Fasting and autoimmune disease

Nutrition and health go hand-in-hand, said Sebastian Brandhorst, PhD, at the 2018 Institute for Functional Medicine (IFM) Annual International Conference in Hollywood, Florida.

A growing body of research supports the idea that fasting and fasting-mimicking diets support cancer treatment, induce stem cell activation, and can be an integral component in addressing autoimmune disease.

In 2016, the Journal of Neuroscience published a study on the effects of Ramadan fasting on fatigue and quality of life in patients with multiple sclerosis (MS). During the summer of 2014, 218 study participants completed a 14 hour fasting period, measuring 20 health factors before and after fasting. Of the patients, 150 of which were female, with relapsing-remitting MS, the majority experienced improvements in a number of factors, including cognitive wellbeing, physical health, energy, health perception, and emotional wellbeing.

Brandhorst walked through an example that used mice receiving chemotherapy treatment. The mice who fasted before treatment were active and energetic. The mice that did not fast before treatment were lethargic, cold to the touch, and sick. While fasting sensitized cancer cells in mice, fasting also reduced the severity of symptoms in patients that have received chemotherapy. In addition, a 2016 clinical trial published in BMC cancer showed that 72 hours of fasting is associated with reduced DNA damage and reversal of lympthocutopenia in patients receiving gemcitabine/cisplatin, carboplatin/taxol.

Nutrient sensing pathways present a target to delay the onset of aging-related diseases, said Brandhorst. Further, research shows that starved animals live healthier and longer. Growth hormone receptor deficiency is associated with a major reduction in pro-aging signaling, cancer, and diabetes in humans. Therefore, needed are dietary interventions that are:

• Short
• Periodic
• Align with good anti-aging practices
• Do not require major lifestyle changes
• Can be integrated into social life

“The effects on health can be tremendous when modulating this,” said Brandhorst. “The benefits have been known for over a century, but it really hasn’t made it in to medicine.”

In response to the research that shows fasting and its powerful effect on chronic disease, Brandhorst and colleagues developed a periodic, short-term dietary intervention, the fasting-mimicking diet. The diet is low protein, low carbohydrates, vegetable-based, and high in polyunsaturated fatty acids. This diet has been shown to lower fasting glucose, increase ketone bodies, lower IGF-1, and increased IGFBP-1, he said.

Though fasting-mimicking diets play a role in managing chronic disease, they also improve motor coordination and memory, promote adult neurogenesis, promote β-cell regeneration and reverse β-cell failure in T2D, and promote expression of genes in pancreatic islets characteristic of embryonic and fetal development.

Specific to autoimmune disease, a fasting-mimicking diet reduced immune cell infiltration and demyelination, according to a 2016 study in Cell Reports. The diet protects against experimental autoimmune encephalomyelitis (EAE).

A clinical trial for the fasting-mimicking diet was supplied by L-Nutra, Inc. The program is designed to achieve fasting-like effects while providing micronutrients. The menu is heavily based on plant-based soups, bars, drinks, snacks, herbal teas, vitamins, and supplements.

On Day 1, participants ate 1,100 kilocalories, 11 percent protein, 46 percent fat, and 43 percent carbohydrate. Days 2-5, participants ate only 720 kilocalories, 9 percent from protein, 44 percent from fat, and 47 percent from carbohydrates. The between-group difference in consumed calories is expected to be about 10 percent, said Brandhorst.

After the first fasting-mimicking diet cycle, participants experienced a 12 percent decrease in fasting glucose, a three-fold increase in β-hydroxybutyrate, a 25 percent decrease in IGF-1, and a 60 percent increase in IGFBP-1. The results were published February 15, 2017 in the journal Science Translational Medicine.

Following three cycles of a fasting-mimicking diet, participants saw a decrease in body weight, body mass index, total body fat, trunk fat, waist circumference, glucose, IGF-1, blood pressure, triglycerides, and total cholesterol, as well as an increase in lean body mass. The study also showed the diet protocol reduced metabolic markers in at-risk subjects. Further, the clinical trial concluded that the diet is safe and potentially effective in the treatment of autoimmune disease, specifically MS.

While research is ongoing, Brandhorst concluded that periodic fasting mimicking diets increase regeneration markets in humans, and decreased risk factors and biomarkers for diabetes and cardiovascular disease. In mice, the protocol resulted in multi-system refeneration, decreased adiposity, decreased cancer, decreased inflammatory diseases, increased immune and cognitive rejuvenation, and increased lifespan. In short, this dietary protocol shows nothing but promise, and larger clinical trials are forthcoming to focus on larger chronic and autoimmune diseases in humans.

“This is one of the most powerful interventions based on the diet,” said Brandhorst.

Editor’s note: This article is part of Integrative Practitioner’s live coverage of the Institute of Functional Medicine’s 2018 Annual International Conference. For a full list of coverage, click here.