While fasting has many health benefits, prolonged calorie restriction can take a toll on patients, both physically and mentally. Diets that mimic the physiological benefits of fasting without the burden of food restriction may be a good alternative. Read on to learn more about fasting mimicking diets, their health benefits, and which patients are likely to benefit most from them.
Prolonged water-only fasting provides many health benefits, including regeneration of the immune system, reduced blood glucose, and autophagy (1). However, prolonged fasting is difficult for most people and can cause adverse effects due to its extreme nature. Researchers have therefore been trying to design diets that might mimic the beneficial effects of prolonged fasting without the stress of complete food restriction.
Previously, I have written about the benefits of intermittent fasting. While intermittent fasting approaches share some characteristics with fasting mimicking diets (FMDs), there are some key distinctions. In this article, I will discuss these differences, the evidence for FMDs in both animal and human studies, and which conditions respond best to FMDs.
Terminology: FMD vs. IF
Before we dive into the evidence, let’s clear up some terminology. My guess is that you’ve probably heard of intermittent fasting (IF) but are less familiar with the concept of a fasting mimicking diet (FMD). Intermittent fasting is a general term used to describe various approaches that use short-term fasting with the overall goal of improving health. Examples of IF approaches include skipping one meal a day, shrinking the eating window (also called time-restricted feeding), or alternate-day fasting.
Under this loose definition, fasting mimicking diets can be considered a type of IF. However, FMDs are much more detailed than most IF approaches and are designed in order to achieve specific biological outcomes. Researchers have developed a very-low-calorie, low-protein diet that causes changes in markers associated with stress resistance and longevity (insulin-growth factor, ketone bodies, and glucose) in a similar manner to prolonged fasting. One FMD cycle on this diet usually lasts for several days (three to five) and cycles are fairly infrequent (one to two times per month). Between cycles, eating resumes as usual without any restrictions (2).
Animal studies show FMD improves health across the board
Since FMD is a relatively new concept, most studies to assess the associated health benefits have been performed in animal models. The physiology that allows organisms to respond and adapt to fasting or starvation conditions first appeared billions of years ago and is present in virtually all organisms (3). Even in S. cerevisiae, a type of yeast, periodic fasting extends lifespan and increases resistance to oxidative stress (4).
Five health benefits of the fasting mimicking diet
Animal models allow researchers to analyze a wider range of health outcomes, such as the regeneration of tissues. Mice are among the most commonly used animal models for studying FMD and are typically given two four-day-long FMD cycles per month, with ad libitum (unrestricted) intake between cycles. In the remaining part of this section, we’ll explore the evidence for FMDs in animal studies.
Metabolic disorders and diabetes
In one mouse study, FMD cycles had profound effects on visceral fat, glucose, and IGF-1 levels. IGF-1 is an endocrine hormone produced primarily in the liver. IGF-1 signaling has been associated with biological aging in some organisms, but whether high levels are good or bad is somewhat controversial (5). After return to an ad libitum (eat as desired) diet, both glucose and IGF-1 levels returned to baseline, but visceral fat remained lower. Mice also showed evidence of significant liver and muscle regeneration as a result of FMD (4). In another study published in February 2017, FMD cycles were shown to reverse late stage Type 2 and even Type 1 diabetes! The FMD triggered epigenetic changes that resulted in expression of prenatal development genes in the adult pancreas. This led to pancreatic β cell regeneration and the return of insulin secretion (6).
An FMD has been shown to promote hippocampal neurogenesis and improve motor learning and memory in old mice (4). In a mouse model of Alzheimer’s, protein restriction cycles have been shown to alleviate the age-dependent impairment in cognitive performance and reduce levels of phosphorylated tau, a protein that forms the tangles characteristic of Alzheimer’s and several other neurological diseases (7).
In a mouse model of multiple sclerosis, FMD reduced clinical severity in all mice and completely reversed symptoms in 20 percent of animals (8). At the molecular level, FMD increased corticosterone levels and regulatory T cells and promoted remyelination in axons. FMD also reduced levels of pro-inflammatory cytokines and immune cells involved in promoting inflammation.
