Part 1 . History and use of sugar

     Imagine a chemical substance that can intoxicate us, can infuse us with energy, and can do so when taken by mouth. It doesn’t have to be injected, smoked, or snorted for us to experience its sublime and soothing effects. Imagine that it mixes well with virtually every food and particularly liquids, and that when given to infants it provokes a feeling of pleasure so profound and intense that its pursuit becomes a driving force throughout their lives. Overconsumption of this substance may have long-term side effects, but there are none in the short term—no staggering or dizziness, no slurring of speech, no passing out or drifting away, no heart palpitations or respiratory distress. When it is given to children, its effects may be only more extreme variations of the apparently natural emotional roller coaster of childhood, from the initial intoxication to the tantrums and whining of what may or may not be withdrawal a few hours later. More than anything, our imaginary substance makes children happy, at least for the period during which they’re consuming it. It calms their distress, eases their pain, focuses their attention, and then leaves them excited and full of joy until the dose wears off. The only downside is that children will come to expect another dose, perhaps to demand it, on a regular basis, so more or less works like a drug. Well, this substance exists and is called sugar!
    Biochemically, the term “sugar” refers to a group of carbohydrate molecules consisting, as the word “carbohydrate” implies, of atoms of carbon and hydrogen. The names of these carbohydrates all end in “-ose”—glucose, galactose, dextrose, fructose, lactose, sucrose, etc. and all of them will dissolve in water and they all taste sweet to us to a greater or lesser extent. When physicians or researchers refer to “blood sugar,” they’re talking about glucose, because it constitutes virtually all of the sugar circulating in our blood.    However, the more common usage of “sugar” refers to sucrose, the white crystalline variety that we put in our coffee or tea or sprinkle on our morning cereal. Sucrose in turn is composed of equal parts glucose and fructose, the two smaller sugars (monosaccharides, in the chemical lingo) bonded together to make the larger one (a disaccharide). Fructose, found naturally in fruits and honey, is the sweetest of all these sugars, and it’s the fructose that makes sucrose particularly sweet. Although sugars like fructose, glucose, and sucrose are found naturally in foods that humans have always eaten, modern foods often contain refined, processed sugars that are anything but natural.
    Without refining, the juice of sugarcane is for local consumption only. Within a day of cutting, the sugarcane stalks will begin to ferment and then rot. But the juice can be squeezed or crushed or pounded out of the cane, and that, in turn, as farmers in northern India discovered by around 500 B.C., can be transformed into a raw sugar by cycles of heating and cooling—a “series of liquid-solid operations.” The sugar crystallizes as the liquid evaporates. One end product is molasses, a thick brown viscous liquid; another, requiring greater expenditures of time and effort, is dry crystalline sugar of colors ranging from brown to white. The greater the refining effort, the whiter and more pure is the end product. When cultivated with the instruments of modern technology, sugarcane can produce (as the sugar industry and nutritionists would state in its defence repeatedly in the twentieth century) more calories per acre to feed a population than any other animal or plant. It can survive years of storage; it travels well; it can be consumed on arrival unheated and uncooked. And, unlike honey or maple syrup, it has no distinctive taste or aftertaste. Refined sugar is colourless and odourless. It is nothing more than the crystallised essence of sweet. Other than salt, it is the only pure chemical substance that humans consume. And it provides four calories of energy per gram.
    

    Anthropologists believe that sugarcane itself was first domesticated in New Guinea about ten thousand years ago. As evidence that it was revered even then, creation myths in New Guinea have the human race emerging from the sexual congress of the first man and a stalk of sugarcane. The plant is technically a grass, growing to heights of twelve to fifteen feet, with juicy stalks that can be six inches around. In tropical soils, sugarcane will grow from cuttings of the stem, and will ripen or mature in a year to a year and a half. The juice or sap from the cane, at least the modern variety, is mostly water and as much as 17% sugar. This makes the cane, sweet to chew but not intensely so. Anthropologists assume that early farmers domesticated the cane for the sweetness to be derived from chewing the stalks and the energy it provided. Well before the art of refining came along, sugarcane domestication had already spread to India, China, the Philippines, and Indonesia.
    It’s a safe bet that humans have tried to extract sugar, at one time or another, from pretty much every substance or plant that was noticeably sweet and held the promise of offering its sugar up in quantity. Honey was consumed throughout Europe and Asia before sugar displaced it, and when European colonists arrived in the New World and found no honey, they introduced honeybees, which Native Americans took to calling the “English Man’s Fly.” Native Americans were using maple syrup as a sweetener before the Europeans arrived, and they introduced the colonists to the taste. (Thomas Jefferson was a proponent of maple syrup because it rendered slave labor unnecessary. The sugar maple, he wrote, “yields a sugar equal to the best from the cane, yields it in great quantity, with no other labor than what the women and girls can bestow….What a blessing.”) But neither maple syrup nor honey can be used to sweeten cold beverages, and neither mixes well with coffee. Neither could be produced in the quantities necessary to compete with sugar. We still consume them, but in limited quantities and for limited uses.
    Crusaders brought sugar home with them to Europe after their campaigns in the Holy Land, where they encountered caravans carrying "sweet salt”. Early in the 12th century, Venice acquired some villages near Tyre and set up estates to produce sugar for export to Europe, where it supplemented honey as the only other available sweetener. Crusade chronicler William of Tyre, writing in the late 12th century, described sugar as "a most precious product, very necessary for the use and health of mankind". The first record of sugar in English is in the late 13th century.  Known worldwide by the end of the medieval period, sugar was very expensive and was considered a "fine spice", but from about the year 1500, technological improvements and New World sources began turning it into a much cheaper bulk commodity.    
    Contemporaries often compared the worth of sugar with valuable commodities including musk, pearls, and spices. Sugar prices declined slowly as its production became multi-sourced throughout the European colonies in the Americas. Once an indulgence only of the rich, the consumption of sugar also became increasingly common among the poor as well. Sugar production increased in the mainland North American colonies, in Cuba, and in Brazil. The labour force at first included European indentured servants and local Native American enslaved people. However, European diseases such as smallpox and African ones such as malaria and yellow fever soon reduced the numbers of local Native Americans. Europeans were also very susceptible to malaria and yellow fever, and the supply of indentured servants was limited. African slaves became the dominant source of plantation workers, because they were more resistant to malaria and yellow fever, and because the supply of enslaved people was abundant on the African coast. In the process of whitening sugar, the charred bones of dead enslaved people were commonly substituted for the traditionally used animal bones. During the 18th century, sugar became enormously popular. Great Britain, for example, consumed five times as much sugar in 1770 as in 1710. By 1750, sugar surpassed grain as "the most valuable commodity in European trade — it made up a fifth of all European imports and in the last decades of the century four-fifths of the sugar came from the British and French colonies in the West Indies. From the 1740s until the 1820s, sugar was Britain's most valuable import.

