Le jeûne n’est pas un remède miracle selon l'INSERM

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INSERM published in 2014 an expert report on the therapeutic efficacy and safety of fasting.

Gueguen and his colleagues published a 2014 INSERM report on the effectiveness and safety of fasting preventive and therapeutic. Current scientific evidence is available to conclude its effectiveness. Fasting the mechanisms are too vague and speculative. Studies have numerous methodological bias. Studies showing profits have low statistical power. The studies on fasting a week relate to rare adverse events, no serious and transient. By cons, serious or potentially serious adverse reactions occur during prolonged fasting and / or if they are not medically supervised.

The Study Rationale

Fasting is an ancient practice of abstaining from any food (solid and liquid), except water, for a shorter or longer period. Long, fasting would Prevention virtues of conservation and health optimization. One in two people would have tried fasting. He is represented by currents of thought and hygienist naturopath. According to WHO, naturopathy emphasizes prevention and health promotion using therapeutic methods that promote self-healing process. Naturopaths may have to advocate the practice of fasting. This would allow for detoxification and revitalization. Hygienism is defined as an art of living healthy respect for the laws of nature and the knowledge of specific foods to the human species.

In France, the practice of fasting is not proposed as part of conventional medical practice. There are associations offering fast courses supervised by physicians. These practices should not be confused with sectarian practices.

The Question

Is fasting an effective therapeutic practice and really safe?

The Protocol

A working group of INSERM has made a report to evaluate the effectiveness and safety of fasting for preventive or therapeutic purposes. The report selected 25 items: 12 comparative studies which only 7 randomized, 9 observational studies, case study 1 and 1 Cochrane meta-analysis. The journals were interested in the practice of fasting in the case of rheumatoid arthritis, various chronic diseases (chronic pain, chronic fatigue syndrome, atopic dermatitis, functional digestive disorders), high blood pressure, obesity and cancer. In addition, two studies were conducted in healthy subjects to evaluate the effects of fasting on biomarkers of cardiovascular risk and the quality of sleep.

The arms control could be a control group without treatment or another active treatment (diet, for example).

The outcomes were clinical in nature (pain, symptom intensity, weight, basic constants, drug use), biological (markers of inflammation). It could be subjective measures reported by patients.

The tested Non-Pharmacological Intervention (NPI)

There are 3 fasting phases:

– Fasting short of 1 to 3-5 days called protein phase,

– Prolonged fasting from 5 days to several weeks called ketone phase,

– The extreme fasting long studied only in animals called terminal.

Generally, naturopaths and hygienists do not advocate fasting as therapy but rather a preventive measure or to allow the agency to be able to self-heal. But other approaches have directions to both preventive and therapeutic purposes. Fasting recommended preventive regards the prevention of overweight, hyperlipidemia, hypercholesterolemia, hyperuricemia, type 2 diabetes, stress, hypertension and smoking. Fasting recommended therapeutically concerning the care of cardiovascular diseases, diseases of the back and joints, digestive tract diseases and various pathologies such as physical and mental exhaustion (burnout), depressive states, chronic fatigue , migraines and headaches.

Fasting can be total or partial, continuous or intermittent, variable duration. It can also be preceded by a preparatory phase, to be followed by a gradual recovery phase of the diet, be associated with the rest.

Main Results

The small number of studies and the methodology used in most cases do not allow to draw conclusions on the effectiveness of fasting in different indications studied. Profits are reported in the case of atopic dermatitis, chronic fatigue syndrome, high blood pressure and side effects associated with chemotherapy. Studies have numerous methodological biases (rare randomization, no multicenter, diversity of types of interventions and related technical…). Studies showing profits have low statistical power. The studies on fasting a week relate to rare adverse events, no serious and transient. By cons, serious or potentially serious adverse reactions occur during prolonged fasting and / or if they are not medically supervised. The fast of the mechanisms remain hypothetical.

What it means for Patients

Fasting is increasingly practiced by the French. Most are satisfied with its effects. This expertise of INSERM reveals that the evidence is lacking to be so positive. If effectiveness is not proven, there seems to be no short-term threat if it is medically supervised. Prolonged fasting has not studied sufficiently studied and urges caution.

What it means for Healthcare Professionals

It is urgent that the medicine based on science studies fasting as is the case with other NMI. This INM could become complementary to other therapies.

What it means for Researchers

This expertise of INSERM concluded that currently available studies on the therapeutic benefits of fasting are too few and often of poor methodological quality. Although presumptions of beneficial effects of fasting exist, it is essential to demonstrate scientifically by new and more adequate and methodologically sound studies.

What it means for Policymakers

This INSERM expert report does not recommend fasting for treating a health problem given the scientific knowledge at present. The therapeutic indications of fasting today fall under a mixture of empiricism and beliefs without serious verification, although animal and clinical observations suggest seem fair promises.

The reference

Gueguen J, Dufaure I, Barry C, Falissard B (2014). Evaluation de l’efficacité de la pratique du jeûne comme pratique à visée préventive ou thérapeutique. Paris: Editions INSERM.

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To reference this Blog en Sante © article.

Ninot G (2016). Fasting is not a miracle treatment for now. Blog en Sante, A80.

© Copyright 2016 Grégory Ninot. All rights reserved.