
Fasting-like Diet Reduces Multiple Sclerosis Symptoms - brahmwg
http://www.neuroscientistnews.com/clinical-updates/fasting-diet-reduces-multiple-sclerosis-symptoms
======
ams6110
What is a "fasting-like" diet? It is presumably not absolute fasting otherwise
no need for the "like" qualifier.

~~~
biot
From the paper [0]:

"Modified human fasting mimicking diet.

A single cycle of the modified fasting mimicking diet consist of Day 1 – pre-
fasting followed by Day 2-8 – very low calorie diet. Day 1-prefasting consists
of an 800 kcal (about 40% of normal caloric intake similar to mouse Day1 FMD)
monodiet (fruit, rice, or potatoes) by preference of individuals. On the
following day patients were recommended to use an oral laxative, Natrium
Sulfuricum (20-40 g). FMD consisted of 100 ml vegetable broth or vegetable
juice with 1 tablespoon of linseed oil 3 times daily, plus additional calorie-
free liquids. The daily calorie intake was predefined with 200 – 350 kcal
(10-18% of normal caloric intake similar to mouse Day 2-3 FMD). Patients were
advised to drink 2-3 L of unsweetened fluids each day (water, and herbal teas)
and to use an enema if tolerated. After the 7-day fasting period solid foods
were stepwise reintroduced for three days, starting with a steamed apple at
day 8. After the fasting and refeeding period a normocaloric, plant-based
Mediterranean diet was maintained until study end."

[0] [http://www.cell.com/cell-
reports/pdfExtended/S2211-1247(16)3...](http://www.cell.com/cell-
reports/pdfExtended/S2211-1247\(16\)30576-9)

~~~
joveian
If this is a real effect, I wonder how many calories a persona can eat and
still get the fasting effect. I have a non-24 hour circadian rhythm (although
some thing still seem synchronized to light), which causes all sorts of
negative effects, and I have found that eating < about 1500 kcal in a day
reliably causes a significant improvement in my functioning two days later.
Normally eating between 1500 and 2000 kcal most days does not cause this
improvement. I am curious if what I am seeing is the same effects as would be
caused by this much lowerer calorie diet or if there are tiers of fasting with
different effects.

Also interesting is that I have had some severe digestive issues for years;
antibiotics helped for a month or two and eating about 3000 kcal over five
days has been just as helpful for a couple of weeks now and seems likely to be
at least as effective as the antibiotics. However, one or two days of calorie
restriction does not have that effect on me. If this fasting result holds for
MS, the effect of fasting on gut bacteria could potentially be part of how it
works.

------
tansey
This seems pretty likely to be placebo effect, at least in the human trials
which are the only parts of the paper I read. The paper cited [0] pre-
registered on clinicaltrials.gov [1] -- which is great and everyone in the
field should do so. However, looking at what they pre-registered, we have:

\- Two different diet treatment regimes: fasting-like for 3 months followed by
Mediterranean diet (FMD), and ketogenic diet (KD).

\- Control diet was simply telling people to eat the same way as usual. So
there's no real accounting for how well a placebo would do here.

\- Measurements included a 54-question survey, adverse event counts, and
various lab measurements. These measurements were taken at start, 1-month,
3-month, and 6-month intervals.

The problem then is that what was report was:

\- Results of the first half of the first treatment (fasting-like for 3
months) for a subset of the measurements. What if things only worked in the
second half? Or if things worked only for KD? So many implicit comparisons
here.

\- Comparison against the control group at 3 months, with reported p-values.
Even though one of the reported measurements was the overall survey results,
all of the values reported are p-values without any mention, that I can find,
of multiple hypothesis testing across all measurements. This comes despite the
fact that for all of the mouse results, they explicitly state they used
Bonferroni correction.

\- Baseline performance which involved no placebo. How many people would have
improved if simply given some bullshit diet? Or if they had simply been given
a diet that was vegetarian, or something that gave them the impression it was
a treatment? Especially in surveys, placebo effect is a huge thing to look out
for. Their more hard metrics like lab results show a more mixed bag with WBC
dropping for fasting subjects. Sure, it returns once the 3 months is over, but
then the supposed quality of life scores drop; so you can't have it both ways,
though their writing makes it sound that way.

I'm not saying it isn't a great result from a bio standpoint. I'm sure the
Cell reviewers found the mouse model results compelling. I just don't see any
way to conclude the broad sweeping title of the article from the actual
content of the paper, and it's unethical to do so without strong evidence.

[0] [http://www.cell.com/cell-
reports/pdfExtended/S2211-1247(16)3...](http://www.cell.com/cell-
reports/pdfExtended/S2211-1247\(16\)30576-9)

[1]
[https://clinicaltrials.gov/ct2/show/NCT01538355?term=NCT0153...](https://clinicaltrials.gov/ct2/show/NCT01538355?term=NCT01538355&rank=1)

~~~
darawk
There is a somewhat interesting philosophical question here. What does it mean
for this result to be the 'placebo effect'?

That is, supposing it is in some sense caused by the psyche, and fasting
reliably produces that effect...is there a sense in which fasting is not its
cause?

Clearly for sugar pill vs drug we can measure the component which is
'placebo'. But here, since it is immeasurable...is it possible to call it a
placebo effect? Or should we refer to effects derived psychologically from
unique subjective experiences in another way.

