Monday, 30 May 2016

ClinicSpeak: intermittent fasting

Will intermittent fasting turnout to be an effective DMT? #ClinicSpeak #MSBlog #MSRsearch

"One of our readers pointed me to the paper below on the apparent health benefits of fasting. The animal study suggests fasting promotes resistance to stress and possibly increased life span. They showed that alternating fasting with feasting extended the lifespan of yeast independently of established genetic factors.  In mice, fasting and feeding,  elevated the number of stem cells and their regenerative capacity. Interestingly, in old mice, this strategy promoted the development of new neuronal cells, i.e. it may have neurorestorative capacity. They then discuss a pilot clinical trial, of three cycles of fasting and feasting which decreased risk factors/biomarkers for aging, diabetes, cardiovascular disease, and cancer without major adverse effects. The authors claim their results support the use of cycles of fasting to promote health. The question is how do we test this strategy safely in MS?"


"As you know intermittent fasting and low-carb diets are currently very popular. These include the Atkins Diet (high-protein low-carb), Dukan Diet (French version of the Atkins diet), more recently the Banting Diet (high-fat, high-protein, low-carb) and the paleo diet (high-fat, high-protein, low-processed carb). How do they work? The theory is they starve the body of sugars and change your metabolism by switching off, or lowering, your circulating levels of insulin. Too much insulin is bad for you and drives the so called metabolic syndrome (truncal obesity, fatty liver, insulin resistance, high cholesterol, hypertension, increased cancer risk, etc.). Interestingly these diets, including intermittent starvation, cause you to become ketotic; your body starts making ketones to feed your brain. Ketones may have several benefits to health, including brain health. There is emerging evidence that they may actually reduce your appetite and ketones may be neuroprotective. There is some evidence that ketogenic diets can improve mitochondrial function (see previous post on  this). Neurologists have also known for decades that some forms of epilepsy are ketone responsive and we treat patients with specific epilepsy syndromes using ketogenic diets. The metabolic changes that underlie ketosis include the rapid mobilisation of fats from adipose tissue, which is why these diets are so effective at causing rapid weight loss. Interestingly, the so called 5:2 diet in which you fast for 2 days of the week may also work via intermittent ketosis."

"How is this all relevant to MS? There is some evidence that ketosis may be neuroprotective in an animal model of MS and the hypothesis paper below makes the case for ketogenic diets as a potential treatment of progressive MS. There are currently some dietary studies testing these hypotheses in MS. I have invited Ellen Mowry, the principal investigator on a trial testing the 5:2 diet, to do a guest post on this subject; let's hope she does it soon."

"What all this tells us is that systemic biology, i.e. metabolism, is important for the brain and may impact on MS. What we need is the evidence before making any recommendations. So if you are considering doing one of these diets please make sure you have discussed it with your neurologist, specialist nurse or family doctor."


Brandhorst et al. A Periodic Diet that Mimics Fasting Promotes Multi-System Regeneration, Enhanced Cognitive Performance, and Healthspan. Cell Metab. 2015 Jul 7;22(1):86-99.

Prolonged fasting (PF) promotes stress resistance, but its effects on longevity are poorly understood. We show that alternating PF and nutrient-rich medium extended yeast lifespan independently of established pro-longevity genes. In mice, 4 days of a diet that mimics fasting (FMD), developed to minimize the burden of PF, decreased the size of multiple organs/systems, an effect followed upon re-feeding by an elevated number of progenitor and stem cells and regeneration. Bi-monthly FMD cycles started at middle age extended longevity, lowered visceral fat, reduced cancer incidence and skin lesions, rejuvenated the immune system, and retarded bone mineral density loss. In old mice, FMD cycles promoted hippocampal neurogenesis, lowered IGF-1 levels and PKA activity, elevated NeuroD1, and improved cognitive performance. In a pilot clinical trial, three FMD cycles decreased risk factors/biomarkers for aging, diabetes, cardiovascular disease, and cancer without major adverse effects, providing support for the use of FMDs to promote healthspan.

