Intermittent Fasting Ramadan Style: Lose More Than 3% Body Fat Off an Already "Lean" 31" Waist in 28 Days. Plus: Why Do the "Fast / Starve Two Times à Week" Diets Work?

Feasting and a wasp waist? Does bring the two together?

You are among the couple of thousand people who have been following the Intermittent Thoughts on Intermittent Fasting Series, here at the SuppVersity you will be aware that despite "fasting windows", "feasts" and "breakfast skipping" a religious fast as it is performed by Muslims all around the world may share several key elements with what fitness fanatics think about, when they hear the words intermittent fasting". There are however a couple of key differences of which you should be aware.

• rising before sunrise and having breakfast will minimize the fasting window - While most people I know personally don't do this, there are families, where everyone gets up before the sun rises to have breakfast. With the huge dinner before bed and a (usually smaller) breakfast right after you stand up in the early AM, the fasting window which would otherwise be up to 18h wide can become pretty narrow.
• not drinking during the fast - It is religious practice, so I am not in the position to criticize it, but for anyone fasting for health purposes not drinking anything during the fasting hours is absolutely not advisable.
• food / diet quality - The average Westerner will probably assume that the food quality sucks during Ramadan, after all the family-get-togethers are not exactly occasions to eat chicken, rice and broccoli, but compared to the regular diet of the inhabitants of the Western obesity belt the self-prepared meals from real food ingredients will probably still entail an improvement in overall diet quality for many people who are fasting for religious reasons.

I guess I could enumerate at least 3 additional factors you may want to keep in mind, when you take a look at the results of the Shruthi, Hassan and Reddy, three scientist from the Bhaskar Medical Colleg in Andhra Pradesh, India, report in a paper that has recently been published in the International Journal of Recent Trends in Science And Technology (Shruthi. 2013).

31" waist as a starting value? Obviously not a US study*

Ramadan fasting increases fatty acid oxidation: In 1995 Jalila El Ati and her colleagues were able to show that the respiratory quotient, i.e. the ratio of carbs / fats that are being burned as fuel decreases by ~10% in healthy 25-39 year old women (El Ati. 1995).

The study was conducted at the research lab of Department of Physiology Bhaskar Medical College during the month of Ramadan in the year 2011 (Aug - Sept). The subjects were 50 young adults in the age group 18-24yrs - with 6 dropouts (personal reasons) that leaves us with data on the changes in body composition, blood pressure, and heart rate from 44 subjects, whose baseline BMI (24kg/m²) was very different from that of the "average" American and whose 31.5" waist is a clear indicator that they were in pretty good shape (compared to those who are currently totally digging alternate day fasting after they have failed with the South Beach, the Weight Watchers and the rest of the "I am a stupid lazy ass and don't want to make the appropriate lifestyle changes" diets in the past.

* Health alarm: Did you know that the average US teenager had a 34" waist, in 2004? That was already 2" more than 5 years before (Li. 2006; data based on NHANES 2004). If we extrapolate a yearly increase of 0.25"  this means we should have arrived at 35.25" today.

You will often hear the proponents of the the idea that some people are simply "naturally lean" state that this is usually a result of the fact that they are eating "frequent small meals" to satiety. So, based on that argumentation you would actually expect that the subjects in the study at hand, who would probably qualify as "naturally lean", may have jeopardized this "natural leanness" by robbing themselves of the opportunity to keep "grazing".

Figure 1: BMI, waist and hip circumference and body fat % before and after 28 days Ramadan fasting (Shruti. 2013)

As the data in figure 1 goes to show you this obviously did not hurt the results of the 44 subjects in the study at hand, who lost an everage of 3.1% body fat within 28 days. Given the fact that all the initially mentioned factors should reduce the efficacy of Ramadan fasting for improvement in body composition compared to that of a fast in the (meanwhile) classic "lean gains" style, this appears pretty damn impressive, right?

If you take into account that the scientists measured only subcutaneous fat (this is a necessary result of using the skinfold method), which is usually comparably slow to respond, it certainly argues for the cosmetic advantage of timed feasting over uncontrolled all-day snacking - whether the same would yet be true if we standardized the caloric and macronutrient intake is questionable (see my comment on the 2-day a week fast in the box below, as well).

