Journal Article

Seven-day fasting as a multimodal complex intervention for adults with type 1 diabetes: Feasibility, benefit and safety in a controlled pilot study

Michalsen, Andreas, Simstich, Johannes, Jenetzky, Ekkehart, Baumann, Andrea, Martin, David D., Berger, Bettina, Stange, Rainer, Schmelzer, Kurt-Martin, Köblös, Diana

2021

Overview

Intermittent as well as prolonged fasting are receiving considerable attention and appear favorable in conditions such as metabolic syndrome, type 2 diabetes, and rheumatic diseases. Fasting for individuals with type 1 diabetes (T1D) is generally considered too risky. However, the ability and possibility to change from carbohydrate- to ketone-based fuel supply might be relevant for individuals with T1D. The aim of this patient-led research was to investigate the feasibility, benefit, and safety of a 7-d multimodal fasting intervention in individuals with T1D. This was a non-randomized controlled pilot study, with 20 participants with T1D and 10 without the disease. Data acquisition took place before, after, and 4 mo after the intervention and daily during intervention. Of the individuals with T1D, 19 finished fasting. A mean β-hydroxybutyrate as representative ketone body increased to 2.8 ± 1.9 mmol/L on day 7; whereas average glucose remained between 4.9 (±1.5) and 7.5 (±2.3) mmol/L (89 ± 27 and 136 ± 40 mg/dL). Mean daily insulin dose was adjusted from 24.4 (3–50) IU on the day before fasting to 7.6 (0–26.7) IU on day 7. Quality of life (WHO-5) normalized from 54 (±4.4) to 68.8 (±15; P = 0.01) after fasting. There was a decrease from before until the follow-up 4 mo later of weight from 77.6 (±20.4) to 76.6 (±20.9) kg (P = 0.023) and for body mass index from 27.68 (±7.04) to 26.74 (±7.15) kg/m2 (P = 0.008). Diastolic blood pressure increased from 69.75 (±11.41) to 75.74 (±8.42) mm Hg (P = 0.028) and stayed in a healthy range on average. Fasting-related side effects were all temporary, and slightly more prevalent in those with type 1 diabetes compared with the reference group. This study demonstrated the feasibility, benefits, and safety aspects of a 7-d fast in adults with T1D. [Display omitted] •No ketoacidosis occurred during 7 d of fasting in a group of 20 individuals with type 1 diabetes.•Change from carbohydrate- to ketone-based fuel is possible for people with type 1 diabetes under stable blood sugar values.•By fasting, body mass index and other symptoms and risk factors may show long-term improvements in adults with type 1 diabetes.•Multimodal 7-d fasting in type 1 diabetes, as a method preferred by many patients, could be proven feasible and might serve as an additional treatment option, when efficacy could be proved within a randomized controlled trial

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Adult / Adults / Blood Glucose / Blood pressure / Body mass index / Body size / Buchinger fasting / Carbohydrates / Data acquisition / data collection / Diabetes / Diabetes mellitus (insulin dependent) / Diabetes mellitus (non-insulin dependent) / Diabetes Mellitus, Type 1 - drug therapy / Diabetes Mellitus, Type 2 / diastolic blood pressure / Disease / Dosage / Fasting / Feasibility / Feasibility Studies / Glucose / Humans / Insulin / insulin-dependent diabetes mellitus / Intervention / Ketoacidosis / ketone bodies / Ketones / Ketosis / Metabolic disorders / Metabolic syndrome / Metabolism / Mindfulness / Multimodal intervention / noninsulin-dependent diabetes mellitus / nutrition / Patient-led research / Physicians / Pilot Projects / Prolonged fasting / Quality of Life / Rheumatic diseases / Safety / Side effects / Type 1 diabetes