    Sugar was “an ideal substance,” says Sidney Mintz in his book “Sweetness and Power: The Place of Sugar in Modern History”.  “It served to make a busy life seem less so; in the pause that refreshes, it eased, or seemed to ease the changes back and forth from work to rest; it provided swifter sensations of fullness or satisfaction than complex carbohydrates did; it combined easily with many other foods, in some of which it was also used (tea and biscuit, coffee and bun, chocolate and jam-smeared bread). No wonder the rich and powerful liked it so much, and no wonder the poor learned to love it.” Unlike alcohol, which was the only commonly available psychoactive substance in the Old World until sugar, nicotine, and caffeine arrived on the scene, the latter three had at least some stimulating properties, and so offered a very different experience, one that was more conducive to the labor of everyday life. These were the “eighteenth-century equivalent of uppers,” writes the Scottish historian Niall Ferguson. “Taken together, the new drugs gave English society an almighty hit; the Empire, it might be said, was built on a huge sugar, caffeine and nicotine rush—a rush nearly everyone could experience.”
    Sugar is extraordinarily useful in food preparation, even when sweetness is not necessarily the desired result, and this is one reason why sugar in all its various names and forms is now ubiquitous in modern processed foods. Sugar allows for the preservation of fruits and berries by inhibiting the growth of micro-organisms that would otherwise cause spoiling. As such, inexpensive sugar made possible the revolution in jams and jellies that began in the mid nineteenth century . It inhibits mold and bacteria in condensed milk and other liquids by increasing what’s called the osmotic pressure of the liquid. It reduces the harshness of the salt that’s used for curing and preserving meat (and the salt increases the sweetness of the sugar). Sugar is an ideal fuel for yeast, and thus the rising and leavening of bread. The caramelisation of sugar provides the light-brown colours in the crust of bread. Dissolve sugar in water and it adds not only sweetness but viscosity, and thus creates the body and what food scientists call the “mouth feel” of a soda or juice. As a seasoning or a spice, it enhances flavours already present in the food, decreases bitterness, and improves texture.
    Mintz has argued as well, that a primary reason that helped sugar through the centuries to escape religious-based criticisms, of the kind pronounced on tea, coffee, rum, and even chocolate, is that, whatever conspicuous behavioural changes may occur when infants consume sugar, it did not cause the kind of “flushing, staggering, dizziness, euphoria, changes in the pitch of the voice, slurring of speech, visibly intensified physical activity, or any of the other cues associated with the ingestion” of these other substances. Sugar appears to be a substance that causes pleasure with a price that is difficult to discern immediately and paid in full only years or decades later. With no visible, directly noticeable consequences, as Mintz says, questions of “long-term nutritive or medical consequences went unasked and unanswered.” Most of us today will never know if we suffer even subtle withdrawal symptoms from sugar, because we’ll never go long enough without sugar to find out.
    Mintz and other sugar historians consider the drug comparison to be so fitting in part because sugar is one of a handful of “drug foods,” to use Mintz’s term, that came out of the tropics, and on which European empires were built from the sixteenth century onward, the others being, tea, coffee, chocolate, rum, and tobacco. Its history is intimately linked to that of these other “drugs”. Rum is distilled, of course, from sugarcane, whereas tea, coffee, and chocolate were not consumed with sweeteners in their regions of origin. In the seventeenth century, however, once sugar was added as a sweetener and prices allowed it, the consumption of these substances in Europe exploded. Sugar was used to sweeten liquors and wine in Europe as early as the fourteenth century; even cannabis preparations in India and opium-based wines and syrups included sugar as a major ingredient.
    The common tendency is to think of this explosion in the use of sugar by humans,  as driven by the mere fact that sugars and sweets taste good. We can call it the “pause that refreshes” hypothesis of sugar history. The alternative way to think about this is that sugar took over our diets because the first taste, whether for an infant today or for an adult centuries ago, is literally, as Michael Pollan put it, an astonishment, a kind of intoxication; “it’s the kindling of a lifelong craving, not identical but analogous to that of other drugs of abuse”. Because it is a nutrient, and because the conspicuous results of its consumption are relatively benign compared with those of nicotine, caffeine, and alcohol—at least in the short term and in small doses—it remained, as Sidney Mintz says, nearly invulnerable to moral, ethical, or religious attacks.
    A second factor in the transformation of sugar into a dietary staple—one of life’s necessities—was technology. The industrial revolution, inaugurated by Watt’s steam engine in 1765, transformed sugar production and refining just as it did virtually every other existing industry in the nineteenth century. By the 1920s, sugar refineries were producing as much sugar in a single day—millions of pounds—as would have taken refineries in the 1820s an entire decade. With sugar becoming so cheap that everyone could afford it, the manner in which we consumed it would change as well. Not only did we add sugar to hot beverages and bake it into wheat products or spread it on top—jams and jellies were two foods that cheap, available sugar made ubiquitous, since fruit could now be preserved at the end of the growing season and provide nutrition (sweetened, of course) all year round—but the concept of a dessert course emerged for the first time in history in the mid-nineteenth century, the expectation of a serving of sweets to finish off a lunch or dinner. The industrial work break also emerged, as a new era of factory workers learned to partake of some combination of nicotine, caffeine, and sugar; cigarettes, coffee and tea, and sweetened biscuits or candy could all be purchased inexpensively.
    

      Lastly, it is worth mentioning how sugar and sweets became, after thousands years of use, a synonymous to love and affection and the language with which we communicate them—“sweets,” “sweetie,” “sweetheart,” “sweetie pie,” “honey,” “honeybun,” “sugar,” and all manner of combinations and variations. Sugar and sweets became a primary contribution to our celebrations of holidays and accomplishments, both major and minor. For some people sugar and sweets have become the tools they used to reward their children’s accomplishments, to demonstrate the love and pride in them, to motivate them, to entice them. Sweets have become the currency of childhood and parenting.
    

 

References

Taubes G. (2017); “The case against sugar” , Alfred A. Knopf, New York,.

Mintz, S. W. (1991) ; “Pleasure, Profit, and Satiation.” In Seeds of Change, ed. J. J. Viola and C. Margolis (Washington, D.C.: Smithsonian Institution).

Mintz, S. W. (1985) ; Sweetness and Power: The Place of Sugar in Modern History. New York: Penguin.

Pollan, M.  (2008);  In Defense of Food. New York: Penguin.

Pollan, M. (2002) ; “When a Crop Becomes King.” New York Times Magazine, July 19: A17.

Pollan, M. (2001) ; The Botany of Desire: A Plant’s-Eye View of the World. New York: Random House.

Ferguson, N. (2002) ; Empire: The Rise and Demise of the British World Order and the Lessons for Global Power. London: Penguin.

Twain, M. (2010);  Autobiography of Mark Twain: The Complete and Authoritative Edition. Vol. 1. Berkeley: University of California Press.

Sugar Research Foundation, Inc (SRF). (1945) ;  Some Facts About the Sugar Research Foundation, Inc., and Its Prize Award Program. Oct. Washington: Sugar Research Foundation, Inc.

Sugar Association, Inc. (SAI). (1978);  Sugar Association, Inc., winter meeting of the board of directors, Chicago, Ill., Feb. 9, 1978. Research projects report, Washington, D.C. Sugar Association, Inc., Records of the Great Western Sugar Company, Colorado Agricultural Archive, Colorado State
University.

Prinsen Geerligs, H. C. (2010);  The World’s Cane Sugar Industry, Past and Present. Cambridge, U.K.: Cambridge University Press. [Originally published in 1912.]

 

How to incorporate the practice of fasting in our everyday life

 

     As we saw in the first part , fasting is the voluntary avoidance of food for health, spiritual, or other reasons. It’s done by someone who is not underweight and has enough stored body fat to live off. When done correctly, fasting should not cause suffering, and certainly never death. Food is easily available, but you choose not to eat it. This can be for any period of time, from a few hours up to a few days or – with medical supervision – even a week or more. You may begin a fast at any time of your choosing, and you may end a fast at will too.