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Why do the fast 2x per week diets work? It's easy the main working principle is a reduction in calorie intake. If you assume you have a 2,400kcal intake and cut back to 800kcal (some prescribe 500kcal) on 2 days that's a 66% (80%) reduction in energy intake. Interestingly, though the compensation effect is much less pronounced than you would expect and occurs usually only on the days after the fast. So, 10% more on the days after the fasting days leaves us with a caloric deficit that will still amount to 2.720kcal (3320kcal for the 500kcal variety) or 10% (20%) per day.

Impressive it is, but in the end it's still basic mathematics: As impressive as it may be, the underlying reason - and this is something all previous Ramadan studies appear to support a simple reduction in energy intake that is, at least in some cases, supported by improvements in diet quality, reductions in carbohydrate and increases in protein intake that are brought about by the elaborate cooking, the absence of snacks and sugar sweetened beverages and the mere fact that you simply cannot stomach the same amount of food you would usually consume in three main meals and two snacks within one or two meals... no matter how huge those meals may be.

Does that exclude that "having AMPK come to its right", sirtuins, increased fatty acid oxidation and the whole fastin' hoopla may figure here, as well? No it does not, but even the significant reduction in systolic and diastolic blood pressure in the study at hand, as well as the improvements in glycemia and lipid metabolism in previous Ramadan studies are, when all is said and done, eventually brought about by the downstream effects of a reduced calorie intake. And this, is by the way also true for the "eat whatever you want all week long and cut back to 800kcal (or 500kcal) mainly from protein on two out of seven days" diets as well (see infobox to the right for an example calculation).

References:

• el Ati J, Beji C, Danguir J. Increased fat oxidation during Ramadan fasting in healthy women: an adaptative mechanism for body-weight maintenance. Am J Clin Nutr. 1995 Aug;62(2):302-7. 
• Li C, Ford ES, Mokdad AH, Cook S. Recent trends in waist circumference and waist-height ratio among US children and adolescents. Pediatrics. 2006 Nov;118(5):e1390-8.
• Shruthi B, Hassan A, Reddy BV. The Effect of Ramadan Fasting on the Body Composition, Blood Pressure, Heart Rate of Healthy Young Adults. International Journal of Recent Trends in Science And Technology, ISSN 2277-2812 E-ISSN 2249-8109, Volume 8, Issue 1, 2013 pp 31-35.

Intermittent Thoughts on Intermittent Fasting - The Fast #2: Health & Longevity Effects of Intermittent Fasting

Image 1: Any roundworms reading this? I hope you know that by not eating enough and feeling miserable you can extend your lifespan ;-)

Thanks Caenorhabditis elegans, or "C. elegans", almost everybody who is able to read a newspaper or online magazine will have heard of the miraculous effects of calorie restriction and fasting on longevity (of this worm!). Since I assume that you possess more gray matter than this transparent nematote, you will probably have asked yourself how, or rather if these results from a worm with an average lifespan of 2-3 weeks translate to human beings,... well, all I can tell you is that leading a miserable life of lifelong dieting appears to work in non-human primates, as well (Kemnitz. 2011). Now, the obvious question is:

How does all that relate to Intermitent Thoughts on Intermittent Fasting? Obviously, none of the roundworms or rhesus monkey's followed Martin Berkhan's intermittent fasting approach, did they?

No, I have not seen pictures of abes on leangains.com, either, so I suppose they did not follow Berkhan's approach, but - and this is the likewise fascinating, as well as surprising, connection - there is scientific evidence that intermittent fasting could reproduce some of the beneficial effects of caloric reduction while avoiding a whole host of its undesirable side-effects. Reason enough for me, to devote this episode of the increasingly popular Intermittent Thoughts on Intermittent Fasting series to the non-cosmetic health effects of intermittent fasting (I know that's not as getting ripped and jacked, guys ;-)

Figure 1: Ramadan fasting leads to profound beneficial changes in inflammatory markers (left) and blood lipids (right) in 20 healthy male non-obese volunteers aged 23-39 (data calculated based on Aksungar. 2006)

We touched on one of this unsexy, yet vitally important health-benefits at the end of the last installment on the metabolic and endocrine effects of fasting, already: the beneficial effect on insulin resistance (as measured by a +44% increase in the inverse of the long-term marker of insulin resistance 1/HOMA-IR and the slight increase in QUICKI) Shariatpanahi et al. had observed in 55 ramadan fasting subjects (Shariatpanahi. 2008) for example constitutes one of these "boring side-effects", of which many dieters fail to realize that improvements in insulin sensitivity or reductions in inflammatory markers and C-reactive protein (cf. figure 1, left), as they were reported by Aksungar et al. in a 2006 study on the effects of religious "intermittent" fasting (Aksungar. 2006) facilitate weight - and more specifically - fat loss.

