Scott Emerson, MD, ABIHM, FACMT

Timeless Healing

Can a longer, healthier life for everyone be achieved through repeated intermittent cycles of caloric restriction?  Can integrative healers use food as medicine to treat and reverse disease?  Can doctors use nutrition prescriptions as an adjunct to traditional medicines to prevent their side effects and increase their effectiveness in treatment of disease? According to a recent series of potentially game changing scientific papers ( Buono & Longo. 2018, Di Biase et al. 2017, O’Flanagan et al. 2017, Cheng et al. 2017,  Choi et al. 2016, Brandhorst et al. 2015,  Lee et al. 2012) , the answer to all of these questions is “probably yes”.   It has been clear for many years that continuous daily caloric restriction defined as 30 to 50 % fewer calories less than eating till “feeling full”, extends lifespan and increases healthspan – the percentage of disease free life, in animals from rodents to monkeys.  This seems to work   even when begun in middle age.   When we look at the realities of the common diseases many in the US currently suffer with, and the dramatic escalation in health care costs we are experiencing to treat these diseases; an effective, low cost, low side effect intervention like dietary manipulation seems like a no-brainer.  The problem is that for most of us, the instant gratification of enjoying abundant food is one of the things that make life worth living, and restricting calories every day by 30 to 50%, just isn’t worth the long-term benefits. But now, preliminary animal studies are showing a possible new dietary approach with great health benefits without being so restrictive on the pleasures of eating – the Fasting Mimicking Diet (FMD).

Fortunately, the FMD is not like what you see in the above photo. Please see post on “Fasting Mimicking Diet Recipes”.

This is not really a diet so much as a different pattern of eating of alternating between caloric restriction and normal eating.  First, for 80 to 85% of the time (25 days per month) you eat your normal diet. Then you cycle to a 5 day pure plant based regimen: day 1 restricted to 5 to 6 calories / pound of weight, then days 2 through 5 you drop to 4 calories / pound of weight/ day.  This is also accompanied by a change in the macronutrient composition of these calories from your regular diet to a low protein, high fat, moderate carbohydrate mix  (approx. 10 % protein, 50 % fat, 40 % carbohydrate).  Allowable drinks are water, 1 cup of black coffee a day, herbal teas, and 2 tablespoons of “Greens Powder” in water daily. No alcohol, no sugary drinks, fruit juices, or sodas.  After 5 days you resume your normal diet for the next 25 days.  Preliminary studies indicate that you begin this whole process with  three to four consecutive months of these cycles to initiate the benefits, then thereafter, two to four of these cycles a year to maintain positive health benefits.

We all evolved as gatherer / scavenger / hunters with periods of abundant food sources alternating with periods of low caloric, low protein intake.  Thus our cells learned to respond to abundant food by switching on a growth, outward expanding type of metabolism, building proteins and well differentiated copies of themselves using the abundant incoming nutrients from feasting.  But when food is scarce our cells switch to a more inward looking, repair, recycling and maintenance metabolism with many cells, instead of making more copies of their existing self, regressing back into their lineage to more youthful stem cell versions of themselves possessing the future option to become multiple different cell types.  The problem with our modern culture and abundance of food is that the brief famine periods never come.  Our cells are continually driven into, and stuck in the outward metabolic mode and out of balance. This is now thought to contribute to development of many chronic illnesses like, diabetes, cancer, and autoimmune diseases. The preliminary data shows that the cycles of the Fasting Mimicking Diet re-activate this metabolic switching between cell building  and cell  refreshing.  It has the power to make us more robust, more disease resistant, and less needy of expensive disease care interventions.

Immune System.  The FMD promotes immune system regeneration, rejuvenation, and rebalancing. It also decreases pathologic inflammation.  In autoimmune diseases where the immune system lymphocytes are attacking and killing normal cells, the FMD triggers the demise of the over reacting cells, replacing them with a new population of normally functioning lymphocytes halting the autoimmune attack.  In cancer where the lymphocytes are not doing enough to kill tumor cells, the FMD rebalances the immune system to increase its cancer killing power.

Diabetes.  In both Type 1 diabetes and late stage Type 2 diabetes a central problem is a deficiency of insulin producing cells  (beta cells) that fail to replicate and increase their numbers in the pancreas.   These cells are stunned and stuck in a dedifferentiated sleeping state. In recent Type 1 and Type2 diabetic animal studies, multiple cycles of the FMD have been found to reboot these “sleepers” into robust, insulin producing cells that on re-feeding actively replicate themselves, restoring beta cell mass and insulin secretion, normalizing glucose levels.  In addition, the insulin resistance problem seen in Type 2 diabetes is reversed.  In normal non-diabetic animals on the FMD, fresh new beta cell regeneration was documented in the pancreas in every cycle upon re-feeding back to a normal diet.

Cancer.  The FMD is being shown to exploit a weakness found in many types of cancer cells: to make them commit suicide, to make it easier for the immune system to kill them, to enhance the effectiveness and decrease the side effects of traditional chemo and radiation therapies.  Unlike normal cells, cancer cells tend to get stuck in growth mode and display less flexibility in properly responding to changing nutrient environments in the body.  During the FMD’s 5 day cycle of low calorie and low protein intake, normal cells simply switch to house cleaning and repair activities, but cancer cells respond by doubling down on trying to grow and making more and more proteins. This creates a huge energy crisis and a toxic stress that weakens them, making them easier to kill.

Some cautions.  Those diabetics on medications that lower blood sugar should consult with their personal physician about either decreasing the dose or discontinuing their medications prior to beginning the FMD as blood sugar may fall too low if this is not done beforehand.  The same goes for those taking blood pressure drugs as blood pressure may fall too low if medication is not carefully adjusted before and during the fast.  Also those who have had recent surgery or who may be immune-compromised actually benefit from some inflammation and may need to postpone starting the FMD until they have healed wounds and recovered some immune function.  In addition, those who are frail, especially those over 65 years old and frail, should not attempt the FMD unless it has been deemed safe before hand by their physician.  Anyone with cancer should coordinate fasting as a part of their cancer treatment with their oncologist or as part of a official clinical trial.  The FMD should NOT be undertaken if pregnant. If you are an athlete in training or competition or your job involves heavy physical activity, defer the use of the FMD until periods of time when the physical demands on your body are not so intense. Finally, as of June, 2020, the effects of the FMD on the immune system’s response to the novel coronavirus (SARS-CoV-2) are unknown.  No one should use the FMD unless you have an extremely low risk of exposure to this virus – completely isolated at home for at least 2 weeks with no exposure to others.

Beyond treating specific diseases, in healthy animals the FMD is being shown to have “youthing” effects:  like increasing bone density, increasing skeletal muscle regeneration, decreasing cardiovascular disease, improving cognitive function and neuro regeneration, weight loss, decreasing visceral fat, increasing lean body mass, and increasing healthspan and lifespan.  This is low cost, non-invasive, total body regenerative and preventative medicine at its best.

Although these findings are preliminary, large human clinical trials are now underway assessing the FMD’s effectiveness and safety in either primary or supportive treatment of a variety of diseases, and in improving the general health, resilience and robustness of those without disease.  In the 5^th century BC, Hippocrates, the father of medicine, wrote ” Let food be thy medicine, and medicine be thy food”.  Now 2500 years later we may be on the cusp of truly scientifically understanding what he so brilliantly knew.