Insights & Discussion
Intermittent fasting and energy-restricted diets may decrease inflammatory markers, especially in overweight and obese individuals, but have no impact on the levels of certain proteins involved in inflammation.
The research involved the systematic search of online medical databases such as Web of Sciences, PubMed, SCOPUS, and Google Scholar until June 2019. The aim was to evaluate the effects of Intermittent fasting (IF) and energy-restricted diets (ERDs) on plasma concentrations of inflammatory biomarker. The study included randomised control trials and the effect sizes were evaluated using a weighted mean difference from the random-effects model. Eighteen eligible trials were included in this meta-analysis.
The results showed a significant reduction in C-reactive protein concentrations, an inflammatory marker, with IF regimens and ERDs, and this reduction was even more profound in overweight and obese individuals. The treatment also showed better results with a longer duration of intervention of eight weeks or more. However, neither dietary model decreased the concentrations of tumor necrosis factor-α or interleukin-6, which are proteins involved in the inflammation process.
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Pomegranate juice consumption appears to somewhat enhance inflammatory status and complete blood count in hospitalized COVID-19 patients.
2023 Complementary Therapies in Medicine Adjuvant pomegranate juice intake improves the inflammatory status of hospitalized COVID-19 patients: A randomized and placebo-controlled trial Yousefi M, Sadriirani M, Mahmoodi S, Samimi B, Pourmahmoudi A, Hosseinikia M, et al.
Randomised Controlled Trial COVID-19 CRP Inflammation
The study was a randomized, double-blinded placebo-controlled trial involving 48 patients and had two parallel arms. As part of their standard hospital care, patients were either given 500 mL of whole pomegranate juice daily or a placebo for a period of 14 days. The researchers focused on measuring inflammatory indicators and complete blood counts both at the start of the study and at the end of the 14-day intervention period.
Following the 14-day intervention, there was a distinguishable decrease in primary outcomes including inflammatory markers such as C reactive protein, interleukin-6, and erythrocyte sedimentation rate in the group that consumed pomegranate juice as compared to the readings before the intervention. In addition, considerable changes were also observed in secondary outcomes such as neutrophils, lymphocytes, platelets, platelets-to-lymphocyte and neutrophils-to-lymphocyte ratios in the pomegranate juice group compared to the parameters before the intervention. Finally, the mean changes in levels of interleukin-6, white blood cells, neutrophils, lymphocyte, platelets, platelets-to-lymphocyte ratio, blood oxygen saturation and MCV were significantly different between the two groups by the end of intervention, while no significant difference was noted in other blood indices.
Intermittent fasting may potentially influence autoimmune diseases like type 1 diabetes and rheumatoid arthritis, by reducing inflammation and supporting cellular repair mechanisms.
2023 Autoimmunity Reviews Intermittent fasting: A promising dietary intervention for autoimmune diseases Barati M, Ghahremani A, Namdar Ahmadabad H
Systematic Review Autoimmune Diseases Intermittent Fasting Rheumatoid Arthritis
Extensive research was done through several electronic databases such as PubMed, Scopus, Embase, and Web of Science. Rigorous inclusion criteria were applied to filter the most relevant studies on the effects of intermittent fasting on autoimmune diseases. No reference to further research trials was mentioned in the methodology.
The results indicate a potential link between intermittent fasting and the management of certain autoimmune diseases. Autoimmune diseases like type 1 diabetes, rheumatoid arthritis, and systemic lupus erythematosus exhibited improvements owing to the reduction in inflammatory markers, improvement in gut microbiota, and enhanced cellular repair resulting from autophagy induced by intermittent fasting. However, results concerning other autoimmune diseases like multiple sclerosis, systemic lupus erythematosus, thyroid diseases, and psoriasis were inconclusive.
Rheumatoid arthritis-specific inflammation can be linked directly to the intestinal microbiota, thus, nutritional interventions against gut dysbiosis could function as a causal therapeutic approach.
