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Periodic fasting has long been demonstrated to have beneficial effects on autoimmune disorders, cancer prevention and treatments, cardiovascular disease, and a myriad of other ailments. This most recent paper by Cheng et al. might add the treatment of Type 1 diabetes to that list[1]. If successful in humans, it has the potential to reverse some or most of the loss of insulin-producing cells within the pancreas. Just as remarkable, the treatment itself is relatively straightforward, consisting of a regimented protocol of periodic fasting-like conditions.

Generally speaking, Type 1 diabetes results from an autoimmune mediated depletion of insulin-secreting pancreatic beta islet cells. In contrast, Type 2 results from lower cellular sensitivity to insulin. Type 2 is primarily caused by environmental factors such as poor diet.

The current medical approach to treating Type 1 diabetes is the periodic administration of insulin, usually through self-administered injections. Most new therapies focused on curing Type 1 diabetes are looking to repopulating beta islet cells through the use of reprogrammed induced pluripotent stem (iPS) cells.

However, these approaches are not as simple as the method demonstrated by Cheng et al in this recent study. The treatment consists of a “fasting mimicking diet” (FMD), which for mice corresponds to 3-4 day cycles of a high-fat and low-calorie diet, maintained for at least a month, followed by refeeding. This was performed on transgenic diabetic mice and also normal mice that had their beta cells depleted through the administration of high doses of a toxic drug.

Results were also repeated using human diabetic primary beta cells in culture. In this case, the treatment consisted of the addition of human serum from individuals undergoing FMD. The results were impressive, with all sets of experimental models exhibiting almost normal responses to glucose and insulin tolerance tests. Perhaps even more unexpectedly, the regrowth of pancreatic islets, following FMD and re-feeding, led to higher ratio of cells differentiating into beta cells, as opposed to other types.

Furthermore, normal diet combined with the addition of the drugs rapamycin and H89, which inhibit mTor and PKA respectively, led to similar results, suggesting that these signalling pathways are required for beta islet cell differentiation.

Conclusion

Can it be so simple that Type 1 diabetes in humans can be reversed by adhering to a similar diet, perhaps in combination with rapamycin and a PKA inhibitor?

Our optimism should be tempered with the fact that earlier studies have also had high hopes. The discovery of a new hormone in 2015, dubbed betatrophin, also appeared to promote beta-islet cell expansion. Unfortunately, this work was later found to be statistically invalid and thus retracted[2]. Clearly, reproducibility is key for all trials.

Right now the study authors have stated that a pilot clinical trial has demonstrated the feasibility of this approach, and more expanded and randomized trials are set to begin. We look forward to the results!

 

Literature

[1] Chia-Wei Cheng, Valentina Villani, Roberta Buono, Min Wei, Sanjeeve Kumar, Omer H. Yilmaz, Pinchas Cohen, Julie B. Sneddon, Laura Perin, Valter D. Longo. “Fasting-mimicking diet promotes Ngn3-driven β-cell regeneration to reverse diabetes”Cell. 2017 Feb 23; 168(5): 775–788.e12. doi: 10.1016/j.cell.2017.01.040

[2] Yi, Peng, Ji-Sun Park, and Douglas A. Melton. “Retraction Notice to: Betatrophin: A Hormone That Controls Pancreatic Β Cell Proliferation.” Cell 168.1-2 (2017): 326. PMC. Web. 30 Mar. 2017.

About the author

Oliver Medvedik

Oliver Medvedik, Co-founder of Genspace citizen science laboratory in Brooklyn NY, earned his Ph.D. at Harvard Medical School in the Biomedical and Biological Sciences program. As part of his doctoral work he has used single-celled budding yeast as a model system to map the genetic pathways that underlie the processes of aging in more complex organisms, such as humans. Prior to arriving in Boston for his doctoral studies, he has lived most of his life in New York City. He obtained his bachelor’s degree in biology from Hunter College, City University of New York. Since graduating from Harvard, he has worked as a biotechnology consultant, taught molecular biology to numerous undergraduates at Harvard University and mentored two of Harvard’s teams for the international genetically engineered machines competition (IGEM) held annually at M.I.T.
  1. December 3, 2017

    Incredible. If it turns out we really are able to reverse type 1 diabetes, then who knows what other chronic ailments we might eventually be able to cure? Type 1 diabetes would’ve been one of the last things I would think we’d find a cure for.

    • mm
      December 3, 2017

      My money is on the recent approach where they modified other cells in the pancreas to produce insulin in the presence of glucose but the immune system does not attack them.

      https://www.leafscience.org/diabetes/

  2. December 13, 2017

    Does anybody know when/where clinical trials are taking place?

  3. March 7, 2018

    I’m already a fasting -Christian. I’ll put my hand up for the trial. I’m on the pump too. I’m on day 7 right now of my fast

  4. April 30, 2018

    I am a type 1 diabetic who started fasting. I completed the GAPS diet for 2 years to restore gut health and microbial diversity in the gut while also following a paleo autoimmune protocol. It lowered my insulin needs significantly, but not fully. I then started fasting and remarkably am able to go anywhere from 1-5 weeks entirely insulin-free, not even needing insulin for meals. I habe done 8 fasting cycles, lasting as long as 3 full days with nothing but water, and it has remarkably worked every single time. People dont believe me when I tell them i’m able to go insulin-free – not even any basal! And I had my c-peptide checked after my last fast while insulin-free and it was completely normal. I didn’t even look diabetic anymore (if only we could get rid of all autoantibodies, because the effects are unfortunately temporary! But even one day as a “normal” person is SUCH a gift and so incredibly freeing).

    • mm
      April 30, 2018

      Interesting, hopefully, science will soon have the solution to T1 and T2. It runs in my family and is something I am hoping to see arrive soon. I have great hope that creating insulin-secreting cells from other non b cells in the pancreas may solve this once and for all.

  5. June 9, 2018

    Hi Melanie!

    That’s pretty remarkable! My wife is a Type 1 for about 20 years now and keeps pretty good control. I was researching fasting for Type 1 to improve her control but didn’t think there could be results like yours! Wonderful.

    How long have you been Type 1? And how much insulin were you taking daily before you started the fasting regiment? I know she would ask me after telling her. Thank you!

    Gary

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