Image 2: Would the issue of dehydration distort the results of Ramadan studies and thus render them irrelevant for our argumentation? (photo Offline Clinic)

As in almost every episode I want to make a few brief statements regarding the "Ramadan model of intermittent fasting". I have already discussed its advantages over "over-other day" or "alternative day" fasting in the second installment of this series and I have hinted at possible problems related to the restriction of water intake within the fasting period in the third installment of the series. Now, in view of the general recommendation to drink more and more frequently to avoid dehydration (USDA), it seems prudent to verify that potential beneficial health effects of fasting are not masked by detrimental side effects of dehydration, if we - once again - want to rely on the available data on religious fasting as part of our argumentation. In a paper published in the European Journal of Clinical Nutrition in 2003, Leiper, Molla and Molla report that despite the fact that "[d]uring the daylight hours of Ramadan fasting, practising Muslims are undoubtedly dehydrating", it is neither "clear whether they are chronically hypohydrated" nor have there been any "detrimental effects on health [...] directly attribut[able] to negative water balance at the levels that may be produced during Ramadan" observed in any scientifically relevant studies (Leiper. 2003). It is thus relatively safe for us to assume that we can neglect he influence of potential dehydration in our initial analysis of respective studies.

Now, what about the longevity effects?

Image 3: The effects the calorie restriction had on the ape on the right is certainly impressive, when you compare it to his 27.6 year old age-mate on the left - would be interesting to see how an "intermittently fasted version would end up ;-) (img. from the Irish Medical Times)

With or without the beneficial effects on cardiovascular risk markers, the question still remains: "Can intermittent fasting mimic the longevity effect of calorie restriction without the constant cravings, continuous hunger and all sorts of "human" problems that won't show in studies on yeast, worms, rodents or even apes (see image 3)?"

In order to answer this question, we will first have to give a clear cut definition of what our understanding of intermittent fasting is, in this context, because, obviously, if we coupled our (intermittent) fast with a a deliberate and severe calorie restriction we would probably end up like Canto, the ape from the the longevity study in image 3 - old, but miserable. What we want, on the other hand, is an intermittent fast, where - within the feeding window - we are allowed to eat to satiety... similar to what we are seeing in religious fasting: no calorie counting and perceived (when compared to normal meal sizes) overeating.

Now, we do already know from the studies cited above (and in previous installments of this series) that one month on a dietary regimen like that provides considerable benefits as far as weight loss, insulin sensitivity, blood lipid ratios (! this is important, because we are knowledgeable enough to give a f*** about total cholesterol & co) and inflammatory markers, all of which are associated not only with an increased life-expectancy (Danaei. 2010), but, more importantly, with an increased life-quality and neurological health (Bronwen. 2006) up into the old(er) ages. From the same studies, we do yet also know that breaking the fast, and returning to our old dietary habits returns these markers to baseline (cf. post values in figure 1). What we do not know, however, is whether ...

1. intermediate improvements in correlates of health and longevity as they can be observed during intermittent periods of Ramadan (intermittent) fasting provide any, or even significant longterm health benefits, and
2. longterm (as in for years and decades) intermittent fasting would not over months or years lose its effect, or even worse, be detrimental to our overall health and thus reduce not extend our life-expectancy and/or life-quality

From rodent studies we already know that a life-long alternate-day feeding protocol increases lifespan in the absence of any caloric reduction (Goodrick. 1990; Mattson. 2000). Evidence that similar beneficial effects, at least as far as mortality from chronic disease is concerned, would occur in human beings comes from a 2007 study by Varaday and Hellerstein (Varaday. 2007), who do yet remark that (as I already pointed out) "more research is required to establish definitively the consequences of ADF [alternate day fasting]".