2023 Journal of Clinical Medicine Intestinal Microbiota Reduction Followed by Fasting Discloses Microbial Triggering of Inflammation in Rheumatoid Arthritis Häupl T, Sörensen T, Smiljanovic B, Darcy M, Scheder-Bieschin J, Steckhan N, et al.
Clinical Study Inflammation Rheumatoid Arthritis
The study initiated by reducing the intestinal microbiome in 20 Rheumatoid Arthritis patients through bowel cleansing and a week of fasting, limiting the intake to 250 kcal/day. It also employed immune monitoring and sequencing of the microbiome. A control group constituting patients with metabolic syndrome was incorporated to serve as a non-inflammatory baseline. To understand the fluctuation and impact on disease activity, disease activity scores were calculated and cytometric profiling was performed, tracing up to 46 different surface markers. Additionally, serum levels of certain cytokines and indicators of mucosal barrier disruption were monitored.
The change in intestinal microbiota, i.e., the effect of fasting on arthritogenic bacteria and the shift in microbial composition, was analyzed using sequencing. The detection of more eukaryotic, predominantly fungal colonizers in RA patients was also observed to understand their potential involvement. Finally, the study investigated the observed increase in endogenous cortisol levels during fasting.
Dietary strategies, such as caloric restriction and ketogenic diets, can alleviate chronic pain and enhance quality of life.
2022 International Journal of Environmental Research and Public Health The Effectiveness of Intermittent Fasting, Time Restricted Feeding, Caloric Restriction, a Ketogenic Diet and the Mediterranean Diet as Part of the Treatment Plan to Improve Health and Chronic Musculoskeletal Pain: A Systematic Review Cuevas-Cervera M, Perez-Montilla J, Gonzalez-Muñoz A, Garcia-Rios M, Navarro-Ledesma S
Systematic Review Caloric Restriction Intermittent Fasting Ketogenic Diet
This systematic review selected 16 articles from various databases including PubMed, Web of Sciences, ProQuest, and Scopus that were published within the last 6 years. These consisted of randomized clinical trials (RCTs), observational studies, and systematic reviews evaluating the effectiveness of different dietary strategies in the treatment of chronic pain. A range of assessment scales—PEDro, PVI, QUALSYT and the Quality Assessment Tool of Systematic Reviews scale— were utilized to gauge the risk of bias in these studies.
The findings indicate an inconclusive consensus on the impact of an intermittent fasting (IF) diet on pain improvement. However, a caloric restriction diet emerged as a potential long-term treatment option for pain. Additionally, time-restricted food and ketogenic diets showed promising results in improving life quality in chronic conditions. Despite some studies indicating opposite results, the majority of the selected articles exhibited good methodological quality on their respective assessment scales.
Fasting followed by a plant-based diet positively impacts disease activity and cardiovascular risk factors in rheumatoid arthritis patients.
2022 Annals of the Rheumatic Diseases POS0583 RHEUMATOID ARTHRITIS BENEFITS FROM FASTING AND PLANT-BASED DIET: AN EXPLORATORY RANDOMIZED CONTROLLED TRIAL (NUTRIFAST) Hartmann AM, Kandil FI, Steckhan N, Häupl T, Kessler CS, Michalsen A, et al.
Randomised Controlled Trial Intermittent Fasting Plant-Based Diet Rheumatoid Arthritis
In the pilot study, patients with rheumatoid arthritis (RA) were split into two groups: one underwent a 7-day fast (consuming no more than 250 calories per day), followed by 11 weeks of a plant-based diet; the other was provided with conventional nutritional counseling according to the recommendations of the German Society for Nutrition for a total of 12 weeks. Disease activity and treatment responses were evaluated at the beginning of the experiment, day 7, week 6, and week 12.
The results showed improvements in disease activity in both the fasting and conventional nutritional counseling groups. Noteworthy was the fact that the fasting group started showing improvements by day 7 as opposed to week 6 in the conventional group. Additionally, cardiovascular risk factors, such as weight and total cholesterol levels, showed more marked improvement in the fasting group compared to the conventional group. These improvements were found to be independent of any antibody status, intervention delivery method, or previous eating habits.
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