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  #1   ^
Old Sat, Oct-13-18, 10:01
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JEY100 JEY100 is online now
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Default BMJ publishes Dr. Fung's 3 case studies on Fasting and T2 Diabetes

From Dr. Fung this morning: We have some very BIG news to share with you! Just this week, the BMJ (the world’s oldest peer-reviewed medical journal) has posted a brand new study based on Dr. Fung’s research that focuses on how Planned Intermittent Fasting can REVERSE Type 2 Diabetes! This is a study worth showing your doctor:

http://casereports.bmj.com/content/...017-221854.full

Myth exploded

Therapeutic use of intermittent fasting for people with type 2 diabetes as an alternative to insulin

Summary

This case series documents three patients referred to the Intensive Dietary Management clinic in Toronto, Canada, for insulin-dependent type 2 diabetes. It demonstrates the effectiveness of therapeutic fasting to reverse their insulin resistance, resulting in cessation of insulin therapy while maintaining control of their blood sugars. In addition, these patients were also able to lose significant amounts of body weight, reduce their waist circumference and also reduce their glycated haemoglobin level.

Background

Type 2 diabetes (T2D) is a chronic disease closely linked to the epidemic of obesity that requires long-term medical attention to limit the development of its wide range of microvascular, macrovascular and neuropathic complications. Many of these complications arise from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. Approximately 10% of the population of the USA and Canada have a diagnosis of T2D, and the morbidity and mortality rates associated with it are fairly high. The economic burden of T2D in the USA is $245 billion.1 2

These three cases exemplify that therapeutic fasting may reduce insulin requirements in T2D. Given the rising cost of insulin, patients may potentially save significant money. Further, the reduced need for syringes and blood glucose monitoring may reduce patient discomfort.

Although lifestyle modifications are universally acknowledged to be the first-line treatment of T2D, adequate glycaemic control is difficult to achieve in majority of obese patients. Bariatric surgery is an effective treatment option for obese patients with T2D, but is invasive, costly and not without its risks. Long-term effects have not been definitively established, and failure of the surgical intervention may occur due to non-compliance with diet and lifestyle factors. In addition, many patients require surgical reversal.3 4 Medications help manage the symptoms of diabetes, but they cannot prevent the progression of the disease.5

Therapeutic fasting has the potential to fill this gap in diabetes care by providing similar intensive caloric restriction and hormonal benefits as bariatric surgery without the invasive surgery. Therapeutic fasting is defined as the controlled and voluntary abstinence from all calorie-containing food and drinks from a specified period of time.6 This differs from starvation, which is neither deliberate nor controlled. During fasting periods, patients are allowed to drink unlimited amounts of very low-calorie fluids such as water, coffee, tea and bone broth. A general multivitamin supplement is encouraged to provide adequate micronutrients. Precise fasting schedules vary depending primarily on the patient’s preference, ranging from 16 hours to several days. On eating days, patients are encouraged to eat a diet low in sugar and refined carbohydrates, which decreases blood glucose and insulin secretion. The full manual of the dietary regimen used in this study has been published and is quoted in the references.7**

As such, patients with T2D can reverse their diseases without the worry of side effects and financial burden of many pharmaceuticals, as well as the unknown long-term risks and uncertainty of surgery, all by means of therapeutic fasting.

** The full manual of the dietary regimen used in this study is Dr. Fung’s book, The Complete Guide to Fasting.


There is a long, active and on-going thread about Dr. Fung and his Fasting protocols in the Diabetes sub-forum, started in July 2014.

http://forum.lowcarber.org/showthread.php?t=472377
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  #2   ^
Old Sat, Oct-13-18, 10:19
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GRB5111 GRB5111 is online now
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This is good news that the principles of IF are getting acknowledged. The BMJ is playing a large role in communicating sound science on nutrition along with taking an important stand in 2016 to not retract Nina Teicholz's article about the DGAs. The BMJ has become a beacon to shine a light on nutritional science. Very encouraging.
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  #3   ^
Old Sat, Oct-13-18, 13:43
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Quote:
Originally Posted by GRB5111
This is good news that the principles of IF are getting acknowledged. The BMJ is playing a large role in communicating sound science on nutrition along with taking an important stand in 2016 to not retract Nina Teicholz's article about the DGAs. The BMJ has become a beacon to shine a light on nutritional science. Very encouraging.

I wonder how much of an effect BMJ editor-in-chief Fiona Godlee is having when it comes to publication of "new" angles in nutrition science. I was impressed with her appearance at the Swiss Re conference earlier this year, she seemed committed to trying to bring people with opposing views together and reaching consensus at whatever level it could be found.

