diabetes II type

Life extension and
disease treatment through
periodic fasting and
caloric restriction -
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Diabetes II type treatment and prevention by fasting and caloric  restriction. Experimental and clinical evidence:

Short story about one of our guests - Sara Bert, from Finland, age 56, arrived on March 2014.  Main diagnosis: Diabetes II type, advanced stage.  

Sara arrived to Budapest on March 30th. We met her at the Budapest airport and brought her to Medical Spa Hotel, located on the beautiful green park- island “Margit”. We booked her a comfortable room with a wonderful view on the Danube. Sara came to our program with a very strong motivation: to lose 10 kg in 3 weeks and to detoxify her body. She insisted on 21 days of water fasting. Usually we do not allow water fasting for more than 4-5 days if client has no experience in fasting before. However, she told us she had experience in fasting: 2 weeks in countryside in Finland, 2 weeks juice fasting in Thailand. Her last fasting experience was 7 years ago. Therefore, we decided to try to go 2 weeks on water fasting (0 Cal. per day) and last week juice fasting (actually 200-300 Cal.a day).

On the next day of her arrival, we checked her cardiovascular system with an experienced and certified local medical doctor, as the main contraindication for fasting is arrhythmic heartbeats. Luckily, her heart was functioning normally. Meanwhile Sara had many health problems: she suffers of typical symptoms of the metabolic syndrome. She suffers arthritis, thyroid gland disease, hypotyreos type 2, fibromyalgia, atherosclerosis and hypertension. However, her most dangerous age related disease was diabetes, II type. She was diagnosed diabetes 10 years ago and since that time, her diabetes progressed sufficiently, so her family doctor advised her to start insulin injections. Her journey was her last chance to try fasting as a last remedy to defeat her diabetes progression. 

After making all necessary discussion with our medical staff, we decided to approve a preliminary plan described above. On her first day with us, her last meal was special fruit salads with carrot, apple and orange. Before going to bed she took laxative, double dosage pills to clean her gastro intestinal tract. Her blood sugar level next morning, her 2nd day was 9.5 (obvious diabetes). Normal range is between 3.5 and 6.2. So, from 2nd day she started drinking only water (0 calories per day). On the day one her blood pressure was 150/100, but gradually it lowered down in several days and becomes normal 135/80. Her blood sugar level also gradually went down and on the 7th day of fasting it to 7.0. During this first week, Sara was very active, walking in the morning in the park 5-7 km every day. She had a massage every second day. Budapest is famous for its thermal spas, which benefit to treat many health problems. Hence, she visited thermal spa pools, located in the Hotel.  The first fasting week was very successful to Sara, her general condition improved substantially. She dropped 3.5 kg and experienced only minor side effects such as headache, and sleepiness, which often occur in the beginning of fasting. Her pain reduced sufficiently. So we were glad to see how her fasting was going and decided to prolong her water fasting for a second week as planned before.

Being experienced fasting practitioners, we knew that diabetes is a very serious disease and can bring us unpleasant surprises. Something happened on her 12th day of fasting. Sara felt very irritated, had dizziness, vision problems, weakness: typical syndromes of diabetic pre coma conditions. We immediately measured her blood sugar level and it was 3.2. It is interesting, that on this crisis 12th day her blood pressure jumped to 170/110. But blood sugar level was more important for us. Usually for clients, who have no diabetes, it is normal that blood sugar drops to 3.0, even 2.0. Non-diabetic people usually tolerate well such low sugar, as at that time after long fasting period, the main fuel in the body becomes not glucose, but ketone bodies from fat. Even the brain, whose usual energy source is glucose, starts to use ketone bodies as up to 70 percent of source fuel after several days of fasting. So at that stage in the brain, only 30% of energy is from glucose. After about a week of fasting, the whole body metabolism changed dramatically, but in a good direction: the body uses fat as a main source of energy - and most important - uses as a fuel all “wrong” tissue materials, like damaged proteins, week old cells and many other old and damaged tissues. All small tumors are shrinking and use as a fuel firstly.