The circadian clock hypothesis

A finding from alternative day fasting studies that may be of paramount importance in view of the "quality of life"-aspect, is the increase in brain-derived neurotropic factor (BDNF) that has been observed in animal studies. BDNF is involved in brain development and plasticity and its (intermittent) fasting-induced elevation could explain the neuroprotective effect of respective feeding patterns (Duran. 2001). In a review of the literature, Fory and Miskin do yet remark that (Froy. 2010)

[...] BDNF could not be [directly] linked to the neuro-protective effects in the brain of calorically restricted rats, but increased levels of another neurotrophic factor, glial cell line-derived factor (GDNF), were correlated with neuro-protection of a calorically restricted primate model of Parkinson's disease. Interestingly, BDNF is also a component of the hypothalamic melanocortin pathway that controls food intake and body weight in adult mice, and it has been implicated in the regulation of energy metabolism.

After all, the scientists believe that IF exhibits part or even all of its effects by (re-)setting clock genes, a hypothesis which despite having its merits would yet lead us into theoretic considerations with little merit to our "intermittent thoughts" on the real-world outcomes of intermittent fasting, which is why I will, at this point, skip forward to the results of a 1999 study into the relation of adipose tissue size and reductions thereof to longevity.

Is it not about eating less, but just about getting leaner?

Image 4: When we are talking about the benefits of losing body fat, this obviously does not imply you have to get in Phil Heath Mr. Olympia '11 shape to live longer (photo bodybuilding.com)

In the introductory paragraphs of this installment of the Intermittent Thoughts on Intermittent Fasting series I somewhat ridiculed the idea of changing one's whole life to get "ripped and buffed", now, after revisiting some of the studies and observing the close correlation of improvements in metabolic health markers, reductions in body fat and consequent life-extending effects of (intermittent) fasting, the central question of Nir Barzilai's and Gaurav Gupta's 1999 paper Revisiting the Role Fat Mass in the Life Extension Induced by Calorie Restriction seems by no means far fetched: What if ain't inflammation and insulin resistance & co that make us fat and reduce our lives, but being fat that leaves us insulin resistant, inflammed & co and thusly reduces our life-expectancy? The answer, according to Barziilai and Gaurav, is simple (Barzilai. 1999):

In fact, all of the benefits of CR on the neuroendocrine system and those related to the improvement in glucose homeostasis can be attributed to decrease in adipose cells and their products.

Probably too simple and above all difficult to treat with a drug and thus not profitable enough to be accepted by the medical establishment. Now, if this would be the case, intermittent fasting would in fact provide the sought-after silver bullet to leading a leaner, healthier life, as both the anecdotal reports on the Net, as well as the the majority of the studies that have been cited in this, as well as the previous installments show quite conclusively that going without food for periods <24h is capable of reducing body fat stores, while preserving lean muscle (and bone) mass. But why, or better how does that work?

Intermittent fasting, fat reduction, health improvements and the cyclicality of life

Illustration 1: It probably is the magic interplay of AMPK and mTOR that produces such remarkable transformations as Duong Nguyen's. We will delve deeper into the their reciprocal interaction in the next installment of the Intermittent Thoughts on Intermittent Fasting Series

Due to its cyclic nature intermittent fasting seems to temporarily produce similar "reductions in protein synthesis" (Barrows. 1978) as the ones which have been established as the fundamental mechanisms of the life-extending effects of calorie restriction as early as in the late 1970s and of which we know today that they partly mediated by an AMPK-induced downregulation of the mTOR pathway. In that, this transient AMPK response to intermittent fasting, which most intermittent fasters further stimulate by exercising in a (semi-)fasted state, appears to be profound enough to stimulate or, according to some recent research (cf. Canto. 2010), we should probably say "sustain" the SIRT1-pathway to an extent that allows dieters to benefit from its immediate fat-mobilizing effect on white adipocytes (Picard. 2004) and its ability to maintain telomer length (and subsequent longevity, cf. Palacios. 2010) without the unwanted muscle-wasting side-effects of prolonged fasting periods.

The fasting induced AMPK expression is yet only one part of the cycle, of which we have learned in this installment that it is responsible for both, the "cosmetic" effects on body fat, which could, after all, be causative and not just corollary or even subsequent to improvements in insulin sensitivity (cf. What Comes First: Inflammation or Obesity?), lipid profiles, and the whole string of beneficial health effects which irrefutably contribute to the longevity effect of inhumane low-calorie diets. In view of the fact that another valuable Sunday afternoon is drawing to a close, the discussion of the second player in this cycle, the mammalian Target of Rapamycin, or in short mTOR, will yet have to be postponed to the next episode of the Intermittent Thoughts on Intermittent Fasting Series - so stay tuned, keep the questions and comments coming and don't forget to check back on Thursday to see what AMPK and mTOR are doing to our man at the 2012 wheelchair nationals, Adelfo Cerame!