So, in theory,  anytime we are not eating ,we are intermittently fasting. But let’s dive into the science behind it.

    Intermittent fasting (IF) covers a broad class of dietary interventions that alternate periods of eating and extended fasting on recurring basis. IF interventions can include periodic 24-hour fasts, intermittent energy restriction (e.g., the 5:2 protocol), and time-restricted eating (TRE). Our bodies need a 24 hour continual source of energy just for the basic metabolic housekeeping – keeping the heart pumping blood, liver and kidney functions, the lungs sucking air, brain function etc. Since we do not eat food all the time, we have a system of storing food energy (in the liver and as body fat) for times where we are not eating, like when we are sleeping for example.  At moments like these , our body needs to pull some of the food energy we’ve stored away to keep our vital organs running. This is the reason we do not die in our sleep every single night.
   So, it becomes obvious that IF is not something unusual but a part of everyday, normal life. Yet somehow we have missed its power and overlooked its therapeutic potential. For example, you may be already intermittently fasting every day , between the dinner and the breakfast of the next day, a period that for most people is approximately 10 hours. Although the main benefits of IF start to appear after 12 hours of not ingesting any food, the 10 hours you stayed without feeding your self still count as IF. Just consider the term “breakfast.” It refers to the meal that breaks your fast – which is done daily in the morning. In that sense, even the English language implicitly acknowledges that fasting should be considered a part of everyday life.
    As we saw in the first part of this series,  at its very core, fasting simply allows the body to use its stored sources of energy – blood sugar and body fat. This is an entirely normal process and humans have evolved these storage forms of food energy precisely so that we can fast for hours or days without detrimental health consequences. Blood sugar and body fat is merely stored food energy ready to fuel the body when food is not available. By fasting, we are lowering blood sugar and body fat by using them precisely for the reason we store them. So, if we need to restore balance in our dietary patterns , if we need to achieve metabolic flexibility or if we need to lose weight, we may simply need to increase the amount of time spent burning food energy.

That’s intermittent fasting.

Intermittent fasting benefits

IF’s most obvious benefit is weight loss. However, there are many potential benefits beyond this, some of which have been known since ancient times.  The fasting periods were often called ‘cleanses,’ ‘detoxifications’ or ‘purifications,’ but the idea is similar – to abstain from eating food for a certain period of time. People believed that this period of abstinence from food would clear their systems of toxins and rejuvenate them. Since we talked excessively about the benefits of fasting in general in the first part of this series, in this post i will just mention the most important benefits of IF reported through scientific research :

• Weight and body fat loss - improved body composition.
• Lowered blood insulin and sugar levels
• Lowered blood insulin and glucose levels - Reversal of type 2 diabetes
• Reduced hemoglobin A1c (A1c) levels
• Improved mental clarity and concentration
• Increased energy
• Increased growth hormone, at least in the short term
• Improved blood cholesterol profile
• Increased longevity
• Activated cellular cleansing by stimulating autophagy
• Reduction of inflammation

 

How can we apply in our everyday life the practice of IF?  Here, i am presenting some of the most important protocols.

Protocols

 

    1.  Time-restricted eating (12:12 fasting, 14:10 - 16:8 fasting, 18:6 fasting, and 20:4 fasting)

    While IF, is a term used to describe a lot of different protocols, it’s most often used to describe something called Time Restricted Eating (TRE)—meaning, restricting the period of time you eat to a set number of hours each day. Time restricted eating, also called time restricted feeding (TRF) in research settings, typically consists of confining all your eating to a 12-hour, 10-hour, 8-hour, 6-hour, or 4-hour window, and fasting the remainder of the day. Lets see them analytically :

• 12-hour fasting

Many experts view a 12-hour eating/12-hour fasting window (think: eating breakfast at 8 a.m. and wrapping up dinner by 8 p.m.) as a great, safe place to start for anyone. It shouldn’t be that difficult , since one can fit the 8 hours of sleep in the 12 hour fasting window, therefore the challenge here is to remain without food for 4 more hours.  Piece of cake !

• 14:10 and 16:8 fasting

Some of the most popular versions of TRE are the 14:10 or 16:8 fasting plans, which consist of a daily 14-hour and 16-hour fast while confining your eating to an 10-hour and 8-hour window respectively. If you can't live without breakfast, slot your food earlier in the day (8 a.m. to 6 pm or 4 p.m.). If you prefer an early dinner, eat in the middle of the day (11 a.m. to 9 pm or 7 p.m.). If you're someone who regularly goes out with friends for late dinners, schedule your eating hours later in the day (1 pm to 11pm or 9 pm).

• 18:6 fasting

Also popular, but a bit more intense, is the 18:6 fasting plan, which is a daily 18-hour fast where you confined your eating to a 6-hour window. If your goal is weight loss and you’ve experienced a plateau on a 16:8 plan, this is the logical next step. While more research is needed, an 18:6 fast likely helps your body burn stored carbohydrates (glycogen) faster so you can start burning fat (in the form of ketones) for fuel, and some believe it may be enough to activate autophagy—a cellular clean-up process that’s associated with longevity.

• 20:4 fasting

The most restrictive of the popular TRE regimens is the 20:4 fast (sometimes called the “warrior diet”), which is a daily 20-hour fast where you confined your eating to a 4-hour window. This essentially breaks down to one meal a day and is not for beginners—you need to work your way up. Compared to a 16:8 or 18:6 fast, it’s speculated that you will burn more fat, lose more weight, and experience greater autophagy on a 20:4 diet, since the fasting hours last for almost all day.

 

       2.  Alternate-day fasting (36 hour fast)

      Also under the umbrella of intermittent fasting is alternate-day fasting (ADF). ADF is just how it sounds: You only eat every other day. So, practically,  you fast for 36 hours on a recurring basis. You finish dinner on day 1 at 7 pm for instance, and you would skip all meals on day 2, and not eat again until breakfast at 7 am on day 3. So that is a total of 36 hours of fasting followed by an 12-hour eating window. While some purists only consume water, herbal tea, and moderate amounts of black coffee on fasting days, others employ the 25 percent rule. In this version, you consume 25 percent of your normal caloric intake on fast days. This protocol has shown really good results for weight loss and reducing inflammation and while many clinics often recommend 36-hours fasts 2-3 times per week for reversing type 2 diabetes, alternate-day fasting is a more extreme approach to IF that may be hard to sustain over the long term. For obvious reasons, is not for beginners, and it should be reserved for specific medical cases.

 

    3.   5:2 plan

    A slightly easier variation of ADF, the 5:2 plan allows you to eat normally for five days every week while eating only 500 to 600 calories on the other two days. You can choose whichever two days of the week you prefer, as long as there is at least one non-fasting day in between them. One common way of planning the week on this protocol , is to fast on Mondays and Thursdays, with two or three small meals, then eat normally for the rest of the week. It’s important to emphasize that eating “normally” does not mean you can eat anything. If you binge on junk food, then you probably won’t lose any weight, and you may even gain weight.

 

Where to place your TRE window?

     The ideal placement of your eating and fasting window will likely depend on a number of factors—work schedule, social obligations, fitness routine, and simply what feels best for your body—but a growing body of research seems to suggest that an earlier eating window may be better. A small but rigorously controlled randomised crossover study from 2019 found that when participants ate between 8 a.m. and 2 p.m., they fared much better than when they ate the same three meals on an 2 p.m. to 8 p.m. schedule.  Moreover , they had lower blood glucose levels during the day and overnight, lower insulin levels, and an ideal cortisol pattern (with levels higher in the morning and lower at night)—all of which suggests an improvement in circadian rhythm. More surprisingly, though, was that after just four days, this earlier eating schedule increased the expression of the SIRT1 gene (associated with longevity and healthy aging) and the LC3A gene (a biomarker of autophagy).

