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How Does Fasting Affect Cognition? An Updated Systematic Review (2013–2020)

  • Nutrition and the Brain (K Ohla, Section Editor)
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Abstract

Purpose of Review

The goal of this review was to provide an update on the literature examining how voluntary, temporary abstention from eating impacts cognitive function.

Recent Findings

We evaluated peer-reviewed articles published between August 2013 and January 2021 that assessed adults, included a measure of cognitive functioning with neutral stimuli, and compared individuals in a fasted state to individuals in a fed state (either within- or between-subject designs). Nineteen articles (21 studies) met inclusion criteria. Sample sizes, fasting methods, and tasks varied across studies. Review of studies indicated that fasting was associated with deficits in cognitive functioning; few studies indicated a benefit in cognitive functioning following a single voluntary fast.

Summary

The heterogeneity and rarity of available studies limits the conclusions that can be drawn. Several crucial psychosocial and sociodemographic moderators remain unexplored. Recommendations for future work are discussed.

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Notes

  1. The Delis-Kaplan Executive Function System (DKEFS) [28] is a standardized assessment battery that is frequently used in studies of executive functioning; we included it by name in order to capture studies that employed it to examination cognitive performance.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Tamney JB. Fasting and modernization. J Sci Stud Relg. 1980;19(2):129–37. https://doi.org/10.2307/1386247.

    Article  Google Scholar 

  2. Kerndt PR, Naughton JL, Driscoll CE, Loxterkamp DA. Fasting: the history pathophysiology and complications. West J Med. 1982;137(5):379–99.

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Maltby JR. Fasting from midnight–the history behind the dogma. Best Pract Res Clin Anaesthesiol. 2006;20(3):363–78. https://doi.org/10.1016/j.bpa.2006.02.001.

    Article  PubMed  Google Scholar 

  4. Harvie M, Howell A. Potential benefits and harms of intermittent energy restriction and intermittent fasting amongst obese overweight and normal weight subjects-a narrative review of human and animal evidence. Behav Sci (Basel). 2017;7(1):4. https://doi.org/10.3390/bs7010004.

    Article  Google Scholar 

  5. Patterson RE, Laughlin GA, LaCroix AZ, Hartman SJ, Natarajan L, Senger CM, et al. Intermittent fasting and human metabolic health. J Acad Nutr Diet. 2015;115(8):1203–12. https://doi.org/10.1016/j.jand.2015.02.018.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Albosta M, Bakke J. Intermittent fasting: is there a role in the treatment of diabetes? A review of the literature and guide for primary care physicians. Clin Diabetes Endocrinol. 2021;7(1):3. https://doi.org/10.1186/s40842-020-00116-1.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lv M, Zhu X, Wang H, Wang F, Guan W. Roles of caloric restriction, ketogenic diet and intermittent fasting during initiation, progression and metastasis of cancer in animal models: a systematic review and meta-analysis. PLoS ONE. 2014;9(12): e115147. https://doi.org/10.1371/journal.pone.0115147.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Mattson MP, Longo VD, Harvie M. Impact of intermittent fasting on health and disease processes. Ageing Res Rev. 2017;39:46–58. https://doi.org/10.1016/j.arr.2016.10.005.

    Article  PubMed  Google Scholar 

  9. Yuen AW, Sander JW. Rationale for using intermittent calorie restriction as a dietary treatment for drug resistant epilepsy. Epilepsy Behav. 2014;33:110–4. https://doi.org/10.1016/j.yebeh.2014.02.026.

    Article  PubMed  Google Scholar 

  10. Kesztyus D, Fuchs M, Cermak P, Kesztyus T. Associations of time-restricted eating with health-related quality of life and sleep in adults: a secondary analysis of two pre-post pilot studies. BMC Nutr. 2020;6(1):76. https://doi.org/10.1186/s40795-020-00402-2.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kim H, Jang BJ, Jung AR, Kim J, Ju HJ, Kim YI. The impact of time-restricted diet on sleep and metabolism in obese volunteers. Medicina. 2020;56(10):540. https://doi.org/10.3390/medicina56100540.