Ramadan Improves Body Composition of Young & Older Men, Young Women Don't Benefit and Women >37y Become Fat During the Fast - Implications for Intermittent Fasting?

It may not be "paleo conform", there but the traditional Ramadan menu is 100% home-made from fresh foods - that alone will make a huge difference.

"I hear you..." What's that supposed to mean? Well, in a way I am running the SuppVersity for me, because I like the idea that people like you come here and think "Hey, today I've learned something new", "... read something interesting" or at even"... have been enlightened". On the other hand, this entails that I got to tailor the topics to your interests as well and since the short Facebook item on the effects of Ramadan fasting on body composition I posted on Facebook, a couple of days ago, which spiked so much interest, I will take it up and write a whole article about this soon-to-be-published study from the Mashhad University of Medical Science and the University of Nicosia (Norouzy. 2013).

Ramadan is not "intermittent fasting"...

... at least not in the sense it's interpreted by most people.In fact, there are a whole host of differences one could think about, but for our purpose which is the use of intermittent fasting as a way to live healthier and/or improve our physique these are just a couple of examples that come to mind:

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  Effect of Ramadan fasting on perceived snack, fluid and food intake in 411 male and 323 female Malaysian Junior Level Muslim athletes (data calculated based on Singh. 2011; originally posted as part of the Intermittent Thoughts on Intermittent Fasting on Sept. 06, 2011)

  The fasting window can actually be pretty small - While all Muslims will eat the lions-share of their energy intake in the evening many rise early (esp. when Ramadan falls into the winter months) and ingest a medium sized breakfast to "make it through the day".
• Food quality (from a health perspective) is not always ideal - While researchers have observed that there seems to be an unconcious increase in protein intake (+6.6% protein; less carbs and fats; Trabelsi. 2011), this is yet not a characteristic feature of the protocol, but rather a result of dining with the family, not snacking and putting an emphasis on whole self-prepared (and more expensive) food.
  
• During the fast Muslims don't drink - This is obviously something anybody following a "lean gains" like intermittent fast or an "alternative day fasting" protocol, where people eat only 500kcal or so two or three times a week and just follow their habitual diet on the other days would not remotely consider. However, in a paper published in the European Journal of Clinical Nutrition in 2003, Leiper, Molla and Molla report that despite the fact that "[d]uring the daylight hours of Ramadan fasting, practising Muslims are undoubtedly dehydrating", it is neither "clear whether they are chronically hypohydrated" nor have there been any "detrimental effects on health [...] directly attribut[able] to negative water balance at the levels that may be produced during Ramadan" observed in any scientifically relevant studies (Leiper. 2003). It is thus relatively safe for us to assume that we can neglect he influence of potential dehydration in our initial analysis of respective studies.
• Other differences  - I guess, I better spend time discussing the latest study and refer you to the Intermittent Thoughts Series, where I discussed the existing differences and implication at length. You can browse the articles here. Start with the first post "Myth #1: A Higher Meal Frequency Equals a Higher Metabolic Rate" from September 4th, 2011 and click yourself through the  rest of the series. You won't regret reading it, I promise ;-)

A one-to-one translation of the results from the study at hand to your efforts of a practical and effective way to lose body fat (this is where it excels - and not in "lean gaining") is thus unwarranted. There may yet still be a couple of things, we can learn from what the observations the Iranian and Greek researchers made in their 240 adult subjects (male: 158) who fasted between sunrise and sunset for at least 20 days.

Figure 1: Body weight and composition before and after Ramadan and percentage changes from baseline according to gender and age; data expressed relative to baseline (Norouzy. 2013)

As the data in figure 1 goes to show you the overall pattern that emerges is positive one. However, the weight the subjects, who were grouped according to age and sex, lost was (as it was to be expected, by the way) not pure fat mass. Still, with the exception of older women all subjects improved their body fat levels.

Is intermittent fasting not for women?

