Effects of short-term energy restriction on liver lipid content and inflammatory status in severely obese adults: results of a randomised controlled trial (RCT) using two dietary approaches

Short-term very low energy diets (VLED) are used in clinical practice prior to bariatric surgery, however, regimens vary and outcomes for a short intervention are unclear. We examined the effect of two VLEDs; a food-based diet (FD) and meal replacement plan (MRP) (LighterLife) over two weeks in a randomised controlled trial (RCT). We collected clinical and anthropometric data, fasting blood samples, and dietary evaluation questionnaires. Surgeons took liver biopsies and made a visual assessment of the liver. We enrolled 60 participants and 54 completed (FD n=26, MRP n=28). Baseline demographic features, reported energy intake, dietary evaluation and liver histology were comparable between groups. Both diets induced significant weight loss. Perceived difficulty of surgery correlated significantly with the degree of steatosis on histology. Circulating inflammatory mediators: CRP, Fetuin-A and IL6 reduced pre to post diet. Diets achieved comparable weight loss and reduction in inflammatory biomarkers, perceived operative difficulty, and patient evaluation. NAFLD histology assessments post-diet were also not significantly different between diets. Results indicate effectiveness of short term very low energy diets and energy restriction irrespective of macronutrient composition although small sample size precluded detection of subtle differences between interventions

Effects of a 21-Day Daniel Fast with and without Krill Oil Supplementation on Blood Lipids and Lipid Peroxidation

Aims: The purposes of this investigation were 1): to replicate or improve upon the findings of the initial study of the Daniel Fast, while 2) maintaining or improving high-density lipoprotein cholesterol (HDL-C) via krill oil supplementation.Methods: 39 subjects (12 men and 27 women) completed a 21-day Daniel Fast. During the fasting period, 19 subjects were randomly assigned to consume krill oil (2 grams per day in capsules), while the other 20 subjects consumed placebo capsules. Blood samples were collected immediately prior to and following the fast and assayed for blood lipids and malondialdehyde.Results: Krill oil supplementation had no effect on blood lipids or malondialdehyde (p \u3e 0.05). Total cholesterol, HDL-C, and low-density lipoprotein cholesterol each decreased significantly from pre to post fast (p \u3c 0.05).Conclusion: Although the findings of the initial Daniel Fast study were largely replicated, krill oil supplementation does not further improve the blood lipid profile or result in a decrease in malondialdehyde.Key Words: Daniel Fast, blood lipids, cholesterol, oxidative stress, malondialdehyde

The impact of religious fasting on human health

The past two decades have seen a rise in the number of investigations examining the health-related effects of religiously motivated fasts. Islamic Ramadan is a 28 - 30 day fast in which food and drink are prohibited during the daylight hours. The majority of health-specific findings related to Ramadan fasting are mixed. The likely causes for these heterogeneous findings are the differences between studies in the following: 1) the amount of daily fasting time; 2) the percentage of subjects who smoke, take oral medications, and/or receive intravenous fluids; and 3) the subjects' typical food choices and eating habits. Greek Orthodox Christians fast for a total of 180 - 200 days each year, and their main fasting periods are the Nativity Fast (40 days prior to Christmas), Lent (48 days prior to Easter), and the Assumption (15 days in August). The fasting periods are more similar than dissimilar, and they can each be described as a variant of vegetarianism. Some of the more favorable effects of these fasts include the lowering of body mass, total cholesterol, LDL-C, and the LDL-C/HDL-C ratio. The Biblical-based Daniel Fast prohibits the consumption of animal products, refined carbohydrates, food additives, preservatives, sweeteners, flavorings, caffeine, and alcohol. It is most commonly partaken for 21 days, although fasts of 10 and 40 days have been observed. Our initial investigation of the Daniel Fast noted favorable effects on several health-related outcomes, including: blood pressure, blood lipids, insulin sensitivity, and biomarkers of oxidative stress. This review summarizes the health-specific effects of these fasts and provides suggestions for future research

A case of trastuzumab-deruxtecan-induced subacute cutaneous lupus erythematous

Drug-induced subacute cutaneous lupus erythematosus (DI-SCLE) is an erythematous, photodistributed, scaly, and annular cutaneous eruption that is clinically similar to subacute cutaneous lupus erythematosus. However, DI-SCLE is associated with medication use and generally resolves or greatly improves following discontinuation. Chemotherapeutic agents are common triggers of DI-SCLE. We report a patient with breast cancer who experienced multiple episodes of DI-SCLE associated with the use of different chemotherapeutic agents for treatment-resistant cancer. Notably, to the best of our knowledge, this case highlights the first reported association of DI-SCLE with trastuzumab deruxtecan. Additionally, this case is unique owing to a component of radiation recall dermatitis, as the rash was prominent in areas that had prior ionizing radiation. A prior history of DI-SCLE in oncology patients who continue to undergo treatment should prompt clinicians to consider DI-SCLE when faced with a new photodistributed, erythematous, annular, and scaly eruption. Early initiation of immunomodulating agents like hydroxychloroquine in patients with a history of moderate to severe DI-SCLE to chemotherapy who continue to undergo anti-cancer treatment may provide benefit and warrants further investigation

