A single cycle of the modified fasting mimicking diet consist of Day 1 – pre-fasting followed by Day 2-8 – very low calorie diet. Day 1-prefasting consists of an 800 kcal (about 40% of normal caloric intake similar to mouse Day1 FMD) monodiet (fruit, rice, or potatoes) by preference of individuals. On the following day patients were recommended to use an oral laxative, Natrium Sulfuricum (20-40 g). FMD consisted of 100 ml vegetable broth or vegetable juice with 1 tablespoon of linseed oil 3 times daily, plus additional calorie-free liquids. The daily calorie intake was predefined with 200 – 350 kcal (10-18% of normal caloric intake similar to mouse Day 2-3 FMD). Patients were advised to drink 2-3 L of unsweetened fluids each day (water, and herbal teas) and to use an enema if tolerated. After the 7-day fasting period solid foods were stepwise reintroduced for three days, starting with a steamed apple at day 8. After the fasting and refeeding period a normocaloric, plant-based Mediterranean diet was maintained until study end."
If this is a real effect, I wonder how many calories a persona can eat and still get the fasting effect. I have a non-24 hour circadian rhythm (although some thing still seem synchronized to light), which causes all sorts of negative effects, and I have found that eating < about 1500 kcal in a day reliably causes a significant improvement in my functioning two days later. Normally eating between 1500 and 2000 kcal most days does not cause this improvement. I am curious if what I am seeing is the same effects as would be caused by this much lowerer calorie diet or if there are tiers of fasting with different effects.
Also interesting is that I have had some severe digestive issues for years; antibiotics helped for a month or two and eating about 3000 kcal over five days has been just as helpful for a couple of weeks now and seems likely to be at least as effective as the antibiotics. However, one or two days of calorie restriction does not have that effect on me. If this fasting result holds for MS, the effect of fasting on gut bacteria could potentially be part of how it works.
No. It's not absolute fasting, although I do that some times. I've been doing alternate-day fasting or a 3/5 diet, for around 6-8 months at a time, for the last several years because it makes me feel better.
There was a great program on the BBC[1] about "fasting-like diets", which generally consist of extreme caloric restriction for some time -- where what counts as "extreme" and "some time" varies from programme to programme -- and when it got to Michael's own experiments with fasting, the description of the feelings are what encouraged me to give it a try.
There was an HN story months ago about a study touting the benefits of a 5 day low cal fast every X months and a startup formed by the researchers is now shipping products based on it http://aboutprolon.com/
Technically a fast-mimicking diet would be: ad-libitum fat, barely sufficient protein (such that protein recycling is maintained --- no idea how to calculate this individually), near-zero (ie. only trace) carbohydrate. I suppose zero protein would most mimick fasting if done for just a few weeks tops but once all degenerate/damaged/mutated/malfunctioning proteins have been degraded for protein recycling or gluconeogenesis, lean tissue gets catabolized and this isn't desirable.) So sounds like:
- a normal-size piece of meat or a box of eggs (or whatever concoctions the vegetationists prefer)
- unlimited ghee/tallow/lard (or whatever oils one's belief system suggests)
- water or 0kcal drinks
- and if prolonged over more than a week or 2, perhaps micronutrient supplementation
Well, that sounds just like a ketogenic diet. They actually investigate keto alongside their fasting diet and find similar benefits in many areas, just not to as large a degree.
This seems pretty likely to be placebo effect, at least in the human trials which are the only parts of the paper I read. The paper cited [0] pre-registered on clinicaltrials.gov [1] -- which is great and everyone in the field should do so. However, looking at what they pre-registered, we have:
- Two different diet treatment regimes: fasting-like for 3 months followed by Mediterranean diet (FMD), and ketogenic diet (KD).
- Control diet was simply telling people to eat the same way as usual. So there's no real accounting for how well a placebo would do here.
- Measurements included a 54-question survey, adverse event counts, and various lab measurements. These measurements were taken at start, 1-month, 3-month, and 6-month intervals.
The problem then is that what was report was:
- Results of the first half of the first treatment (fasting-like for 3 months) for a subset of the measurements. What if things only worked in the second half? Or if things worked only for KD? So many implicit comparisons here.
- Comparison against the control group at 3 months, with reported p-values. Even though one of the reported measurements was the overall survey results, all of the values reported are p-values without any mention, that I can find, of multiple hypothesis testing across all measurements. This comes despite the fact that for all of the mouse results, they explicitly state they used Bonferroni correction.