Apropos women, it's not just that the older women (>37y) did actually gain body fat, the already minimal reduction in body fat (%) in the younger women was also non-significant (p = 0.079 vs. p=0.029 in men). Taken together these results appear to suggest that a non-controlled, intermittent fasting regimen that's based solely on the absence of food intake in the course of the day would be beneficial for men only.

Looks good, tastes good, is good - high protein foods! Unfortunately many  women (obyiously not you, right) have still not gotten the message that by simply making sure you have 30g+ of protein in your three-square meals is probably the easiest way to improve both your physique and health. Still, the study at hand provides further evidence that a low protein intake is not all that makes it more difficult for women to lose fat (learn more)

It should be said, though, that these results stand in conflict with previous studies by Husain et al. who report more, not less weight and body fat loss in the 20-45 year-old female subjects of their Ramadan fasting study (Husain. 1987). An observation they pin on the "increase in energy expenditure" that comes with preparing the meal for the whole family... well, you know that I am not afraid of calling *bs* by its name and this explanation certainly is*bs*. It is in fact much more likely that the differences could be explained by a lower overall energy intake just as the increase in body weight Frost & Pirani observed in the young men in another cohort was solely a result of the nightly binges (Frost. 1987). I mean, we all know that women are more likely to be concerned about the detrimental effects of a high food intake in the evening on their body composition, so that it is not unlikely that the 20-45 year old women in the Husain study were deliberately limiting their energy intake, while the men in the study by Frost & Pirani gave in to their ravenous appetite and the delicious meals their wifes, sisters and aunts had prepared (I will leave it up to you if you call the role allocation "traditional" or "chauvinist", btw. ;-)

This is basically also how Norouzy et al. try to explain the inconsistencies that become obvious, when you compare the study at hand to previous results:

"This inconsistency may be a result of the subject characteristics and, in particular, age, sex and physical activity, as well as the number of hours of fasting observed during Ramadan, which varies according to geographical location from 11 to 19 h a day." (Norouzy. 2013)

Furthermore, the majority of previous studies included young subjects aged <35 years; thus, limited information is available on subjects of older ages and according to Norouzy et al. their study was the first to "attempted to compare changes in body weight and composition in different ages and sex" (Norouzy. 2013). In view of the existing differences in resting energy expenditure and physical activity this could well explain part of the differences between the studies and the high amounts of "null results" (=no change at all) other scientists reported (Ati.1995; Finch. 1998; Ramadan. 2002; Yucel.2004).

Figure 2: Dietary energy, macronutrient and fibre intakes before and during Ramadan and percentage changes from baseline according to gender; I must warn you though, according to the scientists dietary records were not available from all participants (Norouzy. 2013)

Going back to the study at hand, the data in figure 2 indicates that neither the general trends, nor the age and sex-specific differences can be fully explained by changes in total energy (due to high variability borderline significant only in men, totally insignificant in women) or macronutrient ratios (insignificant in both); an observation the Iranian researchers try to explain by differences in nutrient oxidation and changes in energy expenditure during the fasting period and add:

Overtraining and undereating will have your thyroid hormones plummet within no more than four days (learn more) - would Intermittent Fasting make that worse, or could it - as I suggest in the bottom line - maybe even postpone the onset of plummeting T3 and increasing rT3 levels by allowing you to eat to satiety once a day? Respective studies are missing, but it does not sound totally implausible!?

"A previous study investigating the effect of Ramadan on the abdominal fat distribution by computed tomography found reductions only in the visceral fat tissue area, and only in subjects in their twenties and in women, and attributed this to fat redistribution because no changes in weight were observed (Yucel et al., 2004). Thus, although this remains to be investigated, differences between sexes and ages may be a result of differences in nutrient oxidation and changes in energy expenditure during the fasting period. For example, as shown in healthy women aged 25–39 years, Ramadan fasting induced a significant decline in carbohydrate oxidation and a significant increase of fat oxidation, as well as a decline in diurnal energy expenditure, which may be attributed to the absence of post-prandial thermogenesis during fasting (Ati al., 1995). A reduction of energy expenditure during Ramadan was also reported in another study (Sweileh et al., 1992)." (Norouzy. 2013)

Now, these changes in (1) fatty acid oxidation (Ati. 1995), (2) improvements in visceral fat (questionable whether those occurred in the study at hand that did not observe sign. reductions in waist circumference in any group) and (3) overall energy expenditure would unquestionably be of interested for the average physical culturist, as well and (1) could in fact be one of the reasons that numerous people report great fat loss following respective regimen. After all, one of the major obstacles of translating fatty acid oxidation to fat loss is that the latter must occur in the presence of an energy deficit or the body fat that's getting oxidized on time-point T1 is going to be replenished from the fats, carbs and protein on time-point T2.