 

 

How do you manage hunger?

   The million dollar question! “If i am hungry in only 3 hours after eating , how will i be able to fast for many more hours?” … Hunger is not so simple as your stomach being ’empty’. Hunger is, in fact, a highly susceptible state with a complex hormonal regulation at play. In essence, there are two major components to hunger: The unconditioned biological stimuli – that is, the part that will normally stimulate hunger naturally (smells, sights, and tastes of food) and the conditioned stimuli (learned – movie, lecture, morning etc). These conditioned responses can be very powerful and cause great hunger. If for example we consistently eat breakfast every single morning at 7:00am, lunch at 12:00 and dinner at 6:00pm, then the time of the day itself becomes a conditioned stimulus for eating. Even if we ate a huge meal at dinner the night before, and would not otherwise be hungry in the morning, we may become ‘hungry’ because it is 7:00am. The Conditioned Stimulus (time of 7:00) causes the Conditioned Response (hunger). How to combat this? Well, intermittent fasting offers a unique solution. By skipping meals and varying the intervals that we eat, we can break our current habit of feeding 3 times a day. We no longer have a conditioned response of hunger every 3-5 hours.
    And what about the hunger we feel by the unconditioned biological stimuli during our day? The most important thing to realise is, that this type of hunger, usually passes like a wave. It comes and it goes. That is, we may not be hungry one second, but after smelling a steak and hearing the sizzle, we may become quite ravenous. And then, we may engage in an activity and we forget after some minutes completely the steak and our hunger .  Many people worry that hunger during IF will continue to build up until it is intolerable, but this does not normally happen. Approximately 3-6 hours after we eat a meal, we start to feel hunger pangs and may become slightly cranky. But if we simply ignore it and drink a cup of tea or coffee, or we keep ourselves busy with activities , it will often pass.

 

References

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. 2005 Jan;81(1):69-73. doi: 10.1093/ajcn/81.1.69. PMID: 15640462.

Tinsley GM, La Bounty PM. Effects of intermittent fasting on body composition and clinical health markers in humans. Nutr Rev. 2015 Oct;73(10):661-74. doi: 10.1093/nutrit/nuv041. Epub 2015 Sep 15. PMID: 26374764.

Nowosad K, Sujka M. Effect of Various Types of Intermittent Fasting (IF) on Weight Loss and Improvement of Diabetic Parameters in Human. Curr Nutr Rep. 2021 Jun;10(2):146-154. doi: 10.1007/s13668-021-00353-5.

Halberg N, Henriksen M, Söderhamn N, Stallknecht B, Ploug T, Schjerling P, Dela F. Effect of intermittent fasting and refeeding on insulin action in healthy men. J Appl Physiol (1985). 2005 Dec;99(6):2128-36. doi: 10.1152/japplphysiol.00683.2005. Epub 2005 Jul 28. PMID: 16051710.

 

Anton SD, Moehl K, Donahoo WT, et al. Flipping the Metabolic Switch: Understanding and Applying the Health Benefits of Fasting. Obesity (Silver Spring). 2018;26(2):254-268. doi:10.1002/oby.22065

 

Sydney G O'Connor, Patrick Boyd, Caitlin P Bailey, Marissa M Shams-White, Tanya Agurs-Collins, Kara Hall, Jill Reedy, Edward R Sauter, Susan M Czajkowski, Perspective: Time-Restricted Eating Compared with Caloric Restriction: Potential Facilitators and Barriers of Long-Term Weight Loss Maintenance, Advances in Nutrition, Volume 12, Issue 2, March 2021, Pages 325–333

 

Bachman JL, Raynor HA. Effects of manipulating eating frequency during a behavioral weight loss intervention: a pilot randomized controlled trial. Obesity (Silver Spring). 2012 May;20(5):985-92. doi: 10.1038/oby.2011.360. Epub 2011 Dec 15. PMID: 22173575.

Munsters MJ, Saris WH. Effects of meal frequency on metabolic profiles and substrate partitioning in lean healthy males. PLoS One. 2012;7(6):e38632. doi: 10.1371/journal.pone.0038632. Epub 2012 Jun 13. PMID: 22719910; PMCID: PMC3374835.

 

Sievert K, Hussain S M, Page M J, Wang Y, Hughes H J, Malek M et al. Effect of breakfast on weight and energy intake: systematic review and meta-analysis of randomised controlled trials BMJ 2019; 364 :l42 doi:10.1136/bmj.l42

Leonie K Heilbronn, Steven R Smith, Corby K Martin, Stephen D Anton, Eric Ravussin, Alternate-day fasting in nonobese subjects: effects on body weight, body composition, and energy metabolism, The American Journal of Clinical Nutrition, Volume 81, Issue 1, January 2005, Pages 69–73.

 

Kahleova H, Belinova L, Malinska H, Oliyarnyk O, Trnovska J, Skop V, Kazdova L, Dezortova M, Hajek M, Tura A, Hill M, Pelikanova T. Eating two larger meals a day (breakfast and lunch) is more effective than six smaller meals in a reduced-energy regimen for patients with type 2 diabetes: a randomised crossover study. Diabetologia. 2014 Aug;57(8):1552-60. doi: 10.1007/s00125-014-3253-5. Epub 2014 May 18. Erratum in: Diabetologia. 2015 Jan;58(1):205.

 

Jamshed, H., Beyl, R. A., Della Manna, D. L., Yang, E. S., Ravussin, E., & Peterson, C. M. (2019). Early Time-Restricted Feeding Improves 24-Hour Glucose Levels and Affects Markers of the Circadian Clock, Aging, and Autophagy in Humans. Nutrients, 11(6), 1234. https://doi.org/10.3390/nu11061234.

 

Varady, K. A., Bhutani, S., Klempel, M. C., Kroeger, C. M., Trepanowski, J. F., Haus, J. M., Hoddy, K. K., & Calvo, Y. (2013). Alternate day fasting for weight loss in normal weight and overweight subjects: a randomized controlled trial. Nutrition journal, 12(1), 146.

Johnstone AM, Faber P, Gibney ER, Elia M, Horgan G, Golden BE, Stubbs RJ. Effect of an acute fast on energy compensation and feeding behaviour in lean men and women. Int J Obes Relat Metab Disord. 2002 Dec;26(12):1623-8.

Johnstone AM, Faber P, Gibney ER, Elia M, Horgan G, Golden BE, Stubbs RJ. Effect of an acute fast on energy compensation and feeding behaviour in lean men and women. Int J Obes Relat Metab Disord. 2002 Dec;26(12):1623-8. doi: 10.1038/sj.ijo.0802151. PMID: 12461679.