Patients with advanced diabetes metabolism have no such plasticity as people free from diabetes. So, we have to be very cautious as for a person with diabetes more time is needed, that means more fasting days in order metabolism starts changing in a right direction. That is why we changed our tactic for Sara. We had to go something like “one step back and two steps ahead”. So we decided to break a fast and switch Sara immediately to juice fasting, but in fact her fasting was still continuing, as she got with juices only 200-300 calories a day, and we used mostly vegetable and fruit juices with low content of glucose and sucrose. So, the next morning after she started taking juices her blood sugar was 7.6. On the 14th day it was 6.4, on the 16th day 5.5, on 18th day 4.8 and on the 21th day actually the day of her departure her blood sugar level stabilized at 5.0 that was an ideal value for healthy person. So, did Sara cure diabetes? Obviously, it was a tactical victory over diabetes, but not a strategic victory. The main battle with this disease will be homework for Sara that she will do after coming back home. From now on Sara must change her nutrition style completely according to the recommendations we gave to her. And what about her weight? In 21 days she dropped 9 kg. And blood pressure during her last week dropped again to normal values.

Conclusion. To treat or prevent serious chronic illness, like Diabetes II type, someone have to follow fasting regimes not once, but do it periodically, minimum 2 times a year, or better 3 or even 4 times per year. We name such anti-aging diet regime “Anti-Aging Cyclic Nutrition”.

Caloric restriction and intermittent fasting alter hepatic lipid droplet proteome and diacylglycerol species and prevent diabetes in NZO mice. 
Baumeier C1, Kaiser D1, Heeren J2, Scheja L2, John C2, Weise C3, Eravci M3, Lagerpusch M1, Schulze G1, Joost HG1, Schwenk RW1, Schürmann A4.
Biochim Biophys Acta. 2015 May;1851(5):566-76. doi: 10.1016/j.bbalip.2015.01.013. Epub 2015 Jan 31

Caloric restriction and intermittent fasting are known to improve glucose homeostasis and insulin resistance in several species including humans. The aim of this study was to unravel potential mechanisms by which these interventions improve insulin sensitivity and protect from type 2 diabetes. Diabetes-susceptible New Zealand Obese mice were either 10% calorie restricted (CR) or fasted every other day (IF), and compared to ad libitum (AL) fed control mice. AL mice showed a diabetes prevalence of 43%, whereas mice under CR and IF were completely protected against hyperglycemia. Proteomic analysis of hepatic lipid droplets revealed significantly higher levels of PSMD9 (co-activator Bridge-1), MIF (macrophage migration inhibitor factor), TCEB2 (transcription elongation factor B (SIII), polypeptide 2), ACY1 (aminoacylase 1) and FABP5 (fatty acid binding protein 5), and a marked reduction of GSTA3 (glutathione S-transferase alpha 3) in samples of CR and IF mice. In addition, accumulation of diacylglycerols (DAGs) was significantly reduced in livers of IF mice (P=0.045) while CR mice showed a similar tendency (P=0.062). In particular, 9 DAG species were significantly reduced in response to IF, of which DAG-40:4 and DAG-40:7 also showed significant effects after CR. This was associated with a decreased PKCε activation and might explain the improved insulin sensitivity. In conclusion, our data indicate that protection against diabetes upon caloric restriction and intermittent fasting associates with a modulation of lipid droplet protein composition and reduction of intracellular DAG species.

Very-low-calorie diet: a quick therapeutic tool to improve ß cell function in morbidly obese patients with type 2 diabetes.

Malandrucco I, Pasqualetti P, Giordani I, ManfeAm
J Clin Nutr. 2012 Mar;95(3):609-13. Epub 2012 Feb 8.llotto D, De Marco F, Alegiani F, Sidoti AM, Picconi F, Di Flaviani A, Frajese G, Bonadonna RC, Frontoni S.
SourceDepartment of Medicine, University of Rome Tor Vergata, Rome, Italy.

BACKGROUND: Caloric restriction in obese diabetic patients quickly improves glucose control, independently from weight loss. However, the early effects of a very-low-calorie diet (VLCD) on insulin sensitivity and insulin secretion in morbidly obese patients with type 2 diabetes are still unclear. OBJECTIVE: The objective was to study the relative contributions of insulin sensitivity, insulin secretion, or both to improvement in glucose metabolism, after 1 wk of caloric restriction, in severely obese diabetic patients. DESIGN: Hyperglycemic clamps were performed in 14 severely obese (BMI, in kg/m(2): >40) patients with type 2 diabetes in good glucose control (glycated hemoglobin < 7.5%) before and after 7 d of a VLCD (400 kcal/d).RESULTS: The VLCD caused a 3.22 ± 0.56% weight loss (P < 0.001), 42.0% of which was fat loss, accompanied by decreases in fasting plasma glucose (P < 0.05) and triglycerides (P < 0.01). In parallel, the Disposition Index, which measures the body's capability to dispose of a glucose load, increased from 59.0 ± 6.3 to 75.5 ± 6.3 mL· min(-1) · m(-2) body surface area (P < 0.01), because of improvements in indexes of both first- and second-phase insulin secretion (P < 0.02), but with no changes in insulin sensitivity (P = 0.33).CONCLUSION: The marked improvement in metabolic profile, observed in severely obese patients with type 2 diabetes after a 7-d VLCD, was primarily due to the amelioration of ß cell function, whereas no contribution of insulin sensitivity was shown.

