Fasting acts as a catalyst for diet in people with metabolic syndrome

One in four Germans suffers from metabolic syndrome. Several of the four diseases of wealth occur at the same time in this “deadly quartet”: obesity, high blood pressure, lipid metabolism disorders and diabetes mellitus. Each of these factors is a risk factor for serious cardiovascular disease, such as heart attacks and strokes. The treatment is aimed at helping patients lose weight and normalize their lipid and carbohydrate metabolism as well as their blood pressure. In addition to exercise, doctors prescribe a healthy, low-calorie diet. Medication is also often needed. However, the effects of nutrition on the microbiome, immune system, and health are not entirely clear.

A research group led by Dr Sofia Forslund and Professor Dominik N. Müller from the Max Delbrück Center for Molecular Medicine of the Helmholtz Association (MDC) and the Center for Experimental and Clinical Research (ECRC) have now examined the effect of ‘a change of regime. on people with metabolic syndrome. The CRCE is jointly managed by the MDC and the Charité Universitätsmedizin Berlin. “Switching to a healthy diet has a positive effect on blood pressure,” says Andras Maifeld, summarizing the results. “If the diet is preceded by a fast, this effect is intensified.” Maifeld is the first author of the article, which was recently published in the journal Nature communications.

Broccoli on roast beef

Dr Andreas Michalsen, principal consultant of the naturopathic department at the Immanuel hospital in Berlin, and Professor Gustav J. Dobos, president of naturopathy and integrative medicine at the University of Duisburg-Essen, recruited 71 volunteers with the disease. metabolic syndrome and high systolic blood pressure. The researchers divided them into two groups at random.

Both groups followed the Dietary Approach to Stop Hypertension (DASH) diet for three months, designed to fight high blood pressure. This Mediterranean style diet includes lots of fruits and vegetables, whole foods, nuts and legumes, fish, and lean white meat. One of the two groups did not consume any solid food at all for five days before starting the DASH diet.

Based on immunophenotyping, scientists observed how the volunteers’ immune cells changed when they changed their diet. “The innate immune system remains stable during fasting, while the adaptive immune system shuts down,” explains Maifeld. During this process, the number of pro-inflammatory T cells decreases, while regulatory T cells multiply.

A Mediterranean diet is good, but fasting improves it

The researchers used stool samples to examine the effects of fasting on the gut microbiome. Intestinal bacteria work in close contact with the immune system. Certain strains of bacteria metabolize dietary fiber into short-chain anti-inflammatory fatty acids which are beneficial for the immune system. The composition of the gut bacteria ecosystem changes dramatically during fasting. Bacteria that are beneficial to health and lower blood pressure are on the increase. Some of these changes persist even after resuming food intake. The following is particularly noteworthy: “Body mass index, blood pressure and the need for antihypertensive drugs remained lower over the long term in volunteers who began a healthy diet with a five-day fast,” explains Dominik. Müller. Blood pressure normally rises again when only one antihypertensive tablet is missed.

Blood pressure stays lower long term, even three months after fasting

In collaboration with scientists from the Helmholtz Center for Infection Research and McGill University, Montreal, Canada, the Forslund working group conducted a statistical evaluation of these results using artificial intelligence to ensure that this positive effect was indeed attributable to the rapidity and not to the medication that the volunteers were taking. They used methods from a previous study in which they looked at the influence of antihypertensive drugs on the microbiome. “We were able to isolate the influence of the drug and observe that whether or not a person reacts to a change in diet depends on the individual immune response and the gut microbiome,” says Forslund.

If a diet high in fiber and low in fat doesn’t work, there may not be enough gut bacteria in the gut microbiome that metabolize fiber into protective fatty acids. “Those who have this problem often feel that it is not worth the trouble and go back to their old ways,” explains the scientist. It is therefore a good idea to combine a diet with a fast. “Fasting acts as a catalyst for protective microorganisms in the gut. Health clearly improves very quickly and patients can reduce their medication or even often stop taking tablets altogether.” This could motivate them to adopt a healthy lifestyle for the long term.