    Article  PubMed Central  Google Scholar 

  12. Ehrnhoefer DE, Martin DDO, Schmidt ME, Qiu X, Ladha S, Caron NS, et al. Preventing mutant huntingtin proteolysis and intermittent fasting promote autophagy in models of Huntington disease. Acta Neuropathol Commun. 2018;6(1):16. https://doi.org/10.1186/s40478-018-0518-0.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Jackson A, Forsyth CB, Shaikh M, Voigt RM, Engen PA, Ramirez V, et al. Diet in Parkinson’s disease: critical role for the microbiome. Front Neurol. 2019;10:1245. https://doi.org/10.3389/fneur.2019.01245.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wahl D, Coogan SC, Solon-Biet SM, de Cabo R, Haran JB, Raubenheimer D, et al. Cognitive and behavioral evaluation of nutritional interventions in rodent models of brain aging and dementia. Clin Interv Aging. 2017;12:1419–28. https://doi.org/10.2147/CIA.S145247.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Zhang J, Zhan Z, Li X, Xing A, Jiang C, Chen Y, et al. Intermittent fasting protects against Alzheimer’s disease possible through restoring aquaporin-4 polarity. Front Mol Neurosci. 2017;10:395. https://doi.org/10.3389/fnmol.2017.00395.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. McGeown JP, Hume PA, Theadom A, Quarrie KL, Borotkanics R. Nutritional interventions to improve neurophysiological impairments following traumatic brain injury: A systematic review. J Neurosci Res. 2021;99(2):573–603. https://doi.org/10.1002/jnr.24746.

    Article  CAS  PubMed  Google Scholar 

  17. Fann DY, Ng GY, Poh L, Arumugam TV. Positive effects of intermittent fasting in ischemic stroke. Exp Gerontol. 2017;89:93–102. https://doi.org/10.1016/j.exger.2017.01.014.

    Article  PubMed  Google Scholar 

  18. Jeong MA, Plunet W, Streijger F, Lee JH, Plemel JR, Park S, et al. Intermittent fasting improves functional recovery after rat thoracic contusion spinal cord injury. J Neurotrauma. 2011;28(3):479–92. https://doi.org/10.1089/neu.2010.1609.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Fond G, Macgregor A, Leboyer M, Michalsen A. Fasting in mood disorders: neurobiology and effectiveness. A review of the literature. Psychiatry Res. 2013;209(3):253–258. https://doi.org/10.1016/j.psychres.2012.12.018

  20. Bains G, Moh M, Lohman E, Daher N, Silver S, Zamora F, et al. Four weeks of acute intermittent fasting enhances body composition and decreases stress levels in healthy individuals: a pilot study. FASEB J. 2020;34(S1):1. https://doi.org/10.1096/fasebj.2020.34.s1.00464.

    Article  Google Scholar 

  21. • Currenti W, Godos J, Castellano S, Mogavero MP, Ferri R, Caraci F, et al. Time restricted feeding and mental health: a review of possible mechanisms on affective and cognitive disorders. Int J Food Sci Nutr. 2020;72(6):723–33. https://doi.org/10.1080/09637486.2020.1866504. (This article focuses on a specific type of intermittent fasting highlighting its potential therapeutic effects; there is a focus on the positive impact time-restricted feeding can have on cognitive health. The potential biological mechanisms of action are reviewed.)

    Article  PubMed  Google Scholar 

  22. •• Benau EM, Orloff NC, Janke EA, Serpell L, Timko CA. A systematic review of the effects of experimental fasting on cognition. Appetite. 2014;77:52–61. https://doi.org/10.1016/j.appet.2014.02.014. (This is the original systematic review that documented the impact of fasting on cognitive processing across multiple domains.)

    Article  PubMed  Google Scholar 

  23. Lang K, Lopez C, Stahl D, Tchanturia K, Treasure J. Central coherence in eating disorders: an updated systematic review and meta-analysis. World J Biol Psychiatry. 2014;15(8):586–98. https://doi.org/10.3109/15622975.2014.909606.

    Article  PubMed  Google Scholar 

  24. Roberts ME, Tchanturia K, Stahl D, Southgate L, Treasure J. A systematic review and meta-analysis of set-shifting ability in eating disorders. Psychol Med. 2007;37(8):1075–84. https://doi.org/10.1017/S0033291707009877.

    Article  PubMed  Google Scholar 

  25. Wu M, Brockmeyer T, Hartmann M, Skunde M, Herzog W, Friederich HC. Set-shifting ability across the spectrum of eating disorders and in overweight and obesity: a systematic review and meta-analysis. Psychol Med. 2014;44(16):3365–85. https://doi.org/10.1017/S0033291714000294.

    Article  CAS  PubMed  Google Scholar 

  26. Wu M, Hartmann M, Skunde M, Herzog W, Friederich HC. Inhibitory control in bulimic-type eating disorders: a systematic review and meta-analysis. PLoS ONE. 2013;8(12): e83412. https://doi.org/10.1371/journal.pone.0083412.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Kamiński M, Skonieczna-Żydecka K, Nowak J, Stachowska E. Global and local diet popularity rankings, their secular trends, and seasonal variation in Google Trends data. Nutrition. 2020;79: 110759. https://doi.org/10.1016/j.nut.2020.110759.

