects is that it raises blood sugar. So, in someone with blood sugar regulation issues, fasting can actually make them worse.
I’ve seen this time and time again with my patients. Almost all of my patients have blood sugar imbalances. And it’s usually not as simple as “high blood sugar” or “low blood sugar”. They often have a combination of both (reactive hypoglycemia), or strange blood sugar patterns that, on the surface, don’t make much sense. These folks aren’t eating a Standard American Diet. Most of them are already on a paleo-type or low-carb diet. Yet they still have blood sugar issues.
In these cases, cortisol dysregulation is almost always the culprit. When these patients try intermittent fasting, their blood sugar control gets worse. I will see fasting blood sugar readings in the 90s and even low 100s, in spite of the fact that they are eating a low-carb, paleo-type diet.
That’s why I don’t recommend intermittent fasting for people with blood sugar regulation problems. Instead, I suggest that they eat every 2-3 hours. This helps to maintain stable blood sugar throughout the day and prevents cortisol and other stress hormones like epinephrine and norepinephrine from getting involved. When my patients that have been fasting and experiencing high blood sugar readings switch to eating this way, their blood sugar numbers almost always normalize.
I don’t think eating every 2-3 hours is “normal” from an evolutionary perspective. But neither is driving in traffic, worrying about your 401k, or staying up until 2:00am on Facebook. The paleo template is there to guide us, but it’s not a set of rules to be followed blindly. This should also be a reminder that there’s no “one size fits all” approach when it comes to healthcare. Successful treatment depends on identifying the underlying mechanisms for each individual and addressing them accordingly.