Fasting Interventions for Stress, Anxiety and Depressive Symptoms: A Systematic Review and Meta-Analysis

Elisa Berthelot, Damien Etchecopar-Etchart, Dimitri Thellier, Christophe Lancon, Laurent Boyer, Guillaume Fond, Elisa Berthelot, Damien Etchecopar-Etchart, Dimitri Thellier, Christophe Lancon, Laurent Boyer, Guillaume Fond

Abstract

Background: Fasting interventions have shown effectiveness in alleviating stress, anxiety and depressive symptoms. However, no quantitative analysis has been carried out thus far. The objective was to determine the effectiveness of fasting interventions on stress, anxiety and depression and if these interventions were associated with increased or decreased fatigue/energy.

Methods: Overall, 11 studies and 1436 participants were included in the quantitative analyses.

Results: After limiting analyses to randomized controlled trials with low risk of bias, we found that fasting groups had lower anxiety (b = -0.508, p = 0.038), depression levels (b= -0.281, p = 0.012) and body mass index compared to controls without increased fatigue. There was no publication bias and no heterogeneity for these results. These interventions were safe, even in patients with type 2 diabetes.

Conclusions: These results should be taken with a caveat. These results are preliminary and encouraging and fasting appears to be a safe intervention. Data are not sufficient to recommend one fasting intervention more than the others. No study was carried out in psychiatric populations and further trials should be carried out in these populations that may be good candidates for fasting interventions.

Keywords: antidepressant; anxiety; depression; fasting; mental health; obesity; physical health; public health; schizophrenia.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart.
Figure 2
Figure 2
Forests plots of Ramadan studies for stress, anxiety and depression.
Figure 3
Figure 3
Forest plots of fasting intervention controlled studies for anxiety, depression and body mass index.

