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“So don’t give up your eating window just yet! The good question I am hoping researchers will answer next: who loses the most weight? Is it the human who eats three meals and no snacks that include protein, fiber, and healthy fats, or the human who eats two or three meals of that same formula in an 8-hour eating window? I recommend people eat healthy fats, like olive oil, at all their meals for good health and weight loss. We need more studies on intermittent fasting that do not include calorie-restricted diets. I’m not giving up on intermittent fasting yet.”
Heather Awad is a family physician.
She shares her story and discusses her KevinMD article, “Don’t give up on intermittent fasting just yet.”
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow.
Today we have Heather Awad. She is a family physician, and she wrote the KevinMD article “Don’t give up on intermittent fasting just yet.” Heather, welcome to the show.
Heather Awad: Thanks so much for having me.
Kevin Pho: So we’ll get into your article in a little bit, but first off, briefly share your story and journey to where you are today.
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Heather Awad: Sure. I’m someone who likes variety. When I went to medical school, I had a heart for primary care, so I went into family medicine because you get to see so many different things. I actually worked in a variety of types of practices over the years and eventually landed in corporate medicine. I got kind of burnt out and went to becoming a medical acupuncturist. Then I wanted to do something more traditional, so I was a wound care doctor in nursing homes, and that’s where I was during the alpha wave of COVID, which was highly stressful as well.
I did some life coaching and learned how to make commitments to myself instead of just taking care of everybody else, which is kind of a doctor’s problem mindset. So then I thought, “I want to have my own business.” Along the way, I had also gained weight with my four children, done some yo-yo dieting, and discovered how to optimize my own digestive hormones to lose weight, along with that commitment to myself. In doing that, I thought, “Well, let’s put these two together.” So now I coach professional women to lose weight for the last time. My business is Vibrant MD, and I have a Vibrant MD podcast that talks about weight loss. It’s all virtual and online, and I’m really loving that now.
Kevin Pho: Perfect. So walk me through a typical day. Tell me about some of the patients that you may see and some of the techniques that you would use to help them lose weight.
Heather Awad: During a typical week for me, I’ll meet with everyone one-on-one, but I also do some group coaching, because a lot of times we have common problems that we face. We do talk a lot about optimizing our digestive hormones and making weekly goals, but there’s also a lot of mindset to weight loss, you know, keeping commitments to yourself. We all have people in our lives who tell us what to eat and when to eat it. Every event you go to has food. So we do a lot of coaching around those really common social situations that make weight loss difficult as well.
Kevin Pho: So can you give me a story or a case study of one of your successes, in terms of how you can coach someone to overcome that mindset?
Heather Awad: Yes. I had a woman who said, “I get all this. I know what to do, but how do I stick to it?” This is the piece of keeping the commitment to yourself. I said, “Do you go to work every day when you are scheduled to go?” She said, “Well, yes. I work five days a week. I always go.” I said, “If you make a date with your friend to have lunch on Saturday at 12:30, will you show up?” She said, “Yes, I will.” I said, “If you show up for work and you show up for your friends, why don’t you show up for yourself?” She said, “I could show up for myself.” And that was kind of it. It’s funny; it’s little mind shifts that just help people think differently about how they move in the world.
Kevin Pho: All right. So let’s talk more about your KevinMD article on intermittent fasting. It’s titled “Don’t give up on intermittent fasting just yet.” Now, for those who didn’t get a chance to read your article, just walk my audience through it and share the story of why you decided to write it.
Heather Awad: Someone from my program who lost over 30 pounds using intermittent fasting as part of her toolbox texted me this article that was in lots of newspapers and said, “Oh no, intermittent fasting is no good.” I said, “Well, number one, you lost over 30 pounds, so obviously, you know, it worked for you. And number two, the article shows, and the study was about, using a calorie-restricted diet and comparing that with no eating windows and with using intermittent fasting.”
Kevin Pho: And for those who don’t know what intermittent fasting is, just to give some context, let’s just briefly define: What is that?
Heather Awad: Oh, sure. It’s choosing an eating window to eat. Sometimes it’s as simple as 12 hours of eating and 12 hours of not eating. A real common one is 16 hours of fasting and then eating for eight hours. So a lot of people will skip breakfast, then eat for eight hours, and then again not eat till the next day. That’s a real common way that people do it.
Kevin Pho: OK. And then talk about the study that your client brought up to you.
Heather Awad: Yeah. The study was very well done. They compared people who had a calorie-restricted diet and did intermittent fasting, like an eight-hour eating window, and the people who just calorie restricted all day. What I told my client was, “You don’t calorie restrict.” Calorie restricting is miserable in general, isn’t shown to work, and is shown to lead to yo-yo dieting. So they asked a question that I don’t want the answer to, and that my client did not want the answer to. That’s why I said, “Don’t give up on it yet,” because it was a nice study, but I don’t want to know the answer to that question, because I never recommend calorie restriction to people.
Kevin Pho: So if you were to redesign the study, what question would you be asking?