    Article  PubMed  Google Scholar 

  28. Delis D, Kaplan E, Kramer J. D-KEFS: examiners manual. San Antonio: The Psychological Corporation; 2001.

    Google Scholar 

  29. Hoddy KK, Marlatt KL, Cetinkaya H, Ravussin E. Intermittent fasting and metabolic health: from religious fast to time-restricted feeding. Obesity. 2020;28(Suppl 1):S29–37. https://doi.org/10.1002/oby.22829.

    Article  PubMed  Google Scholar 

  30. Persynaki A, Karras S, Pichard C. Unraveling the metabolic health benefits of fasting related to religious beliefs: a narrative review. Nutrition. 2017;35:14–20. https://doi.org/10.1016/j.nut.2016.10.005.

    Article  PubMed  Google Scholar 

  31. Alghafli Z, Hatch T, Rose A, Abo-Zena M, Marks L, Dollahite D. A qualitative study of Ramadan: a month of fasting family and faith. Religions. 2019;10(2):123. https://doi.org/10.3390/rel10020123.

    Article  Google Scholar 

  32. Wasserman DH. Four grams of glucose. Am J Physiol Endocrinol Metab. 2009;296(1):E11-21. https://doi.org/10.1152/ajpendo.90563.2008.

    Article  CAS  PubMed  Google Scholar 

  33. • García CR, Piernas C, Martínez-Rodríguez A, Hernández-Morante JJ. Effect of glucose and sucrose on cognition in healthy humans: a systematic review and meta-analysis of interventional studies. Nutr Rev. 2020;79(2):171–87. https://doi.org/10.1093/nutrit/nuaa036. (Meta-analysis of 10 studies focused on the impact of glucose on cognition. Results were mixed, with some evidence indicating that glucose improved verbal tasks. There was no indication that glucose resulted in impaired cognitive performance. Though some studies included also had fasting, the presence of fasting was not an inclusion criterion.)

    Article  Google Scholar 

  34. Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95: 103208. https://doi.org/10.1016/j.jbi.2019.103208.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Anderson JR, Maki KC, Palacios OM, Edirisinghe I, Burton-Freeman B, Spitznagel MB. Varying roles of glucoregulatory function measures in postprandial cognition following milk consumption. Eur J Nutr. 2020;60:1499–510. https://doi.org/10.1007/s00394-020-02343-9.

    Article  CAS  PubMed  Google Scholar 

  36. Anderson JR, Hawkins MAW, Updegraff J, Gunstad J, Spitznagel MB. Baseline glucoregulatory function moderates the effect of dairy milk and fruit juice on postprandial cognition in healthy young adults. Eur J Nutr. 2018;57(7):2343–52. https://doi.org/10.1007/s00394-017-1505-0.

    Article  CAS  PubMed  Google Scholar 

  37. Howard M, Roiser JP, Gilbert SJ, Burgess PW, Dayan P, Serpell L. Short-term fasting selectively influences impulsivity in healthy individuals. Front Psychol. 2020;11:1644. https://doi.org/10.3389/fpsyg.2020.01644.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Macpherson H, Roberstson B, Sunram-Lea S, Stough C, Kennedy D, Scholey A. Glucose administration and cognitive function: differential effects of age and effort during a dual task paradigm in younger and older adults. Psychopharmacology. 2015;232(6):1135–42. https://doi.org/10.1007/s00213-014-3750-8.

    Article  CAS  PubMed  Google Scholar 

  39. Chaiken SR, Kyllonen PC, Tirre WC. Organization and components of psychomotor ability. Cogn Psychol. 2000;40(3):198–226. https://doi.org/10.1006/cogp.1999.0729.

    Article  CAS  PubMed  Google Scholar 

  40. Murrihy C, Bailey M, Roodenburg J. Psychomotor ability and short-term memory, and reading and mathematics achievement in children. Arch Clin Neuropsychol. 2017;32(5):618–30. https://doi.org/10.1093/arclin/acx033.

    Article  PubMed  Google Scholar 

  41. Solianik R, Zlibinaite L, Drozdova-Statkeviciene M, Sujeta A. Forty-eight-hour fasting declines mental flexibility but improves balance in overweight and obese older women. Physiol Behav. 2020;223: 112995. https://doi.org/10.1016/j.physbeh.2020.112995.