References

    1. Vos T., Lim S.S., Abbafati C., Abbas K.M., Abbasi M., Abbasifard M., Abbasi-Kangevari M., Abbastabar H., Abd-Allah F., Abdelalim A., et al. Global Burden of 369 Diseases and Injuries in 204 Countries and Territories, 1990–2019: A Systematic Analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396:1204–1222. doi: 10.1016/S0140-6736(20)30925-9.
    1. Chevalier G., Siopi E., Guenin-Macé L., Pascal M., Laval T., Rifflet A., Boneca I.G., Demangel C., Colsch B., Pruvost A., et al. Effect of gut microbiota on depressive-like behaviors in mice is mediated by the endocannabinoid system. Nat. Commun. 2020;11:1–15. doi: 10.1038/s41467-020-19931-2.
    1. Fond G.B., Lagier J.-C., Honore S., Lancon C., Korchia T., De Verville P.-L.S., Llorca P.-M., Auquier P., Guedj E., Boyer L. Microbiota-Orientated Treatments for Major Depression and Schizophrenia. Nutrients. 2020;12:1024. doi: 10.3390/nu12041024.
    1. Lassale C., Batty G., Baghdadli A., Jacka F., Villegas A.S., Kivimäki M., Akbaraly T. Healthy dietary indices and risk of depressive outcomes: A systematic review and meta-analysis of observational studies. Mol. Psychiatry. 2019;24:965–986. doi: 10.1038/s41380-018-0237-8.
    1. Matison A.P., Mather K.A., Flood V.M., Reppermund S. Associations between nutrition and the incidence of depression in middle-aged and older adults: A systematic review and meta-analysis of prospective observational population-based studies. Ageing Res. Rev. 2021;70:101403. doi: 10.1016/j.arr.2021.101403.
    1. Liao Y., Xie B., Zhang H., He Q., Guo L., Subramanieapillai M., Fan B., Lu C., McIntyre R.S. Efficacy of omega-3 PUFAs in depression: A meta-analysis. Transl. Psychiatry. 2019;9:1–9. doi: 10.1038/s41398-019-0515-5.
    1. Wadden T.A., Mason G., Foster G.D., Stunkard A.J., Prange A.J. Effects of a very low calorie diet on weight, thyroid hormones and mood. Int. J. Obes. 1990;14:249–258.
    1. Wing R.R., Marcus M.D., Blair E.H., Burton L.R. Psychological Responses of Obese Type II Diabetic Subjects to Very-Low-Calorie Diet. Diabetes Care. 1991;14:596–599. doi: 10.2337/diacare.14.7.596.
    1. Wadden T.A., Stunkard A.J., Brownell K.D., Day S.C. A comparison of two very-low-calorie diets: Protein-sparing-modified fast versus protein-formula-liquid diet. Am. J. Clin. Nutr. 1985;41:533–539. doi: 10.1093/ajcn/41.3.533.
    1. Fabricatore A.N., Wadden T.A., Higginbotham A.J., Faulconbridge L., Nguyen A.M., Heymsfield S.B., Faith M.S. Intentional weight loss and changes in symptoms of depression: A systematic review and meta-analysis. Int. J. Obes. 2011;35:1363–1376. doi: 10.1038/ijo.2011.2.
    1. Sadeghirad B., Motaghipisheh S., Kolahdooz F., Zahedi M.J., Haghdoost A. Islamic fasting and weight loss: A systematic review and meta-analysis. Public Health Nutr. 2014;17:396–406. doi: 10.1017/S1368980012005046.
    1. Harris L., Hamilton S., Azevedo L.B., Olajide J., De Brún C., Waller G., Whittaker V., Sharp T., Lean M., Hankey C., et al. Intermittent fasting interventions for treatment of overweight and obesity in adults. JBI Database Syst. Rev. Implement. Rep. 2018;16:507–547. doi: 10.11124/JBISRIR-2016-003248.
    1. Guerrero A.E., Martín I.S.M., Vilar E.G., Martín M.A.C. Effectiveness of an intermittent fasting diet versus continuous energy restriction on anthropometric measurements, body composition and lipid profile in overweight and obese adults: A meta-analysis. Eur. J. Clin. Nutr. 2021;75:1024–1039. doi: 10.1038/s41430-020-00821-1.
    1. De Cabo R., Mattson M.P. Effects of intermittent fasting on health, aging, and disease. N. Engl. J. Med. 2019;381:2541–2551. doi: 10.1056/NEJMra1905136.
    1. Fond G., Macgregor A., Leboyer M., Michalsen A. Fasting in mood disorders: Neurobiology and effectiveness. A review of the literature. Psychiatry Res. 2013;209:253–258. doi: 10.1016/j.psychres.2012.12.018.
    1. Gergelyfi M., Sanz-Arigita E.J., Solopchuk O., Dricot L., Jacob B., Zénon A. Mental fatigue correlates with depression of task-related network and augmented DMN activity but spares the reward circuit. NeuroImage. 2021;243:118532. doi: 10.1016/j.neuroimage.2021.118532.
    1. Kahleova H., Belinova L., Hill M., Pelikanova T. Do patients with type 2 diabetes still need to eat snacks? Eur. J. Clin. Nutr. 2015;69:755–756. doi: 10.1038/ejcn.2015.46.