Quality of life in type 2 diabetes mellitus after a very low calorie diet and exercise.
Eur J Intern Med. 2012 Mar;23(2):143-9. Epub 2011 Aug 17.
Snel M, Sleddering MA, Vd Peijl ID, Romijn JA, Pijl H, Edo Meinders A, Jazet IM.
SourceDepartment of Endocrinology and Metabolism/General Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
OBJECTIVE: To evaluate whether the addition of exercise to a very low calorie diet (VLCD) has beneficial short- and long-term effects on health-related quality of life (QoL) in obese patients with type 2 diabetes mellitus (T2DM).
METHODS: We included 27 obese, insulin-dependent T2DM patients in a 16-week VLCD study, of whom 13 participated simultaneously in an exercise program (VLCD+E). Before, immediately after and 18months after the intervention anthropometric measurements, glucoregulation and QoL (SF-36, HADS, NHP and MFI-20) were assessed. Patients were compared to healthy lean and obese (matched for body mass index) controls matched for gender and age.
RESULTS: At baseline, T2DM patients had significantly worse QoL scores in 18 and 14 of the 22 subscales of the QoL questionnaires, compared to lean and obese controls, resp. The 16-week VLCD (n=27) decreased bodyweight (-25.4±1.3kg, p<0.0001, p=0.179 between groups), and improved glucoregulation (HbA1c -1.3±0.3%, p<0.0001, p=0.488 between groups) and 9 (VLCD-only) and 11 (VLCD+E) of the 22 subscales of QoL. After 18months, in the VLCD+E group the QoL subscales did not differ from those in obese controls and only 4 of the 22 subscales were significantly worse compared to lean controls. However, in the VLCD-only group 17 and 13 of the 22 QoL subscales were significantly worse compared to the lean and obese controls, resp.
CONCLUSION: A 16-week VLCD induces considerable weight loss, metabolic amelioration, and major improvements in QoL in obese T2DM patients. The addition of exercise is of paramount importance for the maintenance of better QoL.

Intermittent fasting modulation of the diabetic syndrome in streptozotocin-injected rats.
Int J Endocrinol. 2012;2012:962012. Epub 2012 Jan 12.
Belkacemi L, Selselet-Attou G, Hupkens E, Nguidjoe E, Louchami K, Sener A, Malaisse WJ.
SourceLaboratoire de Technologie Alimentaire et Nutrition, Université de Mostaganem, 1070 Mostaganem, Algeria.
This study investigates the effects of intermittent overnight fasting in streptozotocin-induced diabetic rats (STZ rats). Over 30 days, groups of 5-6 control or STZ rats were allowed free food access, starved overnight, or exposed to a restricted food supply comparable to that ingested by the intermittently fasting animals. Intermittent fasting improved glucose tolerance, increased plasma insulin, and lowered Homeostatis Model Assessment index. Caloric restriction failed to cause such beneficial effects. The ß-cell mass, as well as individual ß-cell and islet area, was higher in intermittently fasting than in nonfasting STZ rats, whilst the percentage of apoptotic ß-cells appeared lower in the former than latter STZ rats. In the calorie-restricted STZ rats, comparable findings were restricted to individual islet area and percentage of apoptotic cells. Hence, it is proposed that intermittent fasting could represent a possible approach to prevent or minimize disturbances of glucose homeostasis in human subjects.

Intermittent fasting modulation of the diabetic syndrome in sand rats. II. In vivo investigations.
Int J Mol Med. 2010 Nov;26(5):759-65.
Belkacemi L, Selselet-Attou G, Louchami K, Sener A, Malaisse WJ.