    Article  CAS  PubMed  Google Scholar 

  42. Cherif A, Meeusen R, Farooq A, Briki W, Fenneni MA, Chamari K, et al. Repeated sprints in fasted state impair reaction time performance. J Am Coll Nutr. 2017;36(3):210–7. https://doi.org/10.1080/07315724.2016.1256795.

    Article  PubMed  Google Scholar 

  43. Ginieis R, Franz EA, Oey I, Peng M. The, “sweet” effect: comparative assessments of dietary sugars on cognitive performance. Physiol Behav. 2018;184:242–7. https://doi.org/10.1016/j.physbeh.2017.12.010.

    Article  CAS  PubMed  Google Scholar 

  44. Veasey RC, Gonzalez JT, Kennedy DO, Haskell CF, Stevenson EJ. Breakfast consumption and exercise interact to affect cognitive performance and mood later in the day: A randomized controlled trial. Appetite. 2013;68:38–44. https://doi.org/10.1016/j.appet.2013.04.011.

    Article  CAS  PubMed  Google Scholar 

  45. Doniger GM, Simon ES, Zivotofsky AZ. Comprehensive computerized assessment of cognitive sequelae of a complete 12–16 hour fast. Behav Neurosci. 2006;120(4):804–16. https://doi.org/10.1037/0735-7044.120.4.804.

    Article  PubMed  Google Scholar 

  46. Zajac I, Herreen D, Hunkin H, James-Martin G, Doyen M, Kakoschke N, et al. Modified fasting compared to true fasting improves blood glucose levels and subjective experiences of hunger food cravings and mental fatigue but not cognitive function: results of an acute randomised cross-over trial. Nutrients. 2021;13(1):65. https://doi.org/10.3390/nu13010065.

    Article  CAS  Google Scholar 

  47. Owen L, Scholey AB, Finnegan Y, Hu H, Sunram-Lea SI. The effect of glucose dose and fasting interval on cognitive function: a double-blind placebo-controlled six-way crossover study. Psychopharmacology. 2012;220(3):577–89. https://doi.org/10.1007/s00213-011-2510-2.

    Article  CAS  PubMed  Google Scholar 

  48. Pender S, Gilbert SJ, Serpell L. The neuropsychology of starvation: set-shifting and central coherence in a fasted nonclinical sample. PLoS ONE. 2014;9(10): e110743. https://doi.org/10.1371/journal.pone.0110743.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Zitron-Emanuel N, Ganel T. Does food deprivation affect perceived size? Appetite. 2020;155: 104829. https://doi.org/10.1016/j.appet.2020.104829.

    Article  PubMed  Google Scholar 

  50. Zitron-Emanuel N, Ganel T. Food deprivation reduces the susceptibility to size-contrast illusions. Appetite. 2018;128:138–44. https://doi.org/10.1016/j.appet.2018.06.006.

    Article  PubMed  Google Scholar 

  51. Zitron-Emanuel N, Ganel T. The effect of food deprivation on human resolving power. Psychon Bull Rev. 2018;25(1):455–62. https://doi.org/10.3758/s13423-017-1296-6.

    Article  PubMed  Google Scholar 

  52. Cowan N. The many faces of working memory and short-term storage. Psychon Bull Rev. 2017;24(4):1158–70. https://doi.org/10.3758/s13423-016-1191-6.

    Article  PubMed  Google Scholar 

  53. Baddeley A. Working memory. Curr Biol. 2010;20(4):R136–40. https://doi.org/10.1016/j.cub.2009.12.014.

    Article  CAS  PubMed  Google Scholar 

  54. Diamond A. Executive functions. Annu Rev Psychol. 2013;64:135–68. https://doi.org/10.1146/annurev-psych-113011-143750.

    Article  Google Scholar 

  55. Komiyama T, Sudo M, Okuda N, Yasuno T, Kiyonaga A, Tanaka H, et al. Cognitive function at rest and during exercise following breakfast omission. Physiol Behav. 2016;157:178–84. https://doi.org/10.1016/j.physbeh.2016.02.013.

