Does a 3-day fast reset your immune system?

I’ve been hearing new reports lately that sound an awful lot like pseudoscience: that fasting for an extended time, two days or longer, can reset your immune system and provide other health benefits. I first heard about this when a friend and colleague at Stanford University announced he was going on a 3-day fast. To explain, he pointed to a recent study, which I’ve now read.

Diet advice, including fasting-based diets, can be found all over the Internet, and much of it is nonsense, so I was very skeptical about these latest claims.

This time, though, there might be something to it. The scientific study that my colleague told me about was published back in June by USC’s Valter Longo, who studies aging and longevity. In this paper, Longo and colleagues described remarkable metabolic changes that occurred as a result of prolonged fasting. They found that fasting for 3 days or longer–drinking only water and eating less than 200 calories per day–can truly “reset” some components of your immune system. 

The research looked at both mice and humans. (It’s far easier to run the experiments in mice, of course, but we can’t always trust that the same effects will occur in humans.) In both species, fasting lowered white blood cell counts, which in turn triggered the immune system to start producing new white blood cells. White blood cells (or lymphocytes) are a key component of your body’s immune system.

Longo’s hypothesis is that fasting (or starvation) forces your body to “recycle a lot of the immune cells that are not needed” which explains the drop in the white blood cell count. Two of the key mechanisms are an enzyme called PKA and a hormone called IGF-1, both of which are reduced by fasting. Once you start eating again, your stem cells kick back into high gear to replenish the cells that were recycled.

The human part of the study was much more limited: a group of cancer patients fasted for 1, 2, or 3 days prior to chemotherapy. The idea is that fasting might reduce the harmful side effects of chemotherapy, particularly the immunosuppression caused by some chemotherapeutic drugs. These results are very preliminary: the patients are participating in a phase I clinical trial, which is designed to assess safety, not effectiveness. Nonetheless, the results indicate that a 3-day fast (but not a 1-day fast) was beneficial for these patients.

A key finding in this research is that you have to fast for several days to get any benefit: basically, you have to fully deplete your energy reserves (in the form of glycogen), and it takes your body at least 24 hours, and probably 48 hours or more, to do this. This is much harder than a 1-day fast, which many people do routinely. 

On the other hand, Valter Longo has compared the effects of periodic fasting to long-term caloric restriction, which has been shown to prolong lifespan in mouse and other animals. In a separate review article, Longo wrote: 
“Fasting has the potential to delay aging and help prevent and treat diseases while minimizing the side effects caused by chronic dietary interventions.”
Caloric restriction is extremely difficult to achieve for humans: you have to nearly starve yourself for years. Compared to this, an occasional 3-day fast should be a snap.

Caveats: fasting can be harmful, especially for people who have other health problems. If you’re seriously thinking of trying this, you should consult your doctor first. And this preliminary evidence, though encouraging, is primarily based on mice, not people. We might eventually learn that the benefits of fasting are outweighed by other problems. Fasting for more than two days isn’t easy, either: you’re going to get really hungry. 

Does a 3-day fast truly reset your immune system? Well, maybe not a total reset, but at least a mild refresh. The science suggests that, if you can do it, a prolonged fast for 2-3 days or longer may induce your body to clean out some old immune cells and switch on production of new ones. Stay tuned.

[An interesting aside: this study was lengthy and complex, and the authors apparently went to great lengths to satisfy the peer reviewers: the paper was submitted in October 2012, re-submitted after revision in December 2013, and finally accepted in April 2014. 18 months is a very long time.]

New York governor must decide today about law that protects doctors offering bogus treatments for Chronic Lyme Disease

Lyme disease is carried by tiny ticks; lower right above.
On Monday, the day this article appears, New York will get a new law that protects doctors who offer illegitimate therapies for a non-existent disease—unless Governor Andrew Cuomo vetoes it. The law is written to protect doctors who offer expensive treatments that provide no benefit, and it is being supported by advocacy groups who are thoroughly convinced that these treatments work.

What is this about? Lyme disease. A cadre of doctors has emerged in recent years who specialize in treating something they call Chronic Lyme Disease. They call themselves “Lyme literate,” and some of them have built their entire practices around CLD. Unfortunately for them, and sadly for their patients, this disease does not exist. 