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Exercise prevents, not amplifies, fasting induced protein degradation. In a 2006 paper, Kasperek et al. report that

"Exercise did prevent the increase in the rate of total protein degradation caused by food restriction, which may have important implications in weight reduction diets." (Kasperek. 2006)

And indeed, any type of fast (even an intermittent one) that is intended to improve body composition would be missing out big time without the exercise component - just keep it to a sane level and focus on muscle preserving strength training.

Energy intake counts: If you remember the recent SuppVersity post on the detrimental effects a caloric deficit can have on the thyroid function in the presence of a high volume training regimen after four days only, it may sound hilarious that the bottom line starts with the words "energy intake counts". However, faced with the fact that a very large energy deficit will stall weight loss, people tend to forget that not being in a minimal energy deficit won't allow you to lose weight either (the whole alternate day fasting regimen is based on the simple fact that 90% of the people won't fully compensate for the caloric deficit on the low calorie = fasting days).

In that intermittent fasting or rather the ingestion of one or two large meals instead of many mini-meals may provide an edge over "classic" dieting as it allows for a daily "feast" that could trick your body to believe that the starvation it experienced earlier in the day was already over. This in turn could delay the metabolic slowdown and rock bottom T3 levels Loucks et al. observed in the female participants of their exercise + dieting trial within no more than 4 days (go back and learn all the details about the Loucks study). If that's the case, we would not have an absolute increase in energy expenditure (see pt. 3, above), but at least a relative one - compared to eating 6 mini square meals.

References:

• el Ati J, Beji C, Danguir J. Increased fat oxidation during Ramadan fasting in healthy women: an adaptative mechanism for body-weight maintenance. Am J Clin Nutr. 1995 Aug;62(2):302-7.  
• Frost G, Pirani S. Meal frequency and nutritional intake during Ramadan: a pilot study. Hum Nutr Appl Nutr. 1987 Feb;41(1):47-50.
• Husain R, Duncan MT, Cheah SH, Ch'ng SL. Effects of fasting in Ramadan on tropical Asiatic Moslems. Br J Nutr. 1987 Jul;58(1):41-8.
• Kasperek GJ, Conway GR, Krayeski DS, Lohne JJ. A reexamination of the effect of exercise on rate of muscle protein degradation. Am J Physiol. 1992 Dec;263(6 Pt 1):E1144-50. 
• Leiper JB, Molla AM, Molla AM. Effects on health of fluid restriction during fasting in Ramadan. Eur J Clin Nutr. 2003 Dec;57 Suppl 2:S30-8.
• Ramadan J. Does fasting during Ramadan alter body composition, blood constituents and physical performance? Med Princ Pract. 2002;11 Suppl 2:41-6. 
• Singh R, Hwa OC, Roy J, Jin CW, Ismail SM, Lan MF, Hiong LL, Aziz AR. Subjective Perception of Sports Performance, Training, Sleep and Dietary Patterns of Malaysian Junior Muslim Athletes during Ramadan Intermittent Fasting. Asian J Sports Med. 2011 Sep;2(3):167-76.
• Sweileh N, Schnitzler A, Hunter GR, Davis B. Body composition and energy metabolism in resting and exercising muslims during Ramadan fast. J Sports Med Phys Fitness. 1992 Jun;32(2):156-63. 
• Trabelsi K, El Abed K, Trepanowski JF, Stannard SR, Ghlissi Z, Ghozzi H, Masmoudi L, Jammoussi K, Hakim A. Effects of ramadan fasting on biochemical and anthropometric parameters in physically active men. Asian J Sports Med. 2011 Sep;2(3):134-44.
• Yucel A, Degirmenci B, Acar M, Albayrak R, Haktanir A. The effect of fasting month of Ramadan on the abdominal fat distribution: assessment by computed tomography. Tohoku J Exp Med. 2004 Nov;204(3):179-87.