Very-low-calorie-diets: is there a place for them in the management of the obese diabetic?
Diabetes Metab 2000 Jun;26 Suppl 3:46-51
Monnier L; Colette C; Percheron C; Boniface H.
Service des Maladies Metaboliques, Hopital Lapeyronie, Montpellier.
It is well-recognized that standard caloric restrictions (1500 kcal/day) are usually poorly effective in achieving weight losses in overweight type 2 diabetic patients. For that reason very-low-calorie-diets (VLCDs) were developed as a mean for initiating or accelerating weight reduction. Short-term  studies indicate that VLCDs result generally in weight losses that are three times greater than those obtained with standard low-calorie-diets. Fasting  blood glucose values are improving in parallel to weight losses and in many patients the improvement in glycemic control is better than that expected from the magnitude of weight losses. However the results are rather disappointing after several months or years of follow-up. For example it has been demonstrated that weight regain can be observed as soon as the patient is shifted to a refeeding or maintenance dietary program at the end of the VLCD period. Long-term results on glycemic control and body weight reduction are generally similar with standard low-calorie-diets and with VLCDs, the final results depending on the magnitude of weight loss whatever the prescribed diet. At short-term the VLCDs can be helpful first for initiating weight losses  and second for sensitizing the patient to the potential benefits of complying to dietary measures.

Aggressive weight reduction treatment in the management of type 2 diabetes.
Diabetes Metab 1998 Apr;24(2):116-23
Scheen AJ. Department of Medicine,
CHU Sart Tilman, Belgium.
Most patients with Type 2 diabetes are significantly overweight, and diet-induced weight loss can provide marked improvement in their glycaemic control. As conventional therapy combining diet and exercise usually has a poor long-term success rate, more aggressive weight reduction programmes have been proposed for the treatment of severely obese diabetic patients, including very-low-calorie diets, anti-obesity drugs and bariatric surgery. Very-low-calorie diets usually have a remarkable short-term effect, and energy restriction and weight reduction are positive factors for the glycaemic control of obese diabetic subjects. However, the long-term efficacy of these methods remains doubtful since weight regain is a common phenomenon. Although anti-obesity (anorectic) drugs may help patients to follow a restricted diet and lose weight, their overall efficacy on body weight and glycaemia is generally modest,  and their long-term safety still questionable. Interestingly, serotoninergic anorectic agents have been shown to improve both the insulin sensitivity and glycaemic control of obese diabetic patients independently of weight loss. Bariatric surgery may be helpful in well-selected patients. The correction  of weight excess after successful gastroplasty fully reverses the abnormalities of insulin secretion, clearance and action on glucose metabolism present  in markedly obese non-diabetic patients, and allows interruption or reduction of insulin therapy and antidiabetic oral agents in most obese diabetic patients. In conclusion, weight loss is a major goal in treating obese patients with Type 2 diabetes, and aggressive weight reduction programmes may be used in selected patients refractory to conventional diet and drug treatment. However, long-term prospective studies are needed for more precise determination of the role of such a strategy in the overall management of obese diabetic patients.

Improved metabolic control after supplemented fasting in overweight type II diabetic patients.
Acta Med Scand. 1984;216(1):67-74.
Vessby B, Boberg M, Karlstrom B, Lithell H, Werner I.
Twenty obese type II diabetes patients were treated in a metabolic ward during 4 weeks with a very low calorie regimen (200 kcal/day). They were given dietary advice and reexamined 3 months after discharge. Mean body weight decreased by 10 kg during fasting, blood glucose was normalized, urinary glucose  disappeared and the K-value at i.v. glucose tolerance test increased. Fasting serum insulin concentrations decreased by 54%. Serum triglycerides (TG) decreased by 65%, serum cholesterol (Chol) by 28% and high density lipoprotein (HDL) Chol by 14%. Three months later, only serum TG remained significantly  decreased (-47%) while HDL Chol was significantly higher than on admission (+11%). Fasting blood glucose remained significantly lower (-25%) with a low urinary glucose excretion. Supplemented fasting appears to be a safe and useful tool in the treatment of obese type II diabetics. It causes, at least during a limited follow-up period, a significant improvement in glucose control and lipoprotein metabolism in spite of a concomitant reduction of the antidiabetic medication.