Effects of Dietary Restriction on Cancer Development and Progression

The effects of caloric restriction on tumor growth and progression are known for over a century. Indeed, fasting has been practiced for millennia, but just recently has emerged the protective role that it may exert toward cells. Fasting cycles are able to reprogram the cellular metabolism, by inducing protection against oxidative stress and prolonging cellular longevity. The reduction of calorie intake as well as short- or long-term fasting has been shown to protect against chronic and degenerative diseases, such as diabetes, cardiovascular pathologies, and cancer. In vitro and in vivo preclinical models showed that different restriction dietary regimens may be effective against cancer onset and progression, by enhancing therapy response and reducing its toxic side effects. Fasting-mediated beneficial effects seem to be due to the reduction of inflammatory response and downregulation of nutrient-related signaling pathways able to modulate cell proliferation and apoptosis. In this chapter, we will discuss the most significant studies present in literature regarding the molecular mechanisms by which dietary restriction may contribute to prevent cancer onset, reduce its progression, and positively affect the response to the treatments

A 21 day Daniel Fast improves selected biomarkers of antioxidant status and oxidative stress in men and women

<p>Abstract</p> <p>Background</p> <p>Dietary modification via both caloric and nutrient restriction is associated with multiple health benefits, some of which are related to an improvement in antioxidant status and a decrease in the production of reactive oxygen species. The Daniel Fast is based on the Biblical book of Daniel, is commonly partaken for 21 days, and involves food intake in accordance with a stringent vegan diet. The purpose of the present study was to determine the effect of a 21 day Daniel Fast on biomarkers of antioxidant status and oxidative stress.</p> <p>Methods</p> <p>43 subjects (13 men; 30 women; 35 ± 1 yrs; range: 20-62 yrs) completed a 21 day Daniel Fast following the guidelines provided by investigators. Subjects reported to the lab in a 12 hour post-absorptive state both pre fast (day 1) and post fast (day 22). At each visit, blood was collected for determination of malondialdehyde (MDA), hydrogen peroxide (H₂O₂), nitrate/nitrite (NOx), Trolox Equivalent Antioxidant Capacity (TEAC), and Oxygen Radical Absorbance Capacity (ORAC). Subjects recorded dietary intake during the 7 day period immediately prior to the fast and during the final 7 days of the fast.</p> <p>Results</p> <p>A decrease was noted in MDA (0.66 ± 0.0.03 vs. 0.56 ± 0.02 μmol L^-1; p = 0.004), while H₂O₂demonstrated a trend for lowering (4.42 ± 0.32 vs. 3.78 ± 0.21 μmol L^-1; p = 0.074). Both NOx (18.79 ± 1.92 vs. 26.97 ± 2.40 μmol L^-1; p = 0.003) and TEAC (0.47 ± 0.01 vs. 0.51 ± 0.01 mmol L^-1; p = 0.001) increased from pre to post fast, while ORAC was unchanged (5243 ± 103 vs. 5249 ± 183 μmol L^-1TE; p = 0.974). As expected, multiple differences in dietary intake were noted (p < 0.05), including a reduction in total calorie intake (2185 ± 94 vs. 1722 ± 85).</p> <p>Conclusion</p> <p>Modification of dietary intake in accordance with the Daniel Fast is associated with an improvement in selected biomarkers of antioxidant status and oxidative stress, including metabolites of nitric oxide (i.e., NOx).</p

Effect of a 21 day Daniel Fast on metabolic and cardiovascular disease risk factors in men and women