Anyway, I'd love to see more case studies get this sort of attention. After all, what is a single case study but a carefully monitored n=1? We all have our own individual stories to tell, and as someone in the Swiss Re audience suggested at the time, there are an awful lot of n=1 successes out there.
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Old Sat, Oct-13-18, 13:56
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GRB5111 GRB5111 is online now
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My guess is that the effect of the BMJ's actions would impact the more "mainstream" audience who wouldn't necessarily take part in nutritional N=1 activities; rather, they would be compliant with the practices recommended by the "experts." In this case, I would include the BMJ as one of the voices of the "experts."
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  #5   ^
Old Mon, Oct-15-18, 12:33
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JEY100 JEY100 is online now
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Took a few days for this blow-back, but knew it had to be coming......

After intermittent fasting, these 3 men no longer take insulin for diabetes -- but experts stress caution

https://edition.cnn.com/2018/10/09/...5bJ0uO 3XayTPo


Quote:
Three men with Type 2 diabetes used "intermittent fasting" to reverse their dependence on insulin, according to a report published Tuesday -- but you shouldn't try it without medical supervision, experts say.

The new case report says the three patients also lost weight, and their HbA1Cs, a measure of blood sugar levels, improved.
"People are focused on giving drugs to Type 2 diabetes, but it's a dietary disease," said study author Dr. Jason Fung, medical director of the Intensive Dietary Management Program in Toronto.

Experts say this clashes with the widely held belief that diabetes is strictly a chronic, irreversible disease -- though Fung said that's been changing in recent years.

"In general, the concept of reversing or curing diabetes ... is not well-accepted in the medical field," said Dr. Abhinav Diwan, associate professor of medicine, cell biology and physiology at the Washington University School of Medicine in St. Louis. "It is not even a therapeutic goal when people start to treat diabetics."

The US Centers for Disease Control and Prevention estimates that 9.4% of Americans -- about 30.3 million people -- have diabetes, and nearly a quarter of those are undiagnosed. Ninety to 95% of those cases are Type 2 diabetes. An additional 33.9% of the population, or 84.1 million people, have prediabetes, the agency says.

"Diabetes is the No. 1 cause of kidney failure, lower-limb amputations, and adult-onset blindness," the CDC says.

In the study, patients followed 24-hour fasts several times a week. They ate only dinner on fasting days but could drink water, coffee and broth throughout. They were all men, ages 40, 52 and 67, who had been diagnosed with diabetes 20, 25 and 10 years prior, respectively.

The participants had been diagnosed with Type 2 diabetes, which has been linked to obesity and develops over years due to a combination of genetics and lifestyle. In this type, the body becomes less responsive to insulin, a hormone it needs to balance glucose in the bloodstream.

This is different from Type 1 diabetes, an autoimmune condition in which the pancreas doesn't produce much, if any, insulin. Fasting for those with Type 1 diabetes "may be unsafe due to the increased risk for hypoglycemia," said Diwan, who was not involved in the new study.

However, he has researched fasting and diabetes in mice, looking for important clues at the cellular level about how this might work.
When it comes to this field of research, he said, "these are early days but very exciting." The new report is not a definitive study, he added; it has a small sample size, no control group and limited followup. Existing research in humans is also difficult to compare because it is largely observational, and how to implement fasting hasn't been standardized, Diwan said.

"It is very clear that people who can lose weight have better blood sugar control ... [and] sometimes can get off insulin if not too advanced in their disease," said Dr. Robert Gabbay, chief medical officer at the Joslin Diabetes Center, a nonprofit research and care center in Boston affiliated with Harvard Medical School.

"The most established example of that are people that have bariatric surgery," he added. "They lose significant amounts of weight, and some of them get off all medications."
Gabbay, who was not involved in the new report, calls this a "remission" of diabetes rather than "cure" because, "as far as we know, it's still worthwhile having a yearly eye exam, having a screening for kidney disease and nerve damage, even in those people that normalize their blood sugars, because they may be at continued risk."

"Although, honestly, there aren't enough of those people to know."
Experts like Fung are calling for more research on this topic, which has not gotten much attention from the broader scientific community.
"Intermittent fasting has been in a hinterland for many, many years. There's been really no data on it," Fung said, adding that his proposals for larger studies on fasting and diabetes have been denied by two Toronto hospitals.
He said he's seen thousands of patients in his program, and the new report, which took two years to publish and includes only three patients, is part of an ongoing effort to show early evidence and advocate for larger studies.