~~~
cpncrunch
>fasting reliably produces that effect

First, one study doesn't tell us that fasting "reliably" produces this effect.
Secondly, if it was a placebo effect then fasting would _not_ reliably produce
it. You would likely be able to produce no placebo effect by telling patients
that there will very likely be no effect whatsoever on their symptoms.

>But here, since it is immeasurable...is it possible to call it a placebo
effect?

If it is a placebo effect, you would probably be able to measure it by testing
various other non-fasting diets. The difficulty lies in the inability to have
a sham fasting diet, but you could likely mitigate that by telling patients
there will likely be no effect on their symptoms from fasting.

~~~
dsabanin
Placebos work even when you know[1]

[1]
[http://www.scientificamerican.com/podcast/episode/placebos-w...](http://www.scientificamerican.com/podcast/episode/placebos-
work-even-when-you-know-10-12-23/)

------
tkyjonathan
The Swank diet and later the McDougall diet have been halting and sometimes
slightly regressing MS symptoms in most cases, for decades now. The Swank diet
in particular, has kept people alive with the disease for 34 years.
[https://www.youtube.com/watch?v=kZ5NGLM1k90](https://www.youtube.com/watch?v=kZ5NGLM1k90)

~~~
j-pb
> The Swank diet in particular, has kept people alive with the disease for 34
> years.

It's not an achievement to keep people with MS alive. People with MS have an
average life expectancy that is very close to that of healthy people
(literature varies between a couple of months
[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1069023/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1069023/)
and several years, with 7 being the highest that I've seen
[http://www.nationalmssociety.org/What-is-MS/MS-
FAQ-s](http://www.nationalmssociety.org/What-is-MS/MS-FAQ-s)). It's the
quality of life that sucks for MS patients.

Uninformed statements like these make you sound even more snake oily than you
already sound.

~~~
easytiger
Also a highly varied disease that can have almost no effects vs almost
immediately chronic ones.

~~~
j-pb
Yeah the spectrum is huge, however disease progression is also hard to
predict, so a person with some very heavy relapses at onset might be relapse
free for years afterwards and vice versa.

Iirc though there are some studies that showed that progression is in general
more benign than initially estimated in most cases.

------
rikta
Ramadan is coming :) 20+ hours fasting for 30 days :)

~~~
gokhan
~17 hrs in London in the first day.

Besides, never seen anyone loosing weight during Ramadan. Many eat from iftar
to sunrise non-stop.

------
orangegrain
Isn't this obvious to anyone who follows that diet <-> autoimmune disease?
Also adrenal hormones increase during fasting, as can be commonly seen with
high cortisol levels in those who fast.

"All disease begins in the gut," as someone wise has said in the past.

~~~
Lxr
It's usually "obvious" to people who are not affected by autoimmune disease,
but diet control is generally disappointingly ineffective in reality for most
patients. The truth is autoimmune disease is incredibly complex and we still
don't have satisfactory treatment, diet or otherwise.

~~~
andy_ppp
Can you point to some references to back up your claim that diet control is
disappointing?

It seems to me that diet has such an enormous effect on our bodies that it
should do something; I would say compliance is more the issue than its
effectiveness from my reading of things.

------
horsecaptin
What about ALS?

~~~
adjwilli
That's only cured by watching people splash themselves with cold water.

~~~
curiousgal
You're just bummed because no one _challenged_ you! /s

------
nikolay
Food is so yesterday!

~~~
nikolay
Why all the downvotes? You can't handle a joke?! So pathetic!

~~~
kaoD
Jokes are usually frowned upon in Hacker News. It keeps the conversation
focused and meaningful instead of derailing into chains of puns à la Reddit.

It's not that the community can't handle a joke, it's just trying to avoid the
slippery slope. There are other places for more lighthearted discussion.

Mentioning downvotes is also frowned upon.

Disclaimer: I didn't downvote you, just explaining.

~~~
nikolay
On the contrary - unsubstantiated, silent, cowardly downvotes turn HN into
Reddit.

And my comment was both a joke and a serious statement. As with everything,
you need to find the golden mean, and people today are overeating their way
into chronic disease!

We don't need as much food and as quality food as we think. In fact, fasting
outweighs careful food selection as you can't go wrong with fasting, but you
could and eventually would by following conflicting and ever-changing dietary
guidelines.

There is much wisdom in my single short sentence!

But I start to think that the audience here is incapable of reading between
the lines, which is sad given the HN claims for superior intelligence. In
fact, the San Fran crowd is addicted to food, and based on my personal
experience here; it goes postal when you dare to say something against their
questionable eating habits!