 

"Our food should be our medicine.  Our medicine should be our food.  But to eat when you are sick is to feed your sickness."
                                               - Hippocrates

    Fasting is one of the most ancient and widespread healing traditions in human history. This solution has been practiced by virtually every culture and religion on earth. Hippocrates of Cos (c460 – c370 BC) is widely considered the father of modern medicine. Among the treatments that he prescribed and championed was the practice of fasting. The ancient Greek writer and historian Plutarch (c46 AD– c120 AD) also echoed these sentiments. He famously wrote, “Instead of using medicine, better fast today”. Ancient Greek thinkers Plato and his student Aristotle were also strong supporters of fasting.
    The ancient Greeks believed that medical treatment could be observed from nature. Humans, like most animals, do not eat when they become sick. For this reason, fasting has been called the ‘physician within’. This fasting ‘instinct’ that makes dogs, cats and humans anorexic when sick. This sensation is certainly familiar to everybody. Consider the last time you were sick with the flu. Probably the last thing you wanted to do was eat. So, fasting seems to be a universal human instinct to multiple forms of illnesses. Thus fasting is ingrained into human heritage, and as old as mankind itself. The ancient Greeks also believed that fasting improves cognitive abilities. Think about the last time you ate a huge meal. Did you feel more energetic and mentally alert afterwards? Or, instead did you feel sleepy and a little dopey? More likely the latter. Blood is shunted to your digestive system to cope with the huge influx of food, leaving less blood going to the brain. Result – food coma.
    Fasting is also widely practiced for spiritual purposes and remains part of virtually every major religion in the world. In spiritual terms, it is often called cleansing or purification, but practically, it amounts to the same thing. The practice of fasting developed independently among different religions and cultures, not as something that was harmful, but something that was deeply, intrinsically beneficial to the human body and spirit.

    So fasting is truly an idea that has withstood the test of time.  But what is exactly fasting and what does science say about it?

Fasting involves controlled, voluntary abstinence from caloric intake to achieve a physical, mental, or spiritual outcome.

     Our ancestors would regularly go days or even weeks without food. As a result, humans have evolved specific adaptations to survive, and even thrive, during periods of famine. So, in reality, the body  only exists in one of two states – the fed (high insulin) state or the fasted (low insulin) state. Either we are storing food energy (increasing stores) or we are burning stored energy (decreasing stores). It is one or the other, but not both. More analytically :

Feeding – During meals, insulin levels are raised. This allows uptake of glucose into tissues such as the muscle or brain to be used directly for energy. Excess glucose is stored as glycogen in the liver.
The post-absorptive phase – 6-24 hours after last meal .   Insulin levels start to fall. Breakdown of glycogen releases glucose for energy. Glycogen stores last for roughly 24 hours.
Gluconeogenesis – 24 hours to 2 days – The liver manufactures new glucose from lactate and amino acids in a process called “gluconeogenesis”. Literally, this is translated as “making new glucose”. In non-diabetic persons, glucose levels fall but stay within the normal range.
Ketosis – 2-3 days after beginning fasting – This is when interesting things start to happen for the body. The low levels of insulin reached during fasting, stimulate lipolysis, the breakdown of fat for energy. The storage form of fat, known as triglycerides, is broken into the glycerol backbone and three fatty acid chains. Glycerol is used also for gluconeogenesis. Fatty acids may be used for directly for energy by many tissues in the body, but not the brain. Ketone bodies instead , which are produced from fatty acids during ketosis , are capable of crossing the blood-brain barrier for use by the brain. After four days of fasting, approximately 75% of the energy used by the brain is provided by ketones. The two major types of ketones produced are beta hydroxybutyrate and acetoacetate, which can increase over 70 fold during fasting.
Protein conservation phase – >5 days – High levels of growth hormone maintain muscle mass and lean tissues. The energy for maintenance of basal metabolism is almost entirely met by the use of free fatty acids and ketones. Increased norepinephrine (adrenalin) levels prevent the decrease in metabolic rate.

   We see that the human body has well developed mechanisms for dealing with periods of low food availability. In essence, what is happening while fasting is a process of switching from burning glucose to burning fat . Fat is simply the body’s stored food energy. In times of low food availability, stored food is naturally released to fill the void. So no, the body does not ‘burn muscle’ in an effort to feed itself, at least until all the fat stores are used.

 

Lets have a look on the effects of fasting on Hormonal Adaptation

 

• Insulin

 

    Insulin and insulin resistance are major drivers of obesity. Fasting on the other hand , is the most efficient and consistent strategy to decrease insulin levels. This was first noted decades ago, and widely demonstrated scientifically afterwards. It is quite simple and obvious. All foods raise insulin, so the most effective method of reducing insulin is to avoid all foods. Blood glucose levels remain normal, as the body begins to switch over to burning fat for energy. This effect can be observed in fasting periods as short as 24-36 hours. Longer duration fasts reduce insulin even more dramatically. More recently, alternate daily fasting has been studied as an acceptable technique of reducing insulin.
    Regular fasting, in addition to lowering insulin levels, has also been shown to improve insulin sensitivity significantly. Many argue that this is the missing link in the weight loss puzzle. Most diets reduce highly insulin-secreting foods, but do not address the insulin resistance issue which is crucial in diabetics.  Weight is initially lost, but insulin resistance keeps insulin levels and body weight high. Fasting is an efficient method of reducing insulin resistance.
    Lowering insulin also rids the body of excess salt and water. Insulin causes salt and water retention in the kidney. Very low-carb diets often cause diuresis, the loss of excess water, leading to the contention that much of the initial weight loss is water. While true, diuresis is beneficial in reducing bloating, and feeling ‘lighter’. Some may also note a slightly lower blood pressure. Fasting has also been noted to have an early period of rapid weight loss. For the first five days, weight loss averages 0.9 kg/ day, far exceeding the caloric restriction and likely due to a diuresis of salt and water.

 

• Growth Hormone

 

   Growth hormone is known to increase the availability and utility of fats for fuel. It also helps to preserve muscle mass and bone density. Secretion is known to be pulsatile, making accurate measurement difficult. Growth hormone secretion decreases steadily with age. One of the most potent stimuli to growth hormone secretion is fasting. Over a five-day fasting period growth hormone secretion is more than doubled. The net physiologic effect is to maintain muscle and bone tissue mass over the fasting period.

 

• Adrenalin

 

     Adrenalin levels are increased so that we have plenty of energy to go get more food. For example, 48 hours of fasting produces a 3.6% increase in metabolic rate, not the dreaded metabolic ‘shut-down’. In response to a 4 day fast, resting energy expenditure increased up to 14%.   Rather than slowing the metabolism, instead the body revives it up. Additionally, studies show that the adrenalin-induced fat-burning does not depend upon lowering blood sugar. Presumably, this is done so that we have energy to go out and find more food.

And what about vitamins ,minerals and electrolytes?

    Concerns about malnutrition during fasting are misplaced. Insufficient calories are not a major worry, if the fat stores are quite ample. The main concern is the development of micronutrient deficiency. However, if the fasting regime is accompanied by the use of a multi-vitamin and mineral supplementation that will provide the recommended daily allowance of micronutrients , there should’t be any issue.  It is worth noting, that in 1973 a therapeutic fast of 382 days that resulted in loss of 125 kilos for a patient, was maintained with only a multivitamin potion and had no harmful effect on health . Actually, this man maintained that he had felt terrific during this entire period. The only concern may be a slight elevation in uric acid that has been described in fasting and can be solved by increased water consumption.

Additionally, evidence suggests four brain health effects linked to fasting:

• Brain cell re-generation

 

• Cognitive and psychological benefits

 

• Resilience to neurological conditions

 

• Slowing the effects of aging.

