Sunday, May 28, 2017

Type 2 Diabetes, a Dietary Disease #382: Can fasting “wake-up” the pancreas?

“Fasting Diet for Diabetes ‘Could Repair Pancreas’” is the full title of a WebMD Health piece by Peter Russell in Medscape Medical News. Note that the ‘could repair pancreas’ is within single quotation marks. Still, the headline is provocative and got my attention.  After all, you only get one pancreas, and by the time most people are diagnosed as Type 2 diabetics, a substantial part (up to 80%) of the insulin producing cells in the pancreas have been destroyed. And the evidence is scant that the pancreas can or does create new beta cells.
Thus, as the lede states, “‘Rebooting’ the organ in this way could help [these] insulin-producing cells to repair themselves and start producing the hormone.” “This way” refers to a diet of “a very limited number of high-fat calories.” The researchers compared this restricted-calorie, high-fat diet with biomarkers associated with a water-only diet and found it had “the same physiological effects on the body as more extreme fasting.” Thus, they called the restricted-calorie, high-fat diet a “fasting–mimicking diet.” Alas, the study was done on mice.
Nevertheless, the study, published in the journal Cell, said that “during periods of fasting, the cells go into ‘standby’ mode. Then when feeding begins again, new cells are produced that have the potential to become insulin-producing.” “New cells” is hopeful; “potential” a lot less so…but it is still worth further investigation.
Medscape also reported: “The research team, led by the University of Southern California, says that laboratory tests on tissue samples from people with type 1 diabetes produced similar effects.” Now that IS promising. But this piece, “intended for a consumer audience,” was pretty thin, so I referred to the full article in Cell. Quote:
“In consideration of the challenges and side effects associated with prolonged fasting in humans, we developed a low-calorie, low-protein and low-carbohydrate but high-fat 4-day fasting mimicking diet (FMD) that causes changes in the levels of specific growth factors, glucose, and ketone bodies similar to those caused by water-only fasting. Here, we examine whether cycles of the FMD are able to promote the generation of insulin-producing β cells and investigate the mechanisms responsible for these effects,” the researchers say.
The diet: “…a low-calorie, low-protein and low-carbohydrate but high-fat 4-day fasting mimicking diet…”
Well, the rest of the article in Cell is way over my head, but some aspects of the premise, the findings, and the discussion were comprehensible to me, so I will try to convey a bit of the essence in these excerpted quotes:
“The ability of animals to survive food deprivation is an adaptive response accompanied by the atrophy of many tissues and organs to minimize energy expenditure.” This is related to autophagy, a well known process.
“Stem-cell-based therapies can potentially reverse organ dysfunction and diseases, but the removal of impaired tissue and activation of a program leading to organ regeneration pose major challenges.”
“In mice, a 4-day fasting mimicking diet (FMD) induces a stepwise expression of [certain genes], followed by [another gene]-driven generation of insulin producing ß [beta] cells, resembling that observed during pancreatic development.” The researchers focused on fetal pancreatic development in both mice and humans.
“FMD cycles restore insulin secretion and glucose homeostasis in both T1 and T2 diabetes in mouse models.”
“Fasting conditions reduce [certain intracellular signaling pathways that are central regulators of cell metabolism] and induce [gene] expression and insulin production”
“These results indicate that a FMD promotes the reprogramming of pancreatic cells to restore insulin generation in islets from T1D patients and reverse both T1D and T2D phenotypes in mouse models.”
So far I’m up to fasting 2 and at times 3 days a week. It’s easy. So, I’m not averse to trying a fasting-mimicking-diet (FMD) cycle that “entails [a] 4-day FMD cycle and up to 10 days of re-feeding.” That’s like every 2-weeks!

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