Dr James Johnson Alternate Day Diet

Matthew Shave

I would have made a crappy cave woman, and not just because my hair looks appalling without a good blow-out. The prehistoric eating schedule—subsist on wild berries and creek water till the menfolk slay a wild boar; gorge on boar; repeat—would have done me in.

I know this because I recently tried alternate day fasting (ADF), an eat-one-day/starve-the-next diet that has not only a growing fan base in the blogosphere (including Yahoo's 450-strong Intermittent Fasting chat room), but also adherents in the scientific community who suggest that fasting every other day may be a more lifestyle-friendly way to get the health benefits of intense, long-term calorie restriction (which has been shown to improve the longevity of everything from humans to rhesus monkeys).

Indeed, even Brian M. Delaney, president of the Calorie Restriction Society and author of The Longevity Diet (Marlowe & Company), admits, "Alternate-day fasting is appealing because it lets you focus hunger in manageable periods—instead of being a little hungry all the time, you're very hungry a little of the time." While the comparative benefits of calorie restriction versus ADF have yet to be conclusively studied, the alternate-day version definitely fulfills some of the same promises, including weight loss: In a 2005 study by scientists at Pennington Biomedical Research Center in Baton Rouge, Louisiana, subjects lost an average of 2.5 percent of their weight and about 4 percent of their body fat after three weeks on the diet. Even more interesting, recent studies show ADF may activate a gene that's a potential key to good health and long life.

Which sounds great, except that—for me, at least—all-then-nothing eating is nearly impossible. Going 24 hours on the sugar-free gum, water, and decaf tea suggested in the Pennington study made me lethargic, spacey, and hot-tempered. I'd make it till 8 p.m. then blow it with a pizza binge. Fortunately, some ADF researchers and diet gurus—such as James Johnson, MD, and Donald Laub, MD, coauthors of The Alternate Day Diet (Putnam)—contend that a less draconian approach may offer nearly the same health benefits as every-other-day fasting, without making you chew-your-arm-off hungry. "Our study subjects said noneating days were hell," says Eric Ravussin, PhD, coauthor of the Pennington study as well as a new one on modified ADF. "The only way to make the diet feasible was to add some calories on the 'off' day."

The reason the National Institutes of Health (NIH) is funding several studies on calorie restriction and ADF is what they do on a cellular level. In one of the first rigorous studies of the program, published in 2003, researchers at the National Institute on Aging tested ADF on mice who were trained to gorge when given free access to food; although the mice who ate nothing every other day were too gluttonous on their "on" days to lose any weight, they still exhibited the same positive health changes—increased insulin sensitivity and stress resistance, and longer life span—as those who lost weight by constant calorie restriction. "Scientists had always attributed the positive changes of calorie restriction to weight loss, but here were mice who didn't lose weight and they still were healthier," Ravussin says.

Researchers say semistarving every other day places just enough stress on the body to trigger the activation of the SIRT1 gene, the same one that's switched on when you consume resveratrol, the antioxidant in red wine that may explain the French paradox—the fact that Parisians don't have high rates of heart disease despite their heavy consumption of bernaise and béchamel.

In The Alternate Day Diet, Johnson calls SIRT1, which all humans possess, "the skinny gene" because there's evidence it not only prompts cells to release fat into the bloodstream for use as energy, but also turns off another gene, PPAR-gamma, that is responsible for fat storage. "With PPAR-gamma in off-mode, the body doesn't store fat as easily; instead of storing it, you metabolize it," he says. Indeed, a few studies have shown that animals that eat every other day increase their lean body mass and reduce body fat. "More muscle means a faster metabolism, which means you will use calories more quickly," Johnson says.

According to Krista Varady, PhD, a scientist at the University of California at Berkeley, both ADF and modified ADF may also reduce cancer risk by decreasing cell proliferation. "We're conducting a study of modified ADF to see if the results hold up in people, but there is some evidence from other research that they will," Varady says. "For instance, studies in people have shown that insulin levels decrease after several weeks on the plan."

Eating less every other day—even just 50 percent of your usual calories, whether your "usual" is 1,200 or 4,000—may improve longevity. But if weight loss is the goal, Johnson advocates eating about 20 percent of your usual calories on the "down" day. During "on" days, he says, there is no strictly prescribed calorie count—consume whatever you want (though, logically, he suggests sticking to healthy diet standards: fruits and veggies, lean protein, and whole grains). Johnson himself lost 35 pounds in 11 weeks on the diet; he's kept it off since 2003 by limiting "off" day calories to roughly 1,300, half his usual 2,600.

Surprisingly, "most people eat just 10 percent more than usual on their 'on' days," says William Troy Donahoo, MD, medical director of weight management at Kaiser Permanente in Denver, which is conducting an ongoing study of true ADF, funded by the NIH. "You think you'll pig out, but you really don't compensate, calorie-wise." As for what to eat on low-calorie days, Johnson recommends starting with calorie-counted energy bars or weight-loss drinks. "But you still need to be prepared to endure some hunger," he says. "Four hundred calories will never produce satiety."

According to John Daugirdas, MD, a kidney specialist and author of The QOD Diet: Eating Well Every Other Day (White Swan Publishing), salt is key. "We're used to taking in so much sodium that when we eat less—and therefore consume less salt—we feel weak and washed-out," he says. To obtain what he considers the bare minimum "off" day nutrients—1,500 milligrams of sodium, 2,000 of potassium, and 300 of calcium—Daugirdas suggests sodium-heavy canned tomato juice, plus several mini meals of vegetables and a little protein: an egg white, half a slice of cheese, or his secret weapon, olive-oil-packed sardines. "They have lots of protein and healthy fat to stave off hunger," he claims.

Does ADF have long-term viability? "I don't think it will lead to permanent weight loss," says James Hill, PhD, director of the Center for Human Nutrition at the University of Colorado in Denver and author of a 13-year study of what helps dieters succeed. (His answers sound familiar: regular weigh-ins, plenty of exercise, food diaries, and daily breakfast.) "Once people return to eating normally, they'll regain the weight."

Daugirdas recommends ADF in the short term for people who have fewer than 25 pounds to lose; otherwise, he says, it becomes socially prohibitive and may feed into eating-disorder-like obsession. But Johnson believes it can work for the long haul—with a little flexibility. "If you have dinner plans on your 'off' day, just go for it, and limit your food the next," he says.

I don't think I could eat every other day forever, but I did lose three pounds in two weeks of modified ADF. It also helped reassert my inner cavewoman's mentality of food as necessity, not therapy. "Eating very little every other day helps break emotional, scheduled, and habitual eating habits," Daugirdas says. "You learn to distinguish between real hunger and mindless, automatic eating."

Ginny Graves Ginny Graves is a health and psychology writer from California.

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Dr James Johnson Alternate Day Diet

Source: https://www.elle.com/beauty/health-fitness/advice/a9269/alternate-day-fasting/

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