Intermittent fasting (IF) is an eating pattern with extended periods of little or no food intake (eg 16hrs overnight), to periods of normal food intake (eg 8hrs during the day), on a recurring basis.
There are many different methods of IF.
Numerous religious groups have included fasting in their rituals for centuries. Interestingly, the Greek physician Hippocrates (5th century BCE) would recommend abstinence from food or drink for patients who exhibited certain symptoms of illness.
There has been growing scientific evidence of the multiple health benefits of IF for; insulin resistance, cardiovascular disease, obesity, neurological disorders and ageing. However, can IF modulate the immune system and help with specific Autoimmune disorders?
How does Intermittent Fasting help with Autoimmunity?
Research has shown that IF has significant immunomodulatory effects via the following mechanisms:
Autophagy: is a protective housekeeping mechanism that cells use to eliminate & clear cell debris such as damaged organelles, misfolded proteins and pathogens. Dysregulation of autophagy has been implicated in Autoimmune disease pathophysiology. Fasting is a very potent stimulator of autophagy.
Gut Microbiome: IF increases gut microbial diversity and can promote the expansion of Lactobacillaceae and Bifidobacteriaceae beneficial bacteria. Dysbiosis of the gut microbiota has been implicated in Autoimmune disease pathophysiology.
Anti-Inflammatory: IF promotes anti-inflammatory effects, reduces systemic inflammation and proinflammatory cytokines such as IFN-γ, IL-17 and TNF-α . More specifically, IF reduced TH1 and TH17 cells, antigen-presenting cells, monocytes and lymphocytes in the tissues and blood. IF also increased regulatory T cells and lymphocyte apoptosis thus dampening inflammation. Since Autoimmunity and inflammation co-activate, IF could be an important tool in Autoimmunity.
Intestinal barrier (leaky gut): IF reduces intestinal inflammation and increases regenerative markers of the intestinal barrier. This is significant, since intestinal permeability is often present in Autoimmunity.
Cellular stress resistance: The molecular mechanism of IF involves the triggering of adaptive cellular stress responses. This promotes cell resistance and helps strengthen the immune response.
Which Autoimmune diseases can benefit from Fasting?
The benefits of IF have been studied in Rheumatoid Arthritis, Multiple Sclerosis, Asthma, IBD, Fibromyalgia and mixed connective tissue diseases such as Lupus. There is a need for large randomised clinical trials on IF in the treatment of specific Autoimmune conditions, as the studies to date have been predominantly on animal models or smaller clinical cases. Some findings from key studies:
Irritable Bowel Disease (IBD): In a mouse model of IBD, IF effectively ameliorated the symptoms and pathogenesis of IBD through reducing the inflammation of the intestine and promoting the regeneration and repair of the damaged intestinal lining.
Multiple Sclerosis (MS): In mouse models of MS, IF was concluded to be a safe, feasible and an effective treatment to reduce Autoimmunity and promote regeneration.
Rheumatoid Arthritis (RA): In a trial of 53 RA patients fasting for a period of 7-10 days followed by a vegan diet for 3.5 months, significant improvements were reported in all clinical parameters. In a similar study, twenty RA patients fasting for 7–10 days followed by a strict vegan diet, reported significantly less pain and an improvement in symptoms.
Asthma: A study of asthma in a mouse model indicated that IF lowered the number of eosinophilic infiltrates in the lung. A further trial showed that IF improved clinical outcomes and caused a reduction of inflammation biomarkers and oxidative stress in asthma patients.
Lupus: There have been previous small case studies showing the beneficial effects of IF in Lupus. However, more recently in a mouse model, IF exacerbated lupus nephritis by increasing autoantibody immune complex formation in the kidney. This was contrary to expectations.
IF has recently been studied to see if it is an effective approach to help prevent SARS-CoV-2 infection. It was confirmed that IF can directly activate the immune response or indirectly induce autophagy to cope with the confronting stress of the virus, but more experimental evidence is still needed.
It is clear that there are benefits of IF in modulating the immune system and potentially dampening Autoimmunity, although more clinical trials in the future can confirm this. However, it is very important to be safe when implementing IF, as it may not suit everyone. This is especially important for those with underlying problems such as kidney issues, blood pressure issues or even hormone imbalances. Therefore, it maybe advisable to consult your medical practitioner or work with a professional health practitioner to see how IF can work for you together with other healthy practices.
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