FMD has been shown to rejuvenate the immune system and protect against cancer in mice. One study found a 45 percent reduction in neoplasia incidence in the FMD group relative to the control group. Cycles of FMD beginning at middle age also delayed tumor onset and reduced the number of lesions, which may indicate a switch from malignant to benign tumors. FMD has also been shown to reduce the number of tissues with inflammation and protect against inflammation-associated skin lesions (4).
Immunosenescence is the age-associated decline in hematopoiesis (the creation of new blood cells), resulting in diminished or altered production of adaptive immune cells. FMD causes a rejuvenation of the blood profile and a reversal of this decline by increasing the number of hematopoietic and mesenchymal stem and progenitor cells. Four months of FMD cycles resulted in a significant increase in RBC count and hemoglobin levels compared to baseline. FMD also increased median lifespan of mice by 11 percent and either attenuated age-dependent bone mineral density loss or induced bone regeneration in mice.
Interestingly, there were some contraindications to fasting in older mice. The authors suggest that in older animals, a less severe low-calorie and low-protein diet may be preferable to continue to provide beneficial effects while minimizing malnourishment (4).
FMD: human clinical trials
While most studies on FMD have been done in animal models, there have been a few clinical trials in humans. In one of the most substantial studies to date, performed by Wei et al. (9), they had 71 subjects complete three FMD cycles. Each FMD cycle lasted for five days, and was repeated once every month. During the five-day period, subjects in the FMD group consumed about 34 to 54 percent of their normal caloric intake. The diet composition was approximately 9 to 11 percent protein, 43 to 47 percent carbohydrate, and 44 to 46 percent fat by energy.
The researchers measured several markers in the blood after three FMD cycles, some of which were maintained after returning to their normal diet:
- Subjects who completed three full FMD cycles and returned to their normal diet for five to seven days had significantly reduced body weight, total body fat, trunk fat, absolute lean body mass, waist circumference, IGF-1, systolic and diastolic blood pressure, total cholesterol, LDL, and HDL.
- The effects of FMD on body weight, BMI, waist circumference, IGF-1, and diastolic blood pressure persisted for at least three months after the final FMD cycle.
FMD was found to have especially profound effects in patients at high risk for cardiovascular, metabolic, and age-related disease.
- Individuals who had high baseline levels (>1 mg/liter) of C-reactive protein, a potent marker of inflammation, had significantly lower CRP levels three months post-FMD.
- Subjects with low baseline HDL showed significantly increased three-month follow-up HDL levels.
Altogether, these data suggest that FMD causes many beneficial changes in risk factors for chronic, age-related diseases in both animals and humans. Further studies will only contribute to our understanding of the mechanism behind these changes.
When to prescribe a fasting mimicking diet
FMD clearly has numerous health benefits, as I have outlined in this article. However, it should be noted that fasting does have the potential to make some patients worse, depending on their condition.
Patients who are good candidates for FMD include: those who are fighting chronic infections or trying to lose weight; those who have a weak immune system, neurological issues, type 2 diabetes, or other metabolic problems; and those who are healthy and are simply trying to optimize longevity.
Patients who are typically not good candidates for FMD include: those who are pregnant or have HPA axis dysregulation (“adrenal fatigue”), an eating disorder, or thyroid problems. Fasting is also not usually recommended for children or teens.
Always be sure to monitor patients closely when they start to implement FMD or any type of fasting. If patients start to exhibit symptoms of HPA-D or hypothyroidism, you will need to reconsider their fasting schedule. Remember that each patient will respond to fasting differently.
The FMD, as studied, is currently available from Prolon as a specific package of prepared foods and micronutrients intended to be administered under a doctor’s supervision.
It’s likely that a “homemade” version with similar macronutrient ratios and foods would have the same effects, but this hasn’t yet been studied in a clinical trial. Stay tuned for more discussion about the benefits and practical application of fasting in the future, as this is a topic I’m exploring deeply.
That’s all! Now it’s your turn. Had you heard of fasting mimicking diets? Could your patients benefit from an FMD? Share your thoughts in the comments!