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.

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