In 1921, Rollin Turner Woodyatt reviewed the research on diet and diabetes. He reported that three water-soluble compounds, β-hydroxybutyrate, acetoacetate, and acetone (known collectively as ketone bodies), were produced by the liver in otherwise healthy people when they were starved or if they consumed a very low-carbohydrate, high-fat diet. Dr. Russell Morse Wilder, at the Mayo Clinic, built on this research and coined the term "ketogenic diet" to describe a diet that produced a high level of ketone bodies in the blood (ketonemia) through an excess of fat and lack of carbohydrate. Wilder hoped to obtain the benefits of fasting in a dietary therapy that could be maintained indefinitely. His trial on a few epilepsy patients in 1921 was the first use of the ketogenic diet as a treatment for epilepsy.
Perhaps most importantly, intermittent fasting is one of the simplest strategies we have for taking bad weight off while keeping good weight on because it requires very little behavior change. This is a very good thing because it means intermittent fasting falls into the category of “simple enough that you'll actually do it, but meaningful enough that it will actually make a difference.”
As a lifestyle-leaning research doctor, I needed to understand the science. The Obesity Code seemed the most evidence-based summary resource, and I loved it. Fung successfully combines plenty of research, his clinical experience, and sensible nutrition advice, and also addresses the socioeconomic forces conspiring to make us fat. He is very clear that we should eat more fruits and veggies, fiber, healthy protein, and fats, and avoid sugar, refined grains, processed foods, and for God’s sake, stop snacking. Check, check, check, I agree. The only part that was still questionable in my mind was the intermittent fasting part.
Although many hypotheses have been put forward to explain how the ketogenic diet works, it remains a mystery. Disproven hypotheses include systemic acidosis (high levels of acid in the blood), electrolyte changes and hypoglycaemia (low blood glucose). Although many biochemical changes are known to occur in the brain of a patient on the ketogenic diet, it is not known which of these has an anticonvulsant effect. The lack of understanding in this area is similar to the situation with many anticonvulsant drugs.
To help you make better food choices and avoid binge eating, Mirkin recommends sticking to a 12-hour eating window instead of an 8-hour one. "This allows adequate sleep and prevents late-night munching. It also allows you to fuel evenly throughout the day so that a person is able to meet their nutritional needs without watching the clock so closely," Mirkin explains.
What time period works best? Keeping your eating window earlier—say, from 7 a.m. to 3 p.m.—seems to be the most beneficial. The body’s biological clock is primed to eat earlier in the day, explains Courtney Peterson, PhD, assistant professor of nutrition at the University of Alabama at Birmingham. “In most people, blood sugar control is best in the morning and gets worse as the day progresses. You also digest food faster in the morning. So there’s a metabolic advantage to eating earlier in the daytime,” she says.