The goal of no longer needing insulin is not only a health-related goal, Fung said; it could also mean not having to buy these drugs, which are ever more costly.
But without randomized trials, Diwan said, it's tough to say how effective intermittent fasting is, what's the best way to do it and how sustainable it might be in the long run.
At the very least, "intermittent fasting has been practiced across various cultures," Diwan said, citing his own Hindu culture as an example. "So that tells you right off the bat that it's a doable thing."
Gabbay said "there's conflicting data out there" on fasting diets and weight loss, including studies suggesting that fasting is no more effective for weight loss and maintenance than calorie restriction, and other research showing how some people regain weight.

None of the men in the study had episodes in which their blood sugar dropped dangerously low -- known as hypoglycemia -- but other studies on fasting and diabetes have reported this risk. It could increase if people continue to take their usual dose of insulin while fasting, causing their blood sugar levels to plummet, Fung said.

"Clearly, there is need for caution, because diabetic people are prone to hypoglycemic episodes, and hypoglycemia can be fatal," Diwan said. "People do not want to put them themselves at risk by fasting without consulting a doctor."
Experts say there could be other risks to fasting, such as headaches, fatigue, nausea and insomnia. It may also be less safe for some groups of people to fast, including pregnant women and those who take certain medications.
Gabbay said the new paper accomplishes its goal of warranting further study, but on its own, it's a success story about just three people -- and one would be "hard-pressed to draw any conclusions from this kind of work."
"We always worry when reports of dramatic results are presented, as they may be misinterpreted by people," he said. "In the world of diet and weight loss, things really catch on quickly."



Science Daily with no comments: https://www.sciencedaily.com/releas...81009210738.htm


Newsweek: https://www.newsweek.com/type-2-dia...disease-1159579

Last edited by JEY100 : Mon, Oct-15-18 at 12:51.
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  #6   ^
Old Mon, Oct-15-18, 14:57
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GRB5111 GRB5111 is online now
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Alright, and pair Fung's clinical experiences with Westman's, Unwin's, and Hallberg's Virta Health studies, and the positive influences become wider. Unfortunately, the idea of fasting becomes the lightning rod in this case, as it's unconventional and very hard for people to understand the idea of not eating to improve health. Some who have not read Fung's fasting policies and protocol will conclude that this is irresponsible and dangerous. What fasting is achieving for Fung's patients is equivalent to the dietary changes of eliminating carbs in the patients of Westman, Unwin, and Virta Health. Time restricted feeding (TRF) is a part of all clinical practices mentioned, so it also identifies a need to define fasting and IF. If it's a short duration fast, it can be termed TRF just as easily.

The other thing is that the observation by Gabbay:
Quote:
"It is very clear that people who can lose weight have better blood sugar control ... [and] sometimes can get off insulin if not too advanced in their disease," said Dr. Robert Gabbay, chief medical officer at the Joslin Diabetes Center, a nonprofit research and care center in Boston affiliated with Harvard Medical School.

is the reverse of the sequence in which I now understand this dynamic: People who start to have better blood sugar control can start to lose weight. This idea that losing weight as a singular activity and root cause is naive (triggers the worn-out recommendation to eat less, move more) and is a result of dietary changes that initially get blood sugar levels under control. As the mainstream "experts" get involved, we'll start to see the whole explanation of how carb restriction and IF/TRF works be repeated. Metabolic responses have been very well explained in books by Fung and Westman. There's a lot of catching up to do here for the "experts."
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Old Mon, Oct-15-18, 16:59
M Levac M Levac is offline
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Well done, Jason. It's not just IF, it's also low-carb:
Quote:
All patients followed similar dietary regimen. Patients 1 and 3 followed alternating-day 24-hour fasts, and patient 2 followed the triweekly 24-hour fasts schedule. On fasting days, the patients only consumed dinner, whereas on non-fasting days the patients consumed lunch and dinner. Low-carbohydrate meals were recommended when eating meals. Patients were examined on average twice a month and labs were recorded.

Also, while Jason is eminently cautious with the title "...as an alternative to insulin", the report itself says it's an actual cure:
Quote:
The most noteworthy outcome from this case series is the complete discontinuation of insulin in all three patients. The changes in diabetic medications in all three patients are summarised in table 2. Both patients 2 and 3 discontinued all diabetic medications entirely. Patient 3 discontinued three out of four medications post fasting regimen. All three were able to discontinue their insulin. The minimum number of days to discontinuation of insulin was 5 and the maximum was 18. There was a general reduction of haemoglobin A1C (HbA1C) levels for all patients during the course of the fast. No symptomatic episodes of hypoglycaemia were reported in any of the patients.

As for the "experts" stressing caution, f u.

-edit- That last line is ambiguous. I just wanna make it clear I'm saying fu to the "experts".