- Baseline performance which involved no placebo. How many people would have improved if simply given some bullshit diet? Or if they had simply been given a diet that was vegetarian, or something that gave them the impression it was a treatment? Especially in surveys, placebo effect is a huge thing to look out for. Their more hard metrics like lab results show a more mixed bag with WBC dropping for fasting subjects. Sure, it returns once the 3 months is over, but then the supposed quality of life scores drop; so you can't have it both ways, though their writing makes it sound that way.
I'm not saying it isn't a great result from a bio standpoint. I'm sure the Cell reviewers found the mouse model results compelling. I just don't see any way to conclude the broad sweeping title of the article from the actual content of the paper, and it's unethical to do so without strong evidence.
There is a somewhat interesting philosophical question here. What does it mean for this result to be the 'placebo effect'?
That is, supposing it is in some sense caused by the psyche, and fasting reliably produces that effect...is there a sense in which fasting is not its cause?
Clearly for sugar pill vs drug we can measure the component which is 'placebo'. But here, since it is immeasurable...is it possible to call it a placebo effect? Or should we refer to effects derived psychologically from unique subjective experiences in another way.
First, one study doesn't tell us that fasting "reliably" produces this effect. Secondly, if it was a placebo effect then fasting would not reliably produce it. You would likely be able to produce no placebo effect by telling patients that there will very likely be no effect whatsoever on their symptoms.
>But here, since it is immeasurable...is it possible to call it a placebo effect?
If it is a placebo effect, you would probably be able to measure it by testing various other non-fasting diets. The difficulty lies in the inability to have a sham fasting diet, but you could likely mitigate that by telling patients there will likely be no effect on their symptoms from fasting.
Ya, you're totally right that one study does not prove reliability.
I guess my point is more theoretical. Let's say it was reliable, and let's say that other non-fasting diets didn't produce the effect. Further, let's say that telling them it had no effect didn't prevent it either.
Now, given all that, it's still possible that there is, in some sense, a psychological component (i.e. how you 'feel' when fasting) that causes you to get better in some way. I have always thought this about Airborne and such, for instance. They are total bullshit products that absolutely, categorically do not work. But I drink them when i'm sick anyway, because the effervescence and the flavor feel to me like something that works, so I feel like their placebo effect is better than other things.
I suppose what i'm getting at is that there are some activities/experiences that can engineer better placebo effects than others due to the subjective experience they produce. And I wonder then in what sense is that separable from the thing itself.
The Swank diet and later the McDougall diet have been halting and sometimes slightly regressing MS symptoms in most cases, for decades now.
The Swank diet in particular, has kept people alive with the disease for 34 years.
https://www.youtube.com/watch?v=kZ5NGLM1k90
Yeah the spectrum is huge, however disease progression is also hard to predict, so a person with some very heavy relapses at onset might be relapse free for years afterwards and vice versa.
Iirc though there are some studies that showed that progression is in general more benign than initially estimated in most cases.
Isn't this obvious to anyone who follows that diet <-> autoimmune disease? Also adrenal hormones increase during fasting, as can be commonly seen with high cortisol levels in those who fast.
"All disease begins in the gut," as someone wise has said in the past.
It's usually "obvious" to people who are not affected by autoimmune disease, but diet control is generally disappointingly ineffective in reality for most patients. The truth is autoimmune disease is incredibly complex and we still don't have satisfactory treatment, diet or otherwise.
Can you point to some references to back up your claim that diet control is disappointing?
It seems to me that diet has such an enormous effect on our bodies that it should do something; I would say compliance is more the issue than its effectiveness from my reading of things.
Jokes are usually frowned upon in Hacker News. It keeps the conversation focused and meaningful instead of derailing into chains of puns à la Reddit.
It's not that the community can't handle a joke, it's just trying to avoid the slippery slope. There are other places for more lighthearted discussion.
Mentioning downvotes is also frowned upon.
Disclaimer: I didn't downvote you, just explaining.
On the contrary - unsubstantiated, silent, cowardly downvotes turn HN into Reddit.
And my comment was both a joke and a serious statement. As with everything, you need to find the golden mean, and people today are overeating their way into chronic disease!
We don't need as much food and as quality food as we think. In fact, fasting outweighs careful food selection as you can't go wrong with fasting, but you could and eventually would by following conflicting and ever-changing dietary guidelines.
There is much wisdom in my single short sentence!
But I start to think that the audience here is incapable of reading between the lines, which is sad given the HN claims for superior intelligence. In fact, the San Fran crowd is addicted to food, and based on my personal experience here; it goes postal when you dare to say something against their questionable eating habits!