 

This research on brain health is focused on the use of ketones, molecules that as we saw before, are being produced and used by the body as a source of fuel while fasting. Administration of ketones is a well established therapy since decades for intractable epilepsy and seizures. It should be considered early in the treatment of Dravet syndrome and myoclonic-astatic epilepsy (Doose syndrome). A growing body of literature suggests also that the use of ketones may be beneficial in certain neurodegenerative diseases, including Alzheimer disease, Parkinson’s disease, and amyotrophic lateral sclerosis. In these disorders, ketones appears to be neuroprotective, promoting enhanced mitochondrial function and rescuing adenosine triphosphate production. Ultimately , dietary therapy is a promising intervention for cancer, given that it may target the relative inefficiency of tumors in using ketone bodies as an alternative fuel source.

So, let’s summarise.

    Fasting, but not low calorie diets, results in numerous physiological and hormonal adaptations that all appear to be highly beneficial on many levels. The main benefits of fasting are metabolic flexibility and weight management. In essence, fasting transitions the body from burning sugar to burning fat.  Resting metabolism is NOT decreased but instead increased.  We are, effectively, feeding our bodies through our own fat.  We are ‘eating’ our own fat.  This makes total sense since fat is, in essence, stored food. Fat is food stored away for the long term, like money in the bank.  Short term food is stored as glycogen, like money in the wallet.  The problem we have, is how to access the money in the bank.  As our wallet depletes, we become nervous and go out working to fill it again.  This prevents us from getting access to our stored money in the bank. In the same manner, as our glycogen ‘wallet’ depletes, we get hungry and want to eat.  That makes us look for food, despite the fact that there is more than enough food stored as fat in the body ‘bank’’.  How do we get to that fat to burn it? Fasting provides an easy way in.

 

References

Anderson JW, Herman RH, Newcomer KL. Improvement in glucose tolerance of fasting obese patients given oral potassium. Am J Clin Nutr. 1969 Dec;22(12):1589–1596.

Drenick EJ, Hunt IF, Swendseid ME. Magnesium depletion during prolonged fasting of obese males. J Clin Endocrinol Metab. 1969 Oct;29(10):1341–1348.

Jackson IM, McKiddie MT, Buchanan KD. The effect of prolonged fasting on carbohydrate metabolism: evidence for heterogeneity in obesity. J Endocrinol. 1968 Feb;40(2):259–260.

Jackson IM, McKiddie MT, Buchanan KD. Effect of fasting on glucose and insulin metabolism of obese patients. Lancet. 1969 Feb 8;1(7589):285–287.

Thomson TJ, Runcie J, Miller V. Treatment of obesity by total fasting for up to 249 days. Lancet. 1966 Nov 5;2(7471):992–996.

Stewart, W. K., & Fleming, L. W. (1973). Features of a successful therapeutic fast of 382 days' duration. Postgraduate medical journal, 49(569), 203–209. https://doi.org/10.1136/pgmj.49.569.203

de Groot, S., Pijl, H., van der Hoeven, J., & Kroep, J. R. (2019). Effects of short-term fasting on cancer treatment. Journal of experimental & clinical cancer research : CR, 38(1), 209. https://doi.org/10.1186/s13046-019-1189-9

Grajower, M. M., & Horne, B. D. (2019). Clinical Management of Intermittent Fasting in Patients with Diabetes Mellitus. Nutrients, 11(4), 873. https://doi.org/10.3390/nu11040873

Furmli, S., Elmasry, R., Ramos, M., & Fung, J. (2018). Therapeutic use of intermittent fasting for people with type 2 diabetes as an alternative to insulin. BMJ case reports, 2018, bcr2017221854. https://doi.org/10.1136/bcr-2017-221854

Wilhelmi de Toledo F, Grundler F, Bergouignan A, Drinda S, Michalsen A (2019) Safety, health improvement and well-being during a 4 to 21-day fasting period in an observational study including 1422 subjects. PLoS ONE 14(1): e0209353. https://doi.org/10.1371/journal.pone.0209353

Klein S, Holland OB, Wolfe RR. Importance of blood glucose concentration in regulating lipolysis during fasting in humans. Am J Physiol. 1990 Jan;258(1 Pt 1):E32-9. doi: 10.1152/ajpendo.1990.258.1.E32. PMID: 2405701.
Ho KY, Veldhuis JD, Johnson ML, et al. Fasting enhances growth hormone secretion and amplifies the complex rhythms of growth hormone secretion in man. J Clin Invest. 1988 Apr;81(4):968-75.

Zauner C, Schneeweiss B, Kranz A, et al. Resting energy expenditure in short-term starvation is increased as a result of an increase in serum norepinephrine. Am J Clin Nutr. 2000 Jun;71(6):1511-5.

Sumithran P, Prendergast LA, Delbridge E, et al. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med. 2011 Oct 27;365(17):1597-604. doi: 10.1056/NEJMoa1105816.
Bailey EE, Pfeifer HH, Thiele EA. The use of diet in the treatment of epilepsy. Epilepsy Behav. 2005;6:4–8.

Huttenlocher PR. Ketonemia and seizures: metabolic and anticonvulsant effects of two ketogenic diets in childhood epilepsy. Pediatr Res. 1976;10:536–540.

Otto C, Kaemmerer U, Illert B, et al. Growth of human gastric cancer cells in nude mice is delayed by a ketogenic diet supplemented with omega-3 fatty acids and medium-chain triglycerides. BMC Cancer. 2008;8:122.
Nebeling LC, Miraldi F, Shurin SB, Lerner E. Effects of a ketogenic diet on tumor metabolism and nutritional status in pediatric oncology patients: two case reports. J Am Coll Nutr. 1995;14:202–208.

Maswood N, Young J, Tilmont E, et al. Caloric restriction increases neurotrophic factor levels and attenuates neurochemical and behavioral deficits in a primate model of Parkinson’s disease. Proc Natl Acad Sci U S A. 2004;101:18171–18176.

Kim DY, Davis LM, Sullivan PG, et al. Ketone bodies are protective against oxidative stress in neocortical neurons. J Neurochem. 2007;101:1316–1326.

Bough KJ, Wetherington J, Hassel B, et al. Mitochondrial biogenesis in the anticonvulsant mechanism of the ketogenic diet. Ann Neurol. 2006;60:223–235. An elegant study correlating seizure protection with changes in gene expression, biochemistry, and electrophysiology.

Murphy P, Likhodii S, Nylen K, Burnham WM. The anti-depressant properties of the ketogenic diet. Biol Psychiatry. 2004;56:981–983.

Part 1 . How the state of the eater affects his/her metabolic capacity.

    Most of us have been taught to believe that good nutrition is simply a function of eating the right food and taking the right supplements. Although this is true, there’s more to the equation. What we eat is only half the story of good nutrition. The other half of the story is who we are as eaters. That is, what we think, feel, believe, our levels of stress, relaxation, pleasure, awareness, and the inner stories that we live out all have a real, powerful, and scientific effect on nutritional metabolism.
    Recent advances in the mind-body sciences have been proving what ancient wisdom traditions have been saying for eons—that the mind and body exist on an exquisite continuum, they are connected intrinsically and profoundly impact one another. So the good news is simply this: you can powerfully change your health and your nutritional status by changing you the eater.