Heather Awad: I would look at two groups. I would choose either two or three meals a day without snacks in between, and I would have those people eat some protein, some fiber, and some healthy fats at each meal, and compare that for all day and that for an eating window, like an eight-hour eating window. Because people in my program, if they eat for eight hours, will either eat two or three meals with some time in between, but they always have the protein, the fiber, and the healthy fats. When you calorie restrict, people avoid healthy fats, which are super good for you and also help you feel full, so you don’t need to eat all day long. So I think that those three healthy things need to be in each meal. I say you ignore the calories and just eat and stop when you’re full.
Kevin Pho: And taking a step back, in general, what is the role of intermittent fasting in one of your patients’ diet plans?
Heather Awad: You know, I would say about half the people in my group will use an eating window like eight hours. Some will even do four or six hours with two meals. And then about half will do a 12-hour eating window, some 11, because there’s some research on breast cancer reduction with an 11-hour eating window, and they choose that. Then they just try it and test it out, and you don’t even have to do it every day.
I have a woman who is a former college tennis player, and she uses an eight-hour eating window, except on the tennis mornings, when she eats three meals and doesn’t have an eating window, because she is doing an extreme amount of sports in the morning. So she eats in the morning that day.
Kevin Pho: And in general, what is the data that backs up intermittent fasting?
Heather Awad: The data is not great. What I want to say is it’s not strong. This study they did with the calorie restriction was very strong, but like I said, they asked a question we don’t want to know. There are a lot of very small studies, and what we really need is a bigger study, because these small studies are great. They show people doing this. People like Jason Fung, Dr. Jason Fung, who does a lot with intermittent fasting, have lots of, you know, personal small data as well with his clients. I have found it to be really powerful with my clients, but these are small groups. So it would be lovely to have a big study to really show everyone how it works and get a little more data on how best to make it work.
Kevin Pho: And if someone was interested in starting intermittent fasting, or an eating window as part of your diet plan, for the first time, how would you advise that person?
Heather Awad: I would advise, first, be really open and curious that you’re going to experiment, so that you don’t get mad at yourself if it doesn’t work, or if you have a crummy day with it. Then you’re just like, “Well, I didn’t like that. I’m going to either try it again the same way, or I’m going to do it differently.”
Then I would say a good way to start, too, is to go to three meals and no snacks first, because you’re going to need some time in between. It makes it easier, so you’re not sitting there during your fasting window going, “I want to eat,” you know. You don’t have as many cravings. Then I would say figure out if you like breakfast. If you think, “I’m actually hungry in the mornings,” then go with an eating window like a 12-hour one and eat three meals. If you get up in the morning and you think, “You know what? I could take or leave breakfast,” then have your first meal later and pick an eight-hour eating window. You can pick any time you want, because there is no great data on the exact hours.
So try that. Also, you don’t have to do it every day. Look at a day and say, “This would be a great day. It works well with me. I’m super busy that morning, and I’m going to get so much done at work or so much done with my kids. You know, Wednesdays are the day.” And then try it on Wednesdays and see what you think. If you like it, then try it on some other days as well. So really be open, see what you think, try some things, and go from there.
Kevin Pho: We’re talking to Heather Awad. She’s a family physician. Her KevinMD article is titled “Don’t give up on intermittent fasting just yet.”
Heather, like your background, I’m a primary care physician. I do internal medicine, and as you know, we have 15 minutes in the room with patients with a whole laundry list of things that we need to go over. Obesity and weight loss are extremely important issues. So given your background now with weight loss counseling, what are some of the highest-yield things that I can say in the exam room, given the limited time I have with patients?
Heather Awad: I would say have them pick one thing to try, try it for a few weeks, and see what they like. Have it be something small, whether it’s moving from dessert every day to dessert once a week, or, if they are someone who snacks all day, ask them, “You know, do you want to have just one snack a day and see what happens?” Or just have them come up with something that makes sense to them, that would be a small change that they could turn into a long-term habit if they like it.
And help them have that mindset of being open and curious to try something, because a lot of times we try something new and we put so much weight on it, like, “Oh, I tried this no-snack thing, and it’s terrible. Oh, I’m a bad person. That doctor doesn’t know anything.” I’m going to help them to say, “You’re going to do some experiments and see what you like,” because it really takes the pressure off. So one small change: Try it for a week or two, see what they think, and then see if that can become a habit.
Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?
Heather Awad: Two things, three things. Calorie-restricted diets are miserable, so if you’re thinking about trying one new and you’re not already doing one that you like, don’t try it. I think intermittent fasting is definitely worth trying, and there are podcasts like mine that will give you advice about weight loss. Also, every meal: protein, which can be vegetarian or meat; fiber, which is our vegetables, our berries, these things; and healthy fats, some olive oil, some nut butter, avocado. Every meal should have those things, and you will feel better and lose weight naturally.
Kevin Pho: Heather, thank you so much for sharing your time and insight. Thanks again for being on the show.
Heather Awad: Thanks for having me.
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