12 comments:

  1. Thank you for the detailed explanation in plain terms.

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  2. I stopped the 5/2 approach because it was giving me acid reflux. I am disappointed in the lack of willpower I show vis-a-vis dieting. It seems to be the 'straw that breaks the camel's back' on top of coping with MS. I have lost (some) weight instead by upping the exercise, reducing sugar and alcohol, trying to eat better generally. I am also considering personal training later in the year. If I seriously thought that losing weight would improve the MS, perhaps I could change my mindset, so please keep us informed!

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  3. I'm on the Paleo Diet, I think it's really helping my MS symptoms, I feel wonderful when in ketosis, I recommend it ;)

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  4. Can you do intermittent fasting without getting thinner? I am one of the (sizeable) group of PWMS who struggles to keep weight on. I watched the original television programme on intermittent fasting to improve cardiovascular health and was keen to try it. I have never dared because I am scared of getting unhealthily thin.

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    1. Experiment with eating main meals in the evening. The body has evolved and is best suited to metabolize most effectively in the hours of daylight. Our 'best' metabolism occurs when the sun is at its highest.
      Sumo wrestlers put their weight on by eating the bulk of their calories at night. Give it a try, we all have similarities and differences?

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  5. This is similar to the strict version of The Wahls Protocol (although Wahls does advocate intermittent fasting like the 5-2 but rather a longterm ketosis with high nutrient foods), which a lot of neurologists dimissed as unsupported years ago. It's an interesting study -- thank you for inviting Ellen Mowry to do a guest post. I've seen reports of other studies about prolonged fasting and immune system "reboots" which are interesting. See e.g.: https://news.usc.edu/63669/fasting-triggers-stem-cell-regeneration-of-damaged-old-immune-system/

    I feel better when in ketosis - I have PPMS. It is a noticeable improvement.

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  6. I thought intermittent fasting worked less because of ketosis, and more because of autophagy of older and lower functioning organelles.

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  7. I feel much better after going largely vegan apart from fish. That probably has a lot to do with my strong allergic reactions to dairy and eggs. But the thing that helps my MS more than anything else - in my opinion - is avoiding colds, minor viral infections like the plague. I'm not sure I'd have much faith in fasting personally - I'd be too worried about all the missed opportunities to take in vitamins, minerals etc. and I don't have the biggest appetite, so might struggle to make up for it when not fasting.

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  8. I agree with you, Cordelia - I am 'underweight' and would find it difficult to follow a diet that involved fasting. Energy level is never that good, although fluctuates. This time, do nothing is probably the best approach unfortunately.

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  9. In the paper published in Cell referred to above the FMD appeared to be slightly superior to the ketone idiet in human subjects. In the 5:2 approach, those who are aiming for quicker weight loss will often do three or four day ' fasts' and with this approach the timing of the fasting is critical. There are also varied versions of Paleo. Calorific restriction is not new-indeed it is well established in communities who believe it will stave off the ageing process. Would it not be worth trialling to see if their is any benefit. In an extension of this argument it has been mooted the immune system can be reset and oh the irony if it turned out to be 'let food be thy medicine'.

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  10. Interestingly I followed a strict 500 calorie a day diet in 2007, my body was in Ketosis for most of the time. I lost 4 stone over 4 months, the weight loss was fabulous. I started to experience what i now understand to be L'Hermittes sign. it was a multiple times of day occurrence (but I ignored it). in 2008 my dog was run over and that night, I experienced significant pain in my eye. At the eye hospital the next day I was diagnosed with optic neuritis. I was sent to see a neurologist and within a month I had been diagnosed as having RRMS.
    I am posting this - because if being in ketosis and undertaking a fasting diet is good for MS - I find it strange that my first MS symptoms (I now understand) started after 4 months of being in ketosis!!!!

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