 

    The Automatic Nervous System is the ‘powerhouse’ that prepares our body for unconscious action and consists of two parts: the Sympathetic Nervous System (SNS) , also referred as “fight or flight”  and the Parasympathetic Nervous System (PNS) also referred as “rest and digest”.  It’s an important concept to note that this system is “autonomous” , because it tells us that acts on its own. In other words, you don’t need to tell your autonomic nervous system to do its job — nor can you.
    Our SNS , which triggers our fight or flight response, prepares the body for a perceived threat or danger, increasing blood flow, heart rate  and producing hormones like cortisol or adrenaline , making us more alert and receptive to react. The PNS, which controls our rest and digest response, has the opposite effect of SNS, so instead of increasing the heart rate, it decreases it with the hormone acetylcholine, returning the body to a state of calm and peace. So the PNS basically undoes what the SNS has caused.

 

    It’s easy to see that the fight or flight response is essential in some situations. Undoubtedly, your body's ability to manipulate the smooth muscles, cardiac muscles, and glands in order to produce quicker, faster, stronger reactions when you need them can save your life. However, it’s also easy to see that if you are unable to perceive truly dangerous situations accurately, you may ignite your fight or flight response more often than is necessary. The point here is that you do not want your fight or flight system to be activated when it doesn't need to be. Original research by David S. Goldstein in the journal Cellular and Molecular Neurobiology states: “If the stress response is excessive or prolonged then any of a variety of clinical disorders can arise.” In other word, activating the fight or flight response too often can cause serious health ramifications.

    You should optimally be in a parasympathetic state 80 percent of the time, but many people struggle to be in this state at any point during their day, for any length of time. From the minute the alarm goes off in the morning, moving around all day long, eating on the run, rushing to work, to finally collapsing into bed, the constant demands keep us on edge. For most of us “fight or flight” just doesn’t stop all day. This feature of the nervous system evolved over millions of years as a brilliant safety mechanism to support us during life-threatening events. So, in the moment of stress, the sympathetic response is activated, and something very interesting happens—the digestive system shuts down. It makes perfect sense that when you’re facing an angry gorilla, you don’t need to waste energy digesting your breakfast. All the body’s metabolic energy is directed towards survival. So, you could be eating the healthiest food in the universe, but  if you aren’t eating under the optimum state of digestion and assimilation—which happens to be relaxation—you literally and metabolically are not receiving the full nutritional value of your meal.

    There are many more ways, that having an imbalanced nervous system can affect your health. When in in a chronic sympathetic state, the body typically produces lots of cortisol. This is a very direct way that your body will purposely create more glucose in the blood, so you can keep being active in your daily life. But chronically high cortisol and blood glucose is not ideal, it leads to high oxidation and cell damage, and eventually insulin resistance and type 2 diabetes. Another example of how lifestyle – even the parts that are completely separate from diet – determines your health. Your body is telling itself that immediate survival is more important than regenerating cells, reducing inflammation, detoxifying, or reproducing or any other bodily function that isn’t about surviving a crisis.

So, what has the science to say about the psychology of the eater?

 

• A peaceful state is the best digestive aid.

It’s fascinating how stress, fear, anxiety, anger, judgment and even negative self-talk can literally create a physiologic stress response in the body. This means that we generate more cortisol and insulin, two hormones that have the unwanted effect of signalling the body to store weight, store fat, and stop building muscle. Strange as it may sound, we quite literally change our calorie burning capacity when we’re stressed. What’s more incredible though, is that as we learn to smile more, ease into life and breathe more deeply, the body enters a physiologic relaxation response (rest and digest) . In this state, we actually create our optimal day-in, day-out calorie-burning metabolism. So, you could be following the best weight loss diet in the world, but if you’re an anxious mess, the power of your mind is limiting the weight loss of your body. Far too many people adopt stressful weight loss strategies—impossible to follow diets, overly intense exercise programs, tasteless food, extremely low calorie meal plans—all of which can create the kind of stress chemistry that ensures our weight will stay put. It’s time to relax into weight loss.

 

• Overeating—Could be due to lack of awareness.

Most people think they overeat because they have a willpower problem. Well, here’s the good news—you may not have a willpower problem. The problem for a majority of overeaters is that they don’t actually “eat” when they eat. Studies show that when we aren’t always fully present to the meal, aware of its taste, eating it slowly, or simply feeling nourished by the food, the brain, which requires taste and satisfaction, misses out on a key phase of the nutritional experience. The brain literally thinks it didn’t eat, or didn’t eat enough. And it simply screams back at us—“Hungry!” So, you can dramatically decrease your overeating by increasing your awareness and presence at every meal.

 

• Slower eating means faster metabolism

One of the most basic nutritional questions to ask someone is: “Are you a fast eater, moderate eater or slow eater?” If the answer is “fast”, then it’s time for an overhaul. That’s because the act of eating fast is considered a stressor by the body. Humans are simply not biologically wired for high-speed eating. So when we do eat fast, the body once again enters the physiologic stress response, which results in decreased digestion, decreased nutrient assimilation, increased nutrient excretion, lowered calorie burning rate and a bigger appetite. The bottom line is that you can literally empower your nutritional metabolism simply by slowing down. What’s fascinating is that for many fast eaters, slowing down is quite a challenge. But try this—don’t just eat slowly—eat mindfully , feel nour- ished by your food and take in all the sensations of your meal. And by doing that , you can find pleasure from eating foods that you never thought you liked !

 

• Get rid of toxic nutritional beliefs

Finally, many of us have absorbed toxic nutritional beliefs that are as harmful and debilitating as any of the toxins in our food. Here’s what I mean: It’s surprisingly common for people to believe that “food is the enemy” or “food makes me fat” or “fat in food will become fat on my body” or “my appetite is the enemy” or “as soon as I have the perfect body, then I’ll finally be happy.” Such beliefs may seem harmless, yet they can create a relationship with food and self that’s filled with tremendous suffering and pain. Think about it—if “food is the enemy”, then we are constantly in a fight or flight stress response whenever we eat, or even think about food. Such a powerful stressor can cause all the problems of stress-induced digestive shutdown, decreased calorie burning capacity, and an inner life that’s seldom at peace.

So, the question is: Is your relationship with food nourishing, or punishing?

 

 

Coming soon:

Part 2. How to stay more in Parasympathetic Mode.

 

 

Since there is no registered medicine or vaccine* against COVID-19, the immune system is our best defence, because it supports the body’s natural ability to defend against pathogens (eg. viruses, bacteria, fungi, protozoan, and worms) and resists infections. When the body encounters germs or viruses for the first time, the immune system cannot work properly, and illness can occur. This scenario is what has occurred in the case of COVID-19 . However, as long as the immune system is functioning normally, symptoms from infections such as COVID-19 can go unnoticed for the majority of the people with no serious pre-existing medical conditions.

Building a strong immune system is your best defence against infectious illness and disease. Your immune health depends on the lifestyle choices you make every day. By supporting your body's own natural ability to defend itself against pathogens, you will not only have resistance to colds and flus but to other infectious illnesses and diseases that come your way.

While there are no COVID medications or immunity-boosting supplements that can cure or prevent coronavirus, there are steps you can take to make your defences as strong as possible.

Immune-Strengthening Strategies

Healthy living strategies you can do for your immune system include:

• Eating a healthy, balanced diet and staying hydrated. According to all scientific literature , healthy foods and hydration are vital. Individuals consuming a well-balanced diet are healthier with a strong immune system and have a reduced risk of chronic illness and infectious diseases. Some nutrients are well known to play a key role in immune system health like the antioxidants Vitamin E and Vitamin C, minerals like Selenium and Zinc other Vitamins like Vitamin D, Vitamin A and Omega 3 essential fatty acids. Foods recommended :

- Fruits and vegetables (especially brightly colored ones) are packed with all these nutrients but also have a lot more to offer to the immune system than just their vitamins and minerals. The phytonutrients, fibre, oils and acids in them, which are responsible for their various flavours and colours, are also responsible for their many health, healing and immune-modulating properties. These bioactive compounds are used by the body to directly combat inflammation and infections and support detoxification and immune cell function through a multitude of mechanisms, many of which have yet to be fully understood.

