An interview with Krista Varaday, PhD, Associate Professor, Kinesiology and Nutrition, University of Illinois, College of Applied Health Sciences, and author of The Every-Other-Day Diet, Hachette Books, 2013. We met at the North American Menopause Society conference in October, 2016.
Madeleine Burnside: I think many people are interested in the idea of the alternate-day fast, but I’d love to hear your point of view on that.
Krista Varady: Sure. First I’ll explain what it is. Alternate-day fasting involves one day where we eat 500 calories as a lunch or a dinner alternated with what we call a feast day where people can truly eat whatever they want. Basically, the psychology behind it is that even though you undergo this day of pretty intense calorie restriction, you always get to look forward to the next day where you can eat whatever you want. That was designed to propel people to stick to the diet potentially longer than one with daily calorie restriction, where people tire of the constant tracking and counting and recording. We just completed a one-year study to compare calorie restriction to alternate-day fasting and they actually had the same weight loss results. Altogether I’ve run about ten well-controlled clinical trials involving around six to seven hundred people, and overall obese people lose about one to three pounds per week, and normal weight people lose about a quarter- to a half-pound per week. The main benefits we’ve seen are a lowering in LDL cholesterol and triglycerides, decreases in glucose insulin and insulin resistance, and an elevation in HDL cholesterol over six months. So there are protective effects for both heart disease and diabetes.
MB What kinds of foods would you recommend that people eat on their fast days?
KV What we’ve found throughout the course of these studies is that it helps if someone is consuming fifty to seventy grams of protein on fast days. Specific food items that seem to work are things like chicken with salad—protein from the chicken and vitamins and minerals from vegetables in the salad. You have to keep the dressing down because you can easily consume over three hundred calories with that alone. Even vegetarians can do this diet, but they would have to include tofu or beans or certain legumes.
MB I’ve actually tried your diet, with some success, and I have friends who’ve tried it as well, and among the things they’ve found is that it’s not only on fast days that they begin to start naturally moving away from bad eating habits. It’s not that they lose interest in food, but they intuitively develop a better sense of what they’re really eating.
KV Yes, and that’s what we find too with our studies. My main question in the beginning was how much are people going to eat on their feast days in response to the lack of food on their fast days; and we thought since five hundred calories is roughly twenty-five percent of someone’s average energy needs that they’d compensate with at least seventy-five percent on feast days, but it turned out that people usually eat only ten percent more on feast days, so they’re not bingeing or gorging. The story we always get when people start in our studies is that after the first week they’re excited to go to sleep at the end of a fast day looking forward to waking up and having a really big breakfast, but when they do that they find they’re only able to eat half of it. So there’s something going on in the body that’s actually preventing people from overcompensating, and we’re trying to figure out what that is. We’ve measured changes in hunger fullness hormones, and over the course of eight weeks hunger tends to go down and fullness tends to go up a little bit. At first I thought we had to measure stomach shrinkage, but I talked to a gastroenterologist and apparently that phenomena doesn’t exist—the stomach never shrinks. It’s more an issue of gastric motility—how fast food moves through the stomach as opposed to how much it expands—so we wanted to team-up with a gastroenterologist and see if the food is moving more slowly through the stomach then are you possibly feeling fuller longer.
MB What is the normal amount of calories for a regular individual on a regular day?
KV It depends on age and activity levels, but for middle-aged women it’s around fifteen to sixteen hundred calories and for men eighteen hundred to two thousand. Most nutrition labels will say two thousand, but that’s more for younger people.
MB Have you looked into eating clean and organic foods?
KV We haven’t looked specifically at organic foods, but we do encourage people to consume less processed foods and up their fruit and vegetable intake, and throughout all of our trials people receive weekly one-on-one dietary counseling. Even if this diet doesn’t work for certain people we still want them to leave our center knowing something about nutrition. We definitely encourage everyone, again, to increase their intake of seasonal fruits and vegetables and cut down on processed foods and eating out, and to watch for hidden fats and trans-fats.