    1. NIH Study Quality Assessment Tools|NHLBI, NIH 2021. [(accessed on 1 September 2021)]; Available online: .
    1. Nugraha B., Ghashang S.K., Hamdan I., Gutenbrunner C. Effect of Ramadan fasting on fatigue, mood, sleepiness, and health-related quality of life of healthy young men in summer time in Germany: A prospective controlled study. Appetite. 2017;111:38–45. doi: 10.1016/j.appet.2016.12.030.
    1. Teng N.I.M.F., Shahar S., Manaf Z.A., Das S.K., Taha C.S.C., Ngah W.Z.W. Efficacy of fasting calorie restriction on quality of life among aging men. Physiol. Behav. 2011;104:1059–1064. doi: 10.1016/j.physbeh.2011.07.007.
    1. Hussin N.M., Shahar S., Teng N.I.M.F., Ngah W.Z.W., Das S.K. Efficacy of Fasting and Calorie Restriction (FCR) on mood and depression among ageing men. J. Nutr. Health Aging. 2013;17:674–680. doi: 10.1007/s12603-013-0344-9.
    1. Koushali A.N., Hajiamini Z., Ebadi A., Bayat N., Khamseh F. Effect of Ramadan fasting on emotional reactions in nurses. Iran. J. Nurs. Midwifery Res. 2013;18:232–236.
    1. Mousavi S.A., Rezaei M., Baghni S.A., Seifi M. Effect of fasting on mental health in the general population of Kermanshah, Iran. J. Nutr. Health. 2014;2:65–70.
    1. Martin C.K., Bhapkar M., Pittas A.G., Pieper C.F., Das S.K., Williamson D.A., Scott T., Redman L.M., Stein R., Gilhooly C.H., et al. Effect of Calorie Restriction on Mood, Quality of Life, Sleep, and Sexual Function in Healthy Nonobese Adults. JAMA Intern. Med. 2016;176:743–752. doi: 10.1001/jamainternmed.2016.1189.
    1. Prehn K., Von Schwartzenberg R.J., Mai K., Zeitz U., Witte A.V., Hampel D., Szela A.-M., Fabian S., Grittner U., Spranger J., et al. Caloric Restriction in Older Adults—Differential Effects of Weight Loss and Reduced Weight on Brain Structure and Function. Cereb. Cortex. 2016;27:1765–1778. doi: 10.1093/cercor/bhw008.
    1. Erdem O. The investigation of the effects of Ramadan fasting on the mood state of healthy volunteer persons. Fam. Pract. Palliat. CARE. 2018;3:1–6. doi: 10.22391/fppc.398323.
    1. Kessler C.S., Stange R., Schlenkermann M., Jeitler M., Michalsen A., Selle A., Raucci F., Steckhan N. A nonrandomized controlled clinical pilot trial on 8 wk of intermittent fasting (24 h/wk) Nutrition. 2018;46:143–152.e2. doi: 10.1016/j.nut.2017.08.004.
    1. Al-Ozairi E., Alawadhi M.M., Al-Ozairi A., Taghadom E., Ismail K., Isamil K. A prospective study of the effect of fasting during the month of Ramadan on depression and diabetes distress in people with type 2 diabetes. Diabetes Res. Clin. pract. 2019;153:145–149. doi: 10.1016/j.diabres.2019.05.006.
    1. Secades-Villa R., González-Roz A., García-Pérez Á., Becoña E. Psychological, pharmacological, and combined smoking cessation interventions for smokers with current depression: A systematic review and meta-analysis. PLoS ONE. 2017;12:e0188849. doi: 10.1371/journal.pone.0188849.
    1. Ioannou M., Wartenberg C., Greenbrook J.T.V., Larson T., Magnusson K., Schmitz L., Sjögren P., Stadig I., Szabó Z., Steingrimsson S. Sleep deprivation as treatment for depression: Systematic review and meta-analysis. Acta Psychiatr. Scand. 2021;143:22–35. doi: 10.1111/acps.13253.
    1. Silva D.A., Coutinho E.D.S.F., Ferriani L.O., Viana M.C. Depression subtypes and obesity in adults: A systematic review and meta-analysis. Obes. Rev. 2019;21:e12966. doi: 10.1111/obr.12966.
    1. Grigolon R.B., Trevizol A.P., Gerchman F., Bambokian A.D., Magee T., McIntyre R.S., Gomes F.A., Brietzke E., Mansur R.B. Is Obesity A Determinant Of Success With Pharmacological Treatment For Depression? A Systematic Review, Meta-Analysis And Meta-Regression. J. Affect. Disord. 2021;287:54–68. doi: 10.1016/j.jad.2021.03.032.
    1. Garcia G.D., Pompeo D.A., Eid L.P., Cesarino C.B., Pinto M.H., Gonçalves L.W.P. Relationship between anxiety, depressive symptoms and compulsive overeating disorder in patients with cardiovascular diseases. Rev. Lat.-Am. Enferm. 2018;26:3040. doi: 10.1590/1518-8345.2567.3040.
    1. Ensminger D.C., Salvador-Pascual A., Arango B.G., Allen K.N., Vázquez-Medina J.P. Fasting ameliorates oxidative stress: A review of physiological strategies across life history events in wild vertebrates. Comp. Biochem. Physiol. Part A Mol. Integr. Physiol. 2021;256:110929. doi: 10.1016/j.cbpa.2021.110929.

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