    Article  CAS  PubMed  Google Scholar 

  56. Scholey A, Savage K, O’Neill BV, Owen L, Stough C, Priestley C, et al. Effects of two doses of glucose and a caffeine-glucose combination on cognitive performance and mood during multi-tasking. Hum Psychopharmacol. 2014;29(5):434–45. https://doi.org/10.1002/hup.2417.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Riby LM, Lai Teik Ong D, Azmie NBM, Ooi EL, Regina C, Yeo EKW, et al. Impulsiveness, postprandial blood glucose, and glucoregulation affect measures of behavioral flexibility. Nutr Res. 2017;48:65–75. https://doi.org/10.1016/j.nutres.2017.10.011

  58. Bartholdy S, Cheng J, Schmidt U, Campbell IC, O’Daly OG. Task-based and questionnaire measures of inhibitory control are differentially affected by acute food restriction and by motivationally salient food stimuli in healthy adults. Front Psychol. 2016;7:1303. https://doi.org/10.3389/fpsyg.2016.01303.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Kumar N, Wheaton LA, Snow TK, Millard-Stafford M. Carbohydrate ingestion but not mouth rinse maintains sustained attention when fasted. Physiol Behav. 2016;153:33–9. https://doi.org/10.1016/j.physbeh.2015.10.023.

    Article  CAS  PubMed  Google Scholar 

  60. Kofler MJ, Rapport MD, Sarver DE, Raiker JS, Orban SA, Friedman LM, et al. Reaction time variability in ADHD: a meta-analytic review of 319 studies. Clin Psychol Rev. 2013;33(6):795–811. https://doi.org/10.1016/j.cpr.2013.06.001.

    Article  PubMed  Google Scholar 

  61. Driver J. A selective review of selective attention research from the past century. Br J Psychol. 2001;92(1):53–78. https://doi.org/10.1348/000712601162103.

    Article  CAS  PubMed  Google Scholar 

  62. Stroop JR. Studies of interference in serial verbal reactions. J Exp Psychol. 1935;28:643–62. https://doi.org/10.1037/h0054651.

    Article  Google Scholar 

  63. Stewart SH, Samoluk SB. Effects of short-term food deprivation and chronic dietary restraint on the selective processing of appetitive-related cues. Int J Eat Disord. 1998;21(2):129–35. https://doi.org/10.1002/(sici)1098-108x(199703)21:2%3c129::aid-eat3%3e3.0.co;2-n.

    Article  Google Scholar 

  64. Braem S, Egner T. Getting a grip on cognitive flexibility. Curr Dir Psychol Sci. 2018;27(6):470–6. https://doi.org/10.1177/0963721418787475.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Bolton HM, Burgess PW, Gilbert SJ, Serpell L. Increased set shifting costs in fasted healthy volunteers. PLoS ONE. 2014;9(7): e101946. https://doi.org/10.1371/journal.pone.0101946.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Wonderlich SA, Lilenfeld LR, Riso LP, Engel S, Mitchell JE. Personality and anorexia nervosa. Int J Eat Disord. 2005;37(S1):S68–71. https://doi.org/10.1002/eat.20120.

    Article  PubMed  Google Scholar 

  67. Hemmingsen SD, Wesselhoeft R, Lichtenstein MB, Sjogren JM, Stoving RK. Cognitive improvement following weight gain in patients with anorexia nervosa: a systematic review. Eur Eat Disord Rev. 2020;29(3):402–26. https://doi.org/10.1002/erv.2796.

    Article  PubMed  Google Scholar 

  68. Miles S, Gnatt I, Phillipou A, Nedeljkovic M. Cognitive flexibility in acute anorexia nervosa and after recovery: a systematic review. Clin Psychol Rev. 2020;81: 101905. https://doi.org/10.1016/j.cpr.2020.101905.

    Article  PubMed  Google Scholar 

  69. Shrout PE, Rodgers JL. Psychology, science, and knowledge construction: broadening perspectives from the replication crisis. Annu Rev Psychol. 2018;69:487–510. https://doi.org/10.1146/annurev-psych-122216-011845.

    Article  PubMed  Google Scholar 

  70. Brysbaert M. How many participants do we have to include in properly powered experiments? A tutorial of power analysis with reference tables. J Cogn. 2019;2(1):16. https://doi.org/10.5334/joc.72.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Wang Q. Why should we all be cultural psychologists? Lessons from the study of social cognition. Perspect Psychol Sci. 2016;11(5):583–96. https://doi.org/10.1177/1745691616645552.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Masento NA, Golightly M, Field DT, Butler LT, van Reekum CM. Effects of hydration status on cognitive performance and mood. Br J Nutr. 2014;111(10):1841–52. https://doi.org/10.1017/S0007114513004455.

    Article  CAS  PubMed  Google Scholar 

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Benau, E.M., Makara, A., Orloff, N.C. et al. How Does Fasting Affect Cognition? An Updated Systematic Review (2013–2020). Curr Nutr Rep 10, 376–390 (2021). https://doi.org/10.1007/s13668-021-00370-4

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