MB What I do is interview people about their menopause experience—so far I’ve come close to talking to fifty people—and it’s literally the story of their personal experience that they get to talk about for as long as they want. When I speak to women who have gone through difficult times in menopause, much of what I hear is that there was no one to talk to other than their doctors. Just because you’re going through menopause doesn’t mean that your friends are, because even though there may be an average age, there are tremendous differences in onset and duration and physiological symptoms. It’s very randomized, as in someone you may know who had cancer ten years ago and now you have it, but for them it’s a past experience that they may prefer to forget about.
KV Well, I’m 37 and the average age for menopause is 51, so I have a few years to go. But I find my colleagues who are in their late-40s and 50s are talking to me about it quite a bit. I don’t know if it’s because I’m in nutrition or not, but I find that other women are sharing their stories and warning me about what to expect. I sat down to talk to a professor about a bone health paper we’re doing, and part of the conversation ended up being her telling me everything she felt I needed to know about menopause. I find I do the same thing with pregnancy—I’ll tell other women I don’t know why we’re not talking about this but this is what’s going to happen to your vagina. I had no idea what was going to happen to me the week after delivering a baby vaginally. Why aren’t we talking about this stuff more? I certainly feel that when I’m going through menopause I’m going to talk about it.
MB Well, yes, that’s part of the idea. And I’m certainly interviewing some peri-menopausal women who really don’t have a lot of symptoms, but part of the point is to say that some women don’t, even all the way through it. My mother, for example, had nothing—nothing! I’d be sort of laid out and she’d be saying well, I just don’t know what’s the matter with you, you’ve simply got to be stronger, where’s your willpower! So Sanity Papers is a way to provide all of these long stories and try to get at that. And certainly diet plays a huge role in terms of weight gain and self-perception and the realities of aging.
KV Do women actually gain that much weight—I know that the fat distribution changes, but is there that much gain on top of it?
MB Oh yes, women do gain weight, absolutely. They get on their scales and they just weigh more.
KV I should mention, then, in relation to menopausal status with this diet, that we ran an analysis on the year-long study that we just finished up, and though I never though to separate out the effects of pre-menopausal vs post-menopausal women—we actually exclude peri-menopausal women in our studies because their numbers are all over the place in terms of lipids—we found that post-menopausal women lost twice as much weight as pre-menopausal women. Over the course of a six-month weight loss period followed by a six-month maintenance period, pre-menopausal women lost seven percent of body weight, whereas post-menopausal women lost almost twice as much at twelve percent. It was an amazing finding, but I’m still not sure why that’s the case.
MB I wonder if they had more temporary weight to lose, if it was weight they gained at menopause.
KV Well, that’s a good point, because post-menopausal age was 56 and pre-menopausal age was 37.
MB I’m 67 and I’ve gained weight pretty steadily since menopause, and I don’t eat that much more or very differently than I ever did. If you separate out that ninety percent of us, particularly females, who are obsessed with their weight, and the seventy percent of us who do nothing about it, I think this is important because it has to do with a better sense of self. That’s a valuable thing, because if you’re going through a time when you’re depressed, anxious, irritable and having problems sleeping, you really don’t want to think about your weight on top of it.
KV I’ve never been to a menopause conference before, but sitting in on some of these talks is actually a little terrifying! And then hearing all of these things and having all these women in my department telling me their stories; and my mother, who’s not much of a complainer, has shared her own experiences with me as well. It’s a lot for a woman to go through.
MB What would you tell someone about why they should try the alternate-day fast diet?
KV I wouldn’t recommend it for everyone, I’m just trying to test out other viable options when people have failed at daily calorie restriction or other meal-timing regimens; alternate-day fasting may make it easier for people to naturally calorie-restrict without having to be so crazy about calorie counting every single day. I don’t think this diet works for people who are constant snackers, but it does for people who are able to go without eating for long periods of time naturally. And I find it can be occupation specific, as with doctors or others who work extremely long hours and are used to going for extended periods without meals– those people tend to have very good adherence. Another thing I want to mention is that the first week and a half of the diet is tricky– those first five fast days where you’re getting yourself adjusted to the up-and-down pattern of eating– but after that, people say they have more energy on those fast days, and they’re able to concentrate and continue with their exercise regimen. Once you’re past that hump of the first two weeks you can really see how you’re going to feel on the diet.
