A new study reveals remarkable correlation between fasting and diabetes remission
Intermittent fasting (IF) has become the all rage — done by many to burn fat and stay fit, while others do it to get a clearer mind and detox their bodies. Some of its proud adherents include: Nicole Kidman, Jennifer Aniston, Halle Berry, Scarlett Johansson, Reese Witherspoon, Hugh Jackman, and billionaires like Elon Musk and Jack Dorsey.
Beyond the fad, however, no human trial has looked into the benefits of IF, specifically in helping push diabetes into “remission” (cancellation, reversal).
Until now.
A new randomised, albeit small, trial on IF did just that: it was conducted on 72 Type 2 diabetes (T2D) patients. The research has kicked up excitement in the medical fraternity, as well as a healthy dose of cynicism.
Why is it significant?
It’s a pioneering clinical trial involving Type 2 Diabetes (T2D) patients who undergo intermittent fasting (IF) as “treatment” (instead of medication) which shows — for the first time — how it eventually leads to weight loss, and “remission” of the disease.
The study, titled “Effect of an Intermittent Calorie-restricted Diet on Type 2 Diabetes Remission: A Randomized Controlled Trial” came out December 14, 2022 in the prestigious Journal of Clinical Endocrinology and Metabolism (JCEM), published by Oxford.
In a nutshell, it showed a high percentage of T2D trial patients who experienced remission of the disease, compared to a “control” group. The initial rate of remission was 47 per cent in the treatment group (those who practised IF) and 2.8 per cent in the “control” group (non-IF).
Moreover, the treatment group lost about 9 per cent of their starting body weight; there was no reduction for the “control” side.
The trial on 72 patients — all confirmed T2D patients — was randomised in which there were 36 volunteers assigned to the IF group; the same number was assigned to a control (non-IF) group.
There was a 3-month intervention (when IF was practiced by the treatment group). There was follow-up for three months to assess initial rates of diabetes remission. And, to assess the durability of that remission, a follow-up came at one year (12 months).
The researchers initially screened 246 patients for the trial, and whittled it down to 72 who met their trial criteria.
The study defined remission level as: HbA1c (long term blood sugar level) of 6.5 per cent or less — at least three months after discontinuing diabetes medications.
No.
Due to the study’s small size, it does not mean that the 36 people who responded well to IF can be generalised to a much bigger population. And IF may not work for all diabetes patients.
The study is significant as it’s the first human trial to show an association between IF and T2D remission.
Given the small trial size, however, to conclude that this approach will be broadly effective in the population of people with type 2 diabetes (about 422 million people globally) cannot be made.
It is a diet regimen that alternates between times of fasting — with no food or severe calorie reduction — and periods of eating. Evidence shows those who observe IF alongside curbing carbohydrate consumption with professional medical supervision get improved health “biomarkers”, such as blood pressure and cholesterol levels and weight loss.
There are at least 40 different scientific investigations on the benefits of IF. In 2018, a team led by Roy Taylor, Ahmad Al-Mrabeh and Sviatlana Zhyzhneuskaya published in Cell Metabolism their research showing how remission in human Type 2 diabetes requires a decrease in liver and pancreas fat content.
There were 72 participants — with 36 in each arm (treatment and control), between the ages 38 and 72 years.
The participants had a duration of Type 2 diabetes of 1 to 11 years, a body mass index (BMI) of 19.1 to 30.4 — 66.7% male, and had a history of use of anti-diabetic agent and/or insulin injection.
The team was led by Xiao Yang of the Horticulture College of Hunan Agricultural University, Changsha, China. Other research team members include Huige Shao of the Endocrinology Department, Changsha Central Hospital, in China, and Fangzhou Bian, of the Biological Sciences, University of California Irvine, and Dr Minghai Hu, of the Department of Neurobiology and Human Anatomy, School of Basic Medical Science, Central South University, in Changsha, China.
The researchers randomly allocated the participant at a ratio of 1:1 to the Chinese Medical Nutrition Therapy (CMNT) or control group.
The primary outcome was diabetes “remission” — defined as a stable glycated hemoglobin A1c (HbA1c) level of less than 48 mmol/mol (< 6.5%) for at least 3 months after discontinuing all anti-diabetic medications.
The secondary outcomes included HbA1c level, fasting blood glucose level, blood pressure, weight, quality of life, and medication costs.
On completing the 3-month intervention plus 3-month follow-up, 47.2% (17/36) of participants achieved diabetes remission in the CMNT group, whereas only 2.8% (1/36) of individuals achieved remission in the control group. This is equivalent to an odds ratio of 31.32.
Moreover, the mean body weight of participants in the CMNT group was reduced by 5.93 kg — compared to 0.27 kg in the control group.
After the 12-month follow-up, 44.4% (16/36) of the participants achieved sustained remission, with an HbA1c level of 6.33% (SD 0.87).
The medication costs of the CMNT group were 77.22% lower than those of the control group (60.4/month vs 265.1/month).
A Harvard team medical review of 40 studies found that intermittent fasting was effective for weight loss — with a typical loss of 7-11 pounds over 10 weeks.
The review, however, pointed out that those 40 or so studies had so “much variability” — ranging in size from 4 to 334 subjects, and followed from 2 to 104 weeks.
The review, however, outlined several key points on IF:
Individuals with the following conditions should abstain from intermittent fasting:
Traditionally, fasting is a universal ritual used for health or spiritual benefit, described in a number of religious texts. In addition, the works by Socrates and Plato also describe some benefits from the practice of fasting.
“Beego”, a traditional Chinese water-only fasting practice initially developed for spiritual purposes, later extended to physical fitness purposes.
The researchers recommend more high-quality studies involving a higher number of volunteers in randomised controlled trials, including a follow-up spanning more than a year.
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