Very low calorie diet (VLCD): a useful alternative in the treatment of the obese NIDDM patient.
Capstick F, Brooks BA, Burns CM, Zilkens RR, Steinbeck KS, Yue DK., Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Diabetes Res Clin Pract. 1997 May;36(2):105-11,
Conventional treatment of obese noninsulin dependent diabetes mellitus (NIDDM) patients is often unsatisfactory. In this study the efficacy of Modifast,  a commercial very low calorie diet (VLCD), was evaluated in a population of obese poorly controlled NIDDM patients. The mechanisms of action of VLCD in these patients were also studied by comparing: (i) Plasma insulin and glucose profiles after a VLCD and an isocaloric mixed meal and (ii) plasma amino  acid levels, both at baseline and after four weeks of VLCD treatment. A total of 14 obese NIDDM patients (M/F 7/7. median body mass index (BMI) 38.7 kg-2,  interquartile range (IQ) 34.7-46.5 kg-2, waist circumference 116 cm, IQ 106-139 cm, insulin treated 7/14) with poor diabetic control (HbA1c 8.6%, IQ 7.8-10%) were studied. Patients were given a VLCD (425 kcal/day) for 12 weeks. At baseline, VLCD and isocaloric meal tests were performed on consecutive mornings. Fasting plasma amino acid levels were also determined at baseline and after 4 weeks of VLCD treatment. Weight, waist circumference, HbA1c, blood pressure, fasting plasma insulin, total cholesterol and triglyceride levels all fell significantly following VLCD treatment. Insulin therapy was able to be  ceased in the seven insulin treated patients. Oral hypoglycaemic agent dosage fell from a median of eight (IQ 6-12) to two (IQ 0-8) tablets per day (P = 0.03) in patients initially on this form of therapy. Insulin secretion was higher after VLCD than isocaloric meal (P = 0.04). Fasting plasma alanine  level fell from 512.0 (IQ 412.0-563.0) to 374.0 (IQ 342-472.0) mumol/l (P = 0.04) following VLCD treatment. In conclusion, the short term use of a VLCD is very effective in rapidly improving glycaemic control and promoting substantial weight loss in obese NIDDM patients. Moreover, a VLCD diet increases insulin secretion and reduces substrate for gluconeogenesis. Thus, VLCD treatment may improve glycaemic control by factors more than caloric restriction alone.

Metabolic and cardiovascular effects of very-low-calorie diet therapy in obese patients with Type 2 diabetes in secondary failure: outcomes after 1 year.
Diabet Med. 2003 Apr;20(4):319-24
Dhindsa P, Scott AR, Donnelly R.
School of Medical & Surgical Sciences, University of Nottingham, and Jenny O'Neil Diabetes Centre, Southern Derbyshire Acute Hospitals, NHS Trust, Derby,
UK. AIMS: To evaluate the short-term and 1-year outcomes of an intensive very-low-calorie diet (VLCD) on metabolic and cardiovascular variables in obese patients with Type 2 diabetes (T2DM) and symptomatic hyperglycaemia despite combination oral anti-diabetic therapy +/- insulin, and to assess patient acceptability and the feasibility of administering VLCD treatment to this subgroup of patients in a routine practice setting.
METHODS: Forty obese patients with T2DM (22 M, mean age 52 years, body mass index (BMI) 40 kg/m2, duration of T2DM 6.1 years) and symptomatic hyperglycaemia despite combination oral therapy (n = 26) or insulin + metformin (n = 14) received 8 weeks of VLCD therapy (750 kcal/day) followed by standard diet and exercise advice at 2-3-month intervals up to 1 year. Insulin was discontinued at the start of the VLCD, and anti-diabetic therapy was adjusted individually throughout the study, including (re)commencement of insulin as required.
RESULTS: Immediate improvements in symptoms and early weight loss reinforced good compliance and patient satisfaction. After 8 weeks of VLCD, body weight and BMI had fallen significantly: 119 +/- 19-107 +/- 18 kg and 40.6-36.6 kg/m2, respectively, with favourable reductions in serum total cholesterol (5.9-4.9 mm), blood pressure (10/6 mmHg) and fructosamine (386 +/- 73-346 +/- 49 microm) (equates to an HbA1c reduction of approximately 1%). Sustained improvements were evident after 1 year, with minimal weight regain, e.g. mean body weight 109 +/- 18 kg and BMI 37 +/- 4 kg/m2. Glycaemic control tended to deteriorate after 1 year.
CONCLUSIONS: The absence of a control group is a major limitation, but the results indicate that 8 weeks of VLCD treatment may be effective and well tolerated in symptomatic obese patients with T2DM in secondary failure, producing sustained cardiovascular and metabolic improvements after 1 year. VLCD therapy is a treatment option that deserves greater consideration in this difficult-to-treat patient population.