- Fish for their Omega - 3 — Polyunsaturated fatty acids which are important in immune response as it produces a compound that can prohibit virus replication. Moreover, Omega-3 fatty acids icosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have anti-inflammatory properties that help with easing inflammatory cytokine responses during viral infections. Fish oils, chia seeds and edamame are packed with Omega-3 PUFA.

- Honey, preferably raw, is a good demulcent (it relieves minor pain and inflammation of mucous membranes), has antioxidant properties, and has some antimicrobial effects. It is helpful for coughs and sore throats and can be added to hot tea.

- Garlic contains a variety of compounds that can influence immunity. Some studies have shown that both fresh garlic as well as aged garlic extract and some other garlic supplements may reduce viral upper respiratory infection severity as well as function in the prevention of infection with viruses that can cause colds.

- Probiotics contain “good bacteria” that not only support the health of the gut but also influence immune system functioning and regulation. Studies have shown that probiotic use can decrease the number of respiratory infections, particularly in children.

 

• Removing sugar and processed foods : Cut down processed juices, fizzy drinks , pastries, biscuits and such. A few grams of sugar can destroy your white blood cells' ability to resist infections for several hours.

• Exercising regularly – Moderate, regular physical activity helps to boost immune system function by raising levels of infection-fighting white blood cells and antibodies, increasing circulation, and decreasing stress hormones. Establish and follow an exercise program to not only help prevent respiratory infections but also to improve cognitive and physical resilience.

• Maintaining a healthy weight – Aim for a BMI of 25 or lower. Adults with excess weight are at even greater risk during the COVID-19 pandemic:

- Having obesity increases the risk of severe illness from COVID-19. People who are overweight may also be at increased risk.

- Having obesity may triple the risk of hospitalization due to a COVID-19 infection.

- Obesity is linked to impaired immune function.

- Obesity decreases lung capacity and reserve and can make ventilation more difficult.

- As BMI increases, the risk of death from COVID-19 increases.

 

• Getting quality sleep—Sleep has a big influence on immune function, so it is essential to get plenty of sleep. Practice good sleep hygiene and maintain consistent sleep hours—turn off screens, ensure the room is cool, quiet, and dark, and set a reminder to help yourself go to bed on time.

 

• Reducing stress and developing good coping mechanisms. Chronic stress can negatively alter immune system responses, making you more likely to get sick. Identify your personal stress reduction strategies and practice them regularly. Include activities in your daily life that help you handle stress, like connecting with loved ones, going outside, practicing meditation regularly, making art or other hobbies.

 

• Quitting smoking . Smoking not only increases your risk for complications if you get the virus, it can also make you more likely to contract the disease in the first place. The Centers for Disease Control categorizes smokers as "immunocompromised," which means having a weakened immune system

 

• Drinking alcohol only in moderation. By default, alcohol makes it harder for the immune system to gear up and defend the body against harmful germs. Moreover, alcohol can trigger inflammation in the gut and destroy the microorganisms that live in the intestine and maintain immune system health.

 

Further research has been conducted and the following (among many) additional supplements are now recommended as options for strengthening immunity:

• Beta-glucans – numerous human trials have shown that beta-glucans stimulate activity against viral attack, these findings include a decrease in cold and flu symptoms and upper respiratory tract infections compared to placebo.

• Mushrooms – a variety of mushroom species have been shown to help with immune function in a myriad of ways; some of the medicinal mushrooms include Shiitake, Lion's Mane, Maitake, and Reishi.

• Berberine – found in the roots, rhizomes, and stem bark of various plants, this natural compound has been shown to have antiviral and anti-inflammatory properties; it can be found in goldenseal, goldthread and Oregon grape species.

• Sulforaphane – sulforaphane has potent anti-inflammatory and anti-viral properties; it can be produced in the body in small amounts by eating some cruciferous vegetables or in more therapeutic amounts in dietary supplements containing glucoraphanin and myrosinase enzyme.

• Elderberry – studies have shown that elderberry has properties that appear to help fight viruses; choose a low-sugar capsule or tablet, if possible, as opposed to sugary syrup.

• Echinacea - E. purpurea has been shown to stimulate macrophage activation as well as NK cell activity in both human and animal models and it may be linked directly to increased cytokine expression. Various Echinacea preparations have shown antiviral activity. Echinacea preparations alone have been shown to reduce the frequency, severity, and/or duration of upper respiratory tract symptoms in several trials, and various multi-herb/nutrient formulas containing Echinacea preparations have also been shown to be effective in reducing symptoms.

• Quercetin - Quercetin has been shown to have antiviral effects against both RNA (e.g. influenza and coronavirus) and DNA viruses (e.g.herpesvirus). Quercetin has a pleiotropic role as an antioxidant and anti-inflammatory, modulating signaling pathways that are associated with post-transcriptional modulators affecting post-viral healing.

• Eycalyptus- Essential oils obtained from eucalyptus (Eucalyptus globulus) are traditionally used to treat various respiratory ailments including pharyngitis, bronchitis, and sinusitis. Data of recent studies studies demonstrate marked immunomodulatory properties of both eucalyptus oil and its active ingredient, i.e. eucalyptol. Interestingly, eucalyptus oil has also been shown to have disinfection properties and inhibited the growth of viruses on various utensils and filter devices. Taken together, data from both preclinical and clinical trials point towards the promising therapeutic potential that resides in eucalyptus oil and its active constituent, i.e. eucalyptol in the prevention and treatment of COVID-19.

The main way to prevent infections is to stay away from sick people. As for Covid-19, to prevent illness and avoid being exposed to the virus, the Centers for Disease Control and Prevention (CDC) recommends washing your hands often, avoiding close contact with people who are sick, covering your mouth and nose with a mask when around others, covering coughs and sneezes, and cleaning and disinfecting frequently touched surfaces daily.

*Various vaccines have been registered after writing this post. Nevertheless, this development does NOT strip away our personal responsibility and ability to support our immune system in order to fight viruses and infections.

 

 

References:

Tartof, S. Y., Qian, L., Hong, V., Wei, R., Nadjafi, R. F., Fischer, H., ... & Saxena, T. (2020). Obesity and mortality among patients diagnosed with COVID-19: results from an integrated health care organization. Annals of Internal Medicine.

Simonnet, A., Chetboun, M., Poissy, J., Raverdy, V., Noulette, J., Duhamel, A., ... & LICORN and the Lille COVID-19 and Obesity study group. (2020). High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity.

Healthy habits to help prevent flu. Centers for Disease Control and Prevention. Reviewed November 7, 2019. Accessed March 5, 2020. https://www.cdc.gov/flu/prevent/actions-prevent- flu.htm

Wang Y, Li X, Ge T, et al. Probiotics for prevention and treatment of respiratory tract infections in children: a systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2016;95(31):e4509. doi:10.1097/MD.0000000000004509

Phytonutrients. NutritionFacts. Accessed March 5, 2020. https://nutritionfacts.org/topics/ phytonutrients/

Martineau AR, Jolliffe DA, Hooper RL, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017;356:i6583. doi:10.1136/bmj.i6583

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