Treating disease with diet – new possibilities

There were several reasons I got interested in the low-calorie liquid diet I’ve written about in today’s Daily Mail – mainly the fact that evidence is mounting that it can reverse diabetes and other conditions such as arthritic knees. But also because together with the alternate day diet I think it holds out possibility of using diets as a treatment for metabolic disease in a much more focused way than has been done before.

 However that side of my original feature didn’t make it into the Mail version  – usual reasons of space etc  – but thank heaven for blogs eh? So here are the parts of  the original that went missing.

The currently fashionable diet – at least three books out on it at the moment – is known variously as the ‘2 Day diet’ or the ‘alternate day diet’. It involves cutting back quite drastically on your calories for one or two days a week, after which you eat normally for the rest of the week. Many swear it works wonders and that it’s much easier to follow than facing weeks of tiny portions.

But in the battle of the diets it’s rather a lightweight, especially if you are seriously obese BMI – over 35 – and need to shed stones rather than pounds.  For example, if you are 5ft 7 inches and weigh 16 stone, your BMI will be 36 and you’ll need to drop a minimum of 30 pounds to gain any real health benefits. An alternate day diet is very unlikely to do that and doctors won’t have anything to offer except surgery with all its attendant risks.

 A grizzled contender

Enter the low-calorie liquid diet which is the grizzled contender of this duo – on the circuit for years with a reputation for unreliability – but now armed with new evidence of effectiveness, it’s making a dramatic Rocky-like comeback.

It arrives with the remarkable claim of being able to cure type 2 diabetes, backed by an editorial in the British Journal of General Practice last month (Feb). “If a person is prepared to lose 15 to 20 per cent of their bodyweight and keep it off,” writes GP Dr Mary Pierce, member of the Unit for Lifelong Health and Ageing in London, “there is a very good chance of their diabetes being cured.”

Both of these diets have their good points and in the future could easily be combined in a variety of ways. Together with improved techniques for stopping the weight bounce-back, they could be the start of a revolution that transforms dieting from a worthy but rather ineffectual assistant to drugs and surgery into an effective and evidence based way of either cutting your risk of chronic disease or treating it.

“I tell diabetic patients they have two choices,” says Professor Mike Lean, Chair of Human Nutrition at Glasgow University and lead researcher on a low energy diet trial published this month. “You can either stay on six or seven drugs for life that will at best cut your chances of heart disease by 10 per cent or you can do the low energy diet and get rid of it.” The cost for each patient who lost enough to reverse diabetes was just £2,500.

Drastic calorie drop

Although the low-calorie liquid diet – three months on nutritionally balanced, flavoured drinks delivering 800 calories a day –  seems a long way from almost fasting one day and eating normally the next, they can both trace their ancestry back to  CR (calorie restriction).

Way back in the 1930’s, scientists demonstrated that a drastic calorie drop, which both diets give you, brings with it all sorts of health benefits. Living longer for a start – at least if you are a lab animal. Eating about 60% of normal daily intake increases the life span of laboratory animals by 20% to 40% and they are very healthy – clear arteries, blood pressure, and low glucose and insulin levels.

The problem is that sticking to the sort of calorie restriction that makes animals live longer is really tough. That’s why the alternate day diet was invented by Professor Matt Matson of the Laboratory of Neurosciences at the National Institute on Aging in Baltimore.

Ten years ago he was wondering if it was possible to get the benefits without the pain – you feel permanently, hungry, frequently cold and with a reduced sex drive. To his surprise cutting lab rats calories only every other day was the answer.

Diet to improve asthma

Since then he and other researchers, such as Krista Varady, assistant professor of kinesiology [the science of human movement] and nutrition at University of Illinois, Chicago, have been exploring it’s health benefits.  Mattson has found that it can cut the severity of asthma, while she has shown that it lowers LDL cholesterol. Another group at the Heart Institute in Murray Utah has found that a total fast just once a month reduces the risk of diabetes and heart disease.

Alternate day dieting might also have an effect on brain disorders such as Alzheimer’s. “Fasting creates a certain amount of stress which pushes up brain activity,” explains Mattson. “And this in turn causes a big increase production of a protein that is vital for making new brain cells, learning and memory.”

Research is still at an early stage but rats bred to develop Alzheimer’s began having memory problems six months later than usual when they were put on an alternate day fasting schedule. “That’s a big effect,” says Mattson “perhaps the equivalent of 20 years in people.”

GPs not rewarded for weight loss

As yet none of these very exciting possibilities have been put through proper trials. “We still don’t know exactly who should be fasting, how often or for how many days a week,” says Dr Michelle Harvey, a dietician at Manchester University who has been studying the effect of different calorie cutting schedules on cancer.

The low energy liquid diets obviously trigger off the same healthy processes but they do it for longer and more intensively. They also now have better evidence for some of the benefits such as dramatically improving the mobility of seriously obese patients with arthritic knees.

The effect of the low-calorie diet on, say, Alzheimer’s or cancer is unknown but there’s reason to think it also could have benefits. And what about using the low-calorie drink as a way more simply and strictly controlling the off days? Lots of interesting possibilities.

But it’s a sign of just how far the medical mainstream is away from using diets in a preventative way, let alone as a clinical treatment, to handle the growing obesity and diabetes crisis, that GP’s get no official encouragement for taking effective action against obesity.

This is a campaigning issue for Dr Matthew Capehorn who heads the Rotherham Institute for Obesity and is Clinical Director of the National Obesity Forum. He points out that while GPs get bonus payments for cutting other health risks such heart disease, putting patients on a weight loss program wins them nothing.

“You might think GPs shouldn’t need encouraging,” says Capehorn “but the bonus scheme (known as QOF) concentrates their attention.” There’s now a Commons campaign to change it.