Intermittent feeding and fasting reduces diabetes incidence in BB rats.
Autoimmunity 1999;30(4):243-50
Pedersen CR; Hagemann I; Bock T; Buschard K.
Bartholin Instituttet, Kommunehospitalet, Copenhagen, Denmark.
Food intake may be one of several factors which influence the risk of development of insulin
dependent diabetes mellitus, but the influence of the pattern of food supply has not been studied previously. The aim of the present study was to investigate the effect of intermittent feeding and fasting upon diabetes in BB rats. This study included three groups. Group 1 served as control and included 77 animals, 79% became diabetic. In groups 2 and 3, after weaning, food but not water was withdrawn from the animals: 24 h twice a week in group 2; 24 h every second day in group 3. Group 2 included 40 BB rats, 50% (p < 0.004) became diabetic. Group 3 included 44 BB rats, 52% (p < 0.01) became diabetic. No differences were seen between sexes. Degree of insulitis was not influenced by changed food supply. Regarding blood glucose, no influence was seen among diabetic animals, among non-diabetic animals changed food supply reduced blood glucose values obtained at the end of the study. Intermittent feeding and fasting tended to reduce mean age at the time of iagnosis of diabetes, significance was reached  only in female animals from group 3 compared to group 1. Body weight was obtained weekly. Intermittent feeding and fasting caused a reduced weight gain in  group 2 as well as in group 3 compared to control animals; however, most pronounced in group 3 and also more pronounced among males compared to females. For pre-diabetic and non-diabetic animals comparable influence on body weight was seen. The main conclusion in the study is that intermittent feeding and fasting reduced diabetes incidence.

The effects of three-week fasting diet on blood pressure, lipid profile and glucoregulation in extremely obese patients.
Srp Arh Celok Lek. 2007 Jul-Aug;135(7-8):440-6
[Article in Serbian]
Beleslin B, Cirić J, Zarković M, Vujović S, Trbojević B, Drezgić M.
INTRODUCTION: Obesity is often accompanied by a number of complications including diabetes mellitus and cardiovascular diseases. Elevated blood pressure and lipids, as well as deterioration of glucoregulation are attributed, as the most significant factors, to development of diabetes mellitus and cardiovascular complications in obese patients. OBJECTIVE: The aim of our study was to evaluate the effects of a fasting diet on blood pressure, lipid profile and glucoregulatory parameters.
METHOD: We included 110 patients (33 male and 77 female; mean age 35 +/- 1 years, body weight 131.7 +/- 2.6 kg, body mass index 45.4 +/- 0.8 kg/m2) who were hospitalized for three weeks for the treatment of extreme obesity with the fasting diet. At the beginning, during, and at the end of this period, we evaluated changes in blood pressure, lipid profile, as well as parameters of glucoregulation including glycaemia,  insulinaemia, and insulin sensitivity by HOMA. Oral glucose tolerance test (OGTT) was performed in all patients at the beginning and at the end of the  fasting diet. RESULTS: During the fasting diet, the body weight decreased from 131.7 +/- 2.6 kg to 117.7 +/- 2.4 kg (p < 0.001), the body mass index decreased from 45.4 +/- 0.8 kg/m2 to 40.8 +/- 0.8 kg/m2 (p < 0.001), and both systolic and diastolic blood pressure significantly declined (143 +/- 2 vs.  132 +/- 2 mm Hg, p < 0.001; 92 +/- 2 vs. 85 +/- 2 mm Hg, p < 0.001). In addition, the fasting diet produced a significant decrease in total cholesterol,  LDL cholesterol, triglycerides, as well as basal glycaemia and insulinaemia (p < 0.001) Before the fasting diet, OGTT was normal in 76% of patients, whereas 21% of patients showed glucose intolerance, and 4% of patients diabetes mellitus. After the fasting diet, OGTT was normal in 88% of patients, whereas 12% of patients still had signs of glucose intolerance (p < 0.05). In addition, insulin resistance significantly (p < 0.05) increased from 4 +/- 6% to 89 +/- 13% after the fasting diet.
CONCLUSION: The three-week fasting diet in extremely obese patients produced a significant decrease and normalization of blood pressure, decrease in lipids, and improvement in glucoregulation including the increase in insulin sensitivity.


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