Therapeutic Fasting - Peterborough Regional Health Centre Fung NOV 1 N… · Therapeutic Fasting ....
Transcript of Therapeutic Fasting - Peterborough Regional Health Centre Fung NOV 1 N… · Therapeutic Fasting ....
The person who says it cannot be done
should not interrupt the person doing it
Therapeutic Fasting
Presenter Disclosure
• Presenters – Jason Fung
• Relationships with commercial interests: – Grants/Research Support: None
– Grants/Speakers Bureau/Honoraria: Consulting Fees: None
– Consulting Fees: None
– Other: None
Two Phases of Type 2 Diabetes
Trajectories of glycaemia, insulin sensitivity, and insulin secretion before diagnosis of type 2 diabetes: an
analysis from the Whitehall II study. Lancet 2009; 373: 2215–2221.
Surgical treatment of obesity and its effect on diabetes: 10-y follow-up
Am J Clin Nutr 1992:55(Suppl.):582S-585S
Insulin Resistance
Surgical treatment of obesity and its effect on diabetes: 10-y follow-up
Am J Clin Nutr 1992:55(Suppl.):582S-585S
Beta Cell Dysfunction
Learned Helplessness
• Fact: For most people, type 2 diabetes is a progressive disease.
• eventually oral medications may not be enough to keep blood glucose levels normal. Using insulin to get blood glucose levels to a healthy level is a good thing, not a bad one.
http://www.diabetes.org/diabetes-basics/myths
What is Insulin Resistance?
The New Paradigm
Eat Food Store Sugar in Liver
Produce Fat in Liver Increase Insulin
No Food
“Fasting”
Burn Stored Sugar in Liver
Burn Fat in Liver Decrease Insulin
Functions of Insulin:
1.Increase glucose entry into cells
2.Turn on De Novo Lipogenesis
The ‘Lock and Key’ paradigm
“Internal Starvation” – Cannot drive DNL
The Central Paradox
Functions of Insulin (Insulin resistant cell):
1. Increase glucose entry into cells - resistant
2. Turn on De Novo Lipogenesis - supersensitive
Liver Cells
Stored Sugar
Glycogen
Stored Fat
De Novo Lipogenesis
High Insulin
Low Insulin
Under conditions of high persistent insulin:
Liver becomes full of sugar and fat
Fatty Liver causes Insulin
Resistance!
Stored Sugar
Stored Fat
High Insulin
Low Insulin
Insulin Resistance is an Overflow
Phenomenon
Insulin Resistance is an Overflow
Phenomenon
Beta cell dysfunction
Burnout?
Surgery cures diabetes
Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes
N Engl J Med 2012;366:1567-76 Schauer PR
A: Fasting plasma glucose and weight change 2 years after randomization either to gastric banding or to intensive medical therapy for weight loss and glucose control.
Adjustable gastric banding and conventional therapy for type 2 diabetes JAMA 2008;299:316-232 Taylor R Dia Care 2013;36:1047-1055
Gastric Banding cures Diabetes
Fasting vs. Bariatric Surgery
Rapid Improvement of Diabetes After Gastric Bypass Surgery: Is It the Diet or Surgery?
Diabetes Care. 2013 Mar 25, Lingvay I
http://www.ncbi.nlm.nih.gov/pubmed/23530013
7.3
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Wei
gh
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Diet
Diet +
Surgery 1293
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Dail
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lyce
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Pre
vs
Post
Taylor R Dia Care 2013;36:1047-1055
Copyright © 2011 American Diabetes Association, Inc.
Decrease in Pancreatic Fat
Taylor R Dia Care 2013;36:1047-1055
Copyright © 2011 American Diabetes Association, Inc.
Restoration of Beta Cell Function
Taylor R Dia Care 2013;36:1047-1055
Copyright © 2011 American Diabetes Association, Inc.
