Intermittent fasting replacing insulin in type 2 Diabetes.

Published 9 October 2018:
BMJ Case Reports: S. Furmili et al.

Summary of article:

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.

This case study about three patients with type 2 diabetes illustrates that if patients are well informed about their condition with 6 hour lectures, as well as training in nutrition and the benefits of low carbohydrate diets and intermittent fasting, their Diabetes type 2 can be reversed and they may stop all their antidiabetic drugs.

It is as if two worlds exists in the treatment of type 2 diabetes.

One small world, based on the newest academic developments, see the light and the benefit of low-carbohydrate diets and intermittent fasting, for the reversal of diabetes type 2, while the older school, who believe in the Standard American Diet and the perception that diabetes type 2 is progressive and will eventually needs insulin.

The economic burden of T2D in the USA is $245 billion. One cannot stop wondering if the larger school that try to maintain the status qua is not under the influence of the big pharmaceutical budgets.

Lifestyle modifications are acknowledged to be the first-line treatment of T2D but 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. Medications help manage the symptoms of diabetes, but they cannot prevent the progression of the disease.

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. During fasting periods, patients are allowed to drink unlimited amounts of very low-calorie fluids such as water, coffee and tea without sugar. On eating days, patients are encouraged to eat a diet low in sugar and refined carbohydrates, which decreases blood glucose and insulin secretion.

The case study of three patients on this regime with intermittent fasting had the following conclusions;

• All three patients stop using insulin.
• All three patients experienced drastic weight loss.
• All three patients had drastic fall in Hb1Ac levels.
• Therapeutic fasting is an underutilized intervention
that can provide superior blood glucose reduction. Fasting is a practical dietary strategy.
• With proper education and support, compliance is good.

Educating patients on the benefits of fasting in the management of T2D may aid in the remission of the disease and curtail the use of pharmacological interventions. A systematic review suggested that patients with T2D who have a baseline HbA1C of greater than 8% may achieve better glycaemic control when given individual education rather than usual care. Additionally, patients should be educated about and encouraged to follow an appropriate treatment plan tailored to them. Adherence to a fasting diet should continue to be stressed throughout treatment, because these lifestyle measures and modifications can have a large impact on the degree of diabetic control that patients can achieve, as seen with this case series.

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