MB Are people tired on those days?
KV Irritable. What we call “hangry”. People get headaches, but much of that we found to be attributable to not drinking enough fluids. You never realize how much water is in the food you consume, so going from consuming two thousand to five hundred calories you’re naturally taking in considerably less water, and dehydration is usually a source of headaches.
MB What are the advantages to having a BMI of a certain number?
KV In general the normal BMI is 18.5 to 25, and having a BMI now of 23 is associated with the lowest risk of heart disease, so if you can maintain that throughout your whole life your insulin and glucose levels remain well controlled. It’s also coordinated with cholesterol levels that can be associated with genetics, so somebody may have a normal weight and an LDL that’s off the charts because they have a malfunctioning LDL receptor. Also, lower belly fat is associated with lower levels of all those diabetes and heart disease indicators. Belly fat is associated with a higher release of cytokines or inflammatory factors and higher production of VLDL (very low density lipoprotein) that’s in turn is associated with higher LDL.
MB I have become more interested in women’s ageing, and I recently interviewed a friend of mine who is 93 and in excellent health and who I have to say is quite beautiful and looks like she’s 70. She doesn’t hear or see well, but she’s very active and flexible and exercises every day, and she’s kept her weight virtually the same her whole life. And she and her husband, who’s her same age, eat a super healthy and extremely strict diet—lots of vegetables, nuts, small portions of meat like chicken and fish but no beef or pork, and certainly no processed foods, and they may go out to eat once a year. They’ve cut out all but a little bit of salt, and no sugar. And her and husband’s parents all died in their 60s. When they were about 70 her husband began experiencing angina, and she worked out their whole approach at that time, which was back in the 1980s. And she’s an excellent cook, so everything they eat is tasty and thoughtfully made.
KV I find some people will do that for whatever health reasons, but then they feel kind of miserable, but since as you say she’s a fabulous cook that’s what can make the difference in adherence.[My talk here at the NAMS conference] is about bone health, and as you lose weight you can actually take calcium out of your bones, so though weight loss is mainly good it can also be seen as having negatives. In this study we found that over the course of a year alternate-day fasting actually had no impact on bone, which is good. We measured that by bone mineral density, and there was no difference between pre- and post-menopausal women. That’s important for women to know if they’re considering this diet in post-menopause.
MB Because of what I’m doing with Sanity Papers, I meet so many people who are interested in weight loss who’ve tried dieting in the past but still don’t know quite what to do, so I believe what you’re doing is of great interest, particularly from a wellness point of view. Most people don’t want to do a fad diet that deprives them of essential nutrients or the basic enjoyment of eating, and on those levels I think alternate-day fasting will have a great deal of appeal to them.
KV Again, we were shocked to see that post-menopausal women had such nice weight loss from the diet. One of the subjects that came up in a discussion I was having with a psychologist was that since these women were older they might know what works for them already, because as you say they’re more likely to have tried various different things in the past. The older women who come in to sign on for our studies tend to say at the outset that they’re interested in trying the diet because they think they’d be likely to succeed in following it based on their past experiences.
MB It’s exciting stuff, because as we live longer we want to take better care of ourselves and we need the information that enables us to do that. The people I’ve talked to who’ve gone on this diet, the first week they’re having cheeseburgers the next day, but the second week it’s grilled chicken.
KV Yes, that’s what I’ve noticed too! All of a sudden people care more about what they’re eating and seem to have an appetite for healthier foods, more so than they did before. We’ve never tested that scientifically, but we do notice that people are choosing healthier options overall, and we certainly see a lot less Doritos and Skittles!