Restoration of First Phase Insulin
Response
The Sugar Bowl
The End Game
The Action to Control Cardiovascular Risk in Diabetes Study Group. N Engl J Med 2008;358:2545-2559
ACCORD
Hazard Ratio 1.22
Cumulative Incidences of Events, According to Glucose-Control Strategy
The ADVANCE Collaborative Group. N Engl J Med 2008;358:2560-2572
ADVANCE
0.50 1.00 2.00
Number of events
More
intensive
Less
intensive
Difference in
HbA1c (%)
HR (95% CI)
All-cause mortality 980 884 -0.88 1.04 (0.90,1.20)
CV death 497 441 -0.88 1.10 (0.84,1.42)
Non-CV death 476 432 -0.88 1.02 (0.89,1.18)
Meta-analysis of intensive glucose
control in T2DM: mortality
Favours more intensive Favours less intensive
• Meta-analysis of 27,049 participants and 2370 major vascular events from
– ADVANCE
– UKPDS
– ACCORD
– VADT HR, hazard ratio; CV, cardiovascular
Turnbull FM et al. Diabetologia 2009;52:2288–2298
Recent trials of newer glucose-lowering agents
have been neutral on the primary CV outcome
SAVOR-TIMI 53
EXAMINE
HR: 1.0
(95% CI: 0.89, 1.12)
HR: 0.96
(95% CI: UL ≤1.16)
TECOS
HR: 0.98
(95% CI: 0.88, 1.09)
EMPA-REG
OUTCOME®
ELIXA
HR: 1.02
(95% CI: 0.89, 1.17)
Empagliflozin
DPP-4 inhibitors*
Lixisenatide
CV, cardiovascular; HR, hazard ratio; DPP-4, dipeptidyl peptidase-4
*Saxagliptin, alogliptin, sitagliptin
Adapted from Johansen OE. World J Diabetes 2015;6:1092-96
2013 2014 2015
How To Reverse Type 2 Diabetes
Type 2 diabetes is too much sugar in the body
Treatment
1. Don’t put more in – Low Carbohydrate Diet
2. Burn it off – Intermittent Fasting
Lowering glucose without raising
insulin improves outcomes
Acarbose Treatment and the Risk of Cardiovascular Disease and Hypertension
in Patients with Impaired Glucose Tolerance
JAMA 2003; 290: 486-494
49% RRR
2.5% ARR
Randomized
1,429
patients
3.3 year
follow up
EMPA-REG MACE
31
HR 0.86
(95.02% CI 0.74, 0.99)
p=0.0382*
Cumulative incidence function. MACE, Major Adverse Cardiovascular Event; HR, hazard ratio.
* Two-sided tests for superiority were conducted (statistical significance was
indicated if p≤0.0498)
Myth - Starvation Mode
0
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Fatty
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Ketones
Norepinep
hrine
Metabolic changes over 4 days of fasting
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Insulin
Glucose
Zaunder C Am J Clin Nutr 2000;71:1511–5.
22 Days Alternate Daily Fasting
Heilbronn et al. Am J Clin Nutr 2005;81:69–73.
Fasting Versus Calorie Restriction
Myth - Burn Muscle
Burn Muscle
70 Days Alternate Daily Fasting
Obesity (2010) 18, 2152-2159
Fasting
versus
Calorie
Restriction
From: Kevin Hall
Myth – It doesn’t work
If I don’t eat, will I lose
weight?
Fasting Advantages
• Flexibility
• Convenience
• Free
• Simplicity
Add To Any Diet
You don't eat meat?
You don't eat wheat?
You have a nut allergy?
You don't have time?
You don't have money?
You are travelling all the time?
You don't cook?
Unlimited Power
Can We Cure Type 2 Diabetes?
No Diabetes – no diabetic
nephropathy, no diabetic foot
ulcers, diabetic retinopathy,
reduced stroke, MI, cancers
No Drugs, No Surgery, No
Cost
12 month intensive dietary
management regime to cure
diabetes
Time to get started…
www.intensivedietarymanagement.com