Last edited by M Levac : Mon, Oct-15-18 at 21:10.
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Old Tue, Oct-16-18, 18:53
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bevangel bevangel is offline
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Quote:
"In general, the concept of reversing or curing diabetes ... is not well-accepted in the medical field," said Dr. Abhinav Diwan, associate professor of medicine, cell biology and physiology at the Washington University School of Medicine in St. Louis. "It is not even a therapeutic goal when people start to treat diabetics."


The mere fact that Diwan (or any other doctor) would say that reversing or curing diabetes is not even a therapeutic goal when treating diabetes says a hell of a lot to me! Many many cancers still cannot be reversed or cured and thirty years ago very very few cancers were reversible or curable. Yet NO DOCTOR would EVER say that reversing or curing the patient's cancer was not even a therapeutic goal!

The goal was ALWAYS to cure or reverse, or at least slow the progress of the cancer. Even back when nobody had any idea how they might do that, EVERY cancer doctor and a gazillion cancer researchers were beating the bush looking desperately for cures. Any suggestion of the possibility that some particular protocol might actually cure a cancer and a hundred scientists started following up on it, writing a research proposal to get funding to test that particular protocol. (I know because, until he retired, my husband was one of those gazillion cancer researchers!) And, because they LOOKED, they have now FOUND ways to cure many cancers and ways to at least slow the progression of most others.

But diabetes? "Meh, it's incurable... no point in even looking for a cure... that's not even a treatment goal! Just put your patients on insulin and move on."

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Old Wed, Oct-17-18, 07:00
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JEY100 JEY100 is online now
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Old Wed, Oct-17-18, 08:04
M Levac M Levac is offline
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Marika Sboros wrote:
Quote:
This is an observational study and refers to just three cases – all in men. As such, the researchers are aware that it is not possible to draw firm conclusions on the wider success or otherwise for treating type 2 diabetes.

No, it's not an observational study. An observational study is a study of data such as patient records and food questionnaires, then a study of correlations between two variables with the assumption of causation. Here, it's a study of three case reports. A case report is a report on an intervention, i.e. we applied this treatment and here are the results of this treatment. The study part of this study is the amalgamation of the three case reports' results.

Typically, a case report is written when the diagnosis and/or treatment and/or outcome is unconventional and extraordinary. The treatment - intermittent fasting to treat diabetes type 2 - is indeed unconventional. The fact that this treatment is a cure for two of the three patients is extraordinary, considering the disease is officially deemed incurable.

What the researchers are aware of or not in the grand scheme of things is irrelevant. Case reports are intended to be read by other practicing doctors who deal with the same diagnoses and are searching either for solutions to their failed prescribed treatment or for alternative treatments. This study of three case reports should fit those needs.

It's important to note that a case report rests squarely on the author's reputation as a practicing doctor. As such, it's deemed much more clinically relevant by other practicing doctors.
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Old Wed, Oct-17-18, 09:27
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cotonpal cotonpal is online now
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Quote:
Originally Posted by M Levac
It's important to note that a case report rests squarely on the author's reputation as a practicing doctor. As such, it's deemed much more clinically relevant by other practicing doctors.


My father was a doctor. As I child I used to peruse his medical journals, both JAMA (Journal of the American Medical Association) and The New England Journal of Medicine. It was the case reports that drew my attention the most even if I usually didn't understand the science I did understand whether or not the doctors had figured it out. These case reports were a regular and unquestioned part of these journals, appearing every issue and unquestioned as to their relevance. So Jason Fung is doing precisely what doctors have always done, reporting on treatment and outcomes in difficult or unusual cases.
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Old Wed, Oct-17-18, 14:47
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teaser teaser is online now
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"Anecdotal," "case study" and even "observational" are not synonyms for "doesn't prove anything." It sort of depends. Injecting insulin into a child who was wasting away in the 20's--n=1, but the healthy weight gain proved something. The more remarkable an event is, the more improbable that it happens by chance, the smaller the sample size needed.

You may need a thousand or ten thousand subjects to show that an intervention--let's say, statins--will give benefit to one out of 200 subjects. In the case of diabetes remission--spontaneous remission without the dietary intervention is of vanishingly small probability. Maybe you won't know for certain that it will reverse the disease in any one person--but you'll know for certain once it does. The only question is, for people this works for, what's the best way to go about things, not whether the basic approach works.

As far as remission of type II diabetes goes--it's embarrassing how many very low calorie, or protein sparing modified fast, and fasting studies have shown remission of diabetes. You cannot read this literature without tripping over this accidental/incidental finding again and again. And yes, the bariatric surgery studies. And the Newcastle studies.
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