<p>Abstract</p> <p>Background</p> <p>Dietary modification via caloric restriction is associated with multiple effects related to improved metabolic and cardiovascular health. However, a mandated reduction in kilocalories is not well-tolerated by many individuals, limiting the long-term application of such a plan. The Daniel Fast is a widely utilized fast based on the Biblical book of Daniel. It involves a 21 day <it>ad libitum </it>food intake period, devoid of animal products and preservatives, and inclusive of fruits, vegetables, whole grains, legumes, nuts, and seeds. The purpose of the present study was to determine the efficacy of the Daniel Fast to improve markers of metabolic and cardiovascular disease risk.</p> <p>Methods</p> <p>43 subjects (13 men; 30 women; 35 ± 1 yrs; range: 20-62 yrs) completed a 21 day period of modified food intake in accordance with detailed guidelines provided by investigators. All subjects purchased and prepared their own food. Following initial screening, subjects were given one week to prepare for the fast, after which time they reported to the lab for their pre-intervention assessment (day 1). After the 21 day fast, subjects reported to the lab for their post-intervention assessment (day 22). For both visits, subjects reported in a 12 hr fasted state, performing no strenuous physical activity during the preceding 24-48 hrs. At each visit, mental and physical health (SF-12 form), resting heart rate and blood pressure, and anthropometric variables were measured. Blood was collected for determination of complete blood count, metabolic panel, lipid panel, insulin, HOMA-IR, and C-reactive protein (CRP). Subjects' self-reported compliance, mood, and satiety in relation to the fast were also recorded. Diet records were maintained by all subjects during the 7 day period immediately prior to the fast (usual intake) and during the final 7 days of the fast.</p> <p>Results</p> <p>Subjects' compliance to the fast was 98.7 ± 0.2% (mean ± SEM). Using a 10 point scale, subjects' mood and satiety were both 7.9 ± 0.2. The following variables were significantly (p < 0.05) lower following the fast as compared to before the fast: white blood cell count (5.68 ± 0.24 vs. 4.99 ± 0.19 10³·μL^-1), blood urea nitrogen (13.07 ± 0.58 vs. 10.14 ± 0.59 mg·dL^-1), blood urea nitrogen/creatinine (14.74 ± 0.59 vs. 11.67 ± 0.68), protein (6.95 ± 0.07 vs. 6.77 ± 0.06 g·dL^-1), total cholesterol (171.07 ± 4.57 vs. 138.69 ± 4.39 mg·dL^-1), LDL-C (98.38 ± 3.89 vs. 76.07 ± 3.53 mg·dL^-1), HDL-C (55.65 ± 2.50 vs. 47.58 ± 2.19 mg·dL^-1), SBP (114.65 ± 2.34 vs. 105.93 ± 2.12 mmHg), and DBP (72.23 ± 1.59 vs. 67.00 ± 1.43 mmHg). Insulin (4.42 ± 0.52 vs. 3.37 ± 0.35 μU·mL^-1; p = 0.10), HOMA-IR (0.97 ± 0.13 vs.0.72 ± 0.08; p = 0.10), and CRP (3.15 ± 0.91 vs. 1.60 ± 0.42 mg·L^-1; p = 0.13), were lowered to a clinically meaningful, albeit statistically insignificant extent. No significant difference was noted for any anthropometric variable (p > 0.05). As expected, multiple differences in dietary intake were noted (p < 0.05), including a reduction in total kilocalorie intake (2185 ± 94 vs. 1722 ± 85).</p> <p>Conclusion</p> <p>A 21 day period of modified dietary intake in accordance with the Daniel Fast is 1) well-tolerated by men and women and 2) improves several risk factors for metabolic and cardiovascular disease. Larger scale, randomized studies, inclusive of a longer time period and possibly a slight modification in food choice in an attempt to maintain HDL cholesterol, are needed to extend these findings.</p

Obesity-Related Oxidative Stress: the Impact of Physical Activity and Diet Manipulation

Obesity-related oxidative stress, the imbalance between pro-oxidants and antioxidants (e.g., nitric oxide), has been linked to metabolic and cardiovascular disease, including endothelial dysfunction and atherosclerosis. Reactive oxygen species (ROS) are essential for physiological functions including gene expression, cellular growth, infection defense, and modulating endothelial function. However, elevated ROS and/or diminished antioxidant capacity leading to oxidative stress can lead to dysfunction. Physical activity also results in an acute state of oxidative stress. However, it is likely that chronic physical activity provides a stimulus for favorable oxidative adaptations and enhanced physiological performance and physical health, although distinct responses between aerobic and anaerobic activities warrant further investigation. Studies support the benefits of dietary modification as well as exercise interventions in alleviating oxidative stress susceptibility. Since obese individuals tend to demonstrate elevated markers of oxidative stress, the implications for this population are significant. Therefore, in this review our aim is to discuss (i) the role of oxidative stress and inflammation as associated with obesity-related diseases, (ii) the potential concerns and benefits of exercise-mediated oxidative stress, and (iii) the advantageous role of dietary modification, including acute or chronic caloric restriction and vitamin D supplementation