First, I should be clear that Lyme disease is a real illness. It’s caused by a bacterium known as Borrelia burgdorferi, a small spirochete carried by ticks. (Aside: I was part of the scientific team that first sequenced this bacterium.) In most cases, Lyme disease responds well to a short treatment with antibiotics, and patients are fully cured. (See this excellent short video from Dr. Paul Auwaerter of Johns Hopkins School of Medicine.) Lyme disease ticks are really tiny, about the size of a poppy seed, and many people get bitten without realizing it. The ticks are carried by deer, and the disease has become more common as deer populations have exploded in suburban areas of the northeastern U.S.

Claims about "chronic" Lyme aren't new. As reported by Patricia Callahan and Trine Tsouderos in the Chicago Tribune back in 2010, 
“doctors around the country are telling patients with common medical problems such as back pain, poor concentration and fatigue that their ailments stem from a chronic form of Lyme disease that can evade standard treatment and wreak havoc for years. To fight what they believe is a persistent infection, the doctors often order months or years of intravenous antibiotics, which can cost tens of thousands of dollars.”
Long-term antibiotic usage doesn’t help, as multiple studies have shown (for example, Klempner et al. here and here). Even worse, it can create drug-resistant bacteria and other very serious, even fatal, complications.

But let’s not get distracted. The NY law is emphatically not providing support for Lyme disease patients, or funding new research into Lyme disease treatments. This law has one purpose: to protect doctors who want to use unproven, possibly dangerous therapies on unsuspecting or confused patients. Callahan and Tsouderos documented multiple cases where doctors told patients with other diseases—such as Lou Gehrig’s disease—that they had Lyme, and then treated them with expensive, unapproved drugs.

The New York legislature, apparently convinced by advocacy groups that chronic Lyme disease is real, passed a law whose sole purpose is to protect ill-informed doctors who want to use unproven (often expensive) therapies on sick patients. These groups are lobbying like crazy to convince Governor Cuomo to sign the law, claiming that it will protect Lyme patients. If anything, it will do the opposite. The law itself
“prohibits the investigation of any claim of medical professional misconduct based solely on treatment that is not universally accepted by the medical profession… including, but not limited to, the treatment of Lyme disease.”
So there it is: no funding for Lyme disease research or treatment. And the language is so broad that it protects almost any treatment, no matter how crazy—all the practitioner has to do is point out that the treatment is “not universally accepted.” An accurate name for this law might be the "freedom to experiment on unsuspecting patients act.”

Let's hope Cuomo rejects this law today. Otherwise, New York may become a haven for illicit, unscientific, and possibly harmful medical practices.

U.S. Education Department helps bail out for-profit college that lured students into bad loans

Talk about trying to fly under the radar: announcing a deal during Thanksgiving week is a sure sign that someone—in this case the U.S. Department of Education—doesn’t want you to notice.

In the deal announced on November 20, a student debt collection company, ECMC Group, will buy 56 college campuses from Corinthian Colleges Inc., a for-profit university. Corinthian runs these campuses in 17 states under the names Everest College, Everest Institute, and Wyotech.

Corinthian, until recently a high-flying for-profit university, has flourished thanks to federal largesse: its students received Pell grants totalling over $400 million in 2012-2013, and it receives about $1.4 billion a year in federal aid.

All of this money supports a for-profit university (one of the Yugos of higher education) whose students have egregiously high rates of loan defaults and who often fail to complete their programs. These failure rates are a direct consequence of Corinthian’s strategy of targeting the poor and disadvantaged with “promises of jobs and good wages that would support their families.”

Just a few months ago, the Consumer Financial Protection Bureau (CFPB) sued Corinthian Colleges for its “predatory lending scheme,” claiming that 
“Corinthian lured tens of thousands of students to take out private loans to cover expensive tuition costs by advertising bogus job prospects and career services. Corinthian then used illegal debt collection tactics to strong-arm students into paying back those loans while still in school.”
After the CFPB announcement, the U.S. Education Department began restricting federal student aid to Corinthian schools, which Corinthian said would “put it at risk of failure.”  

Now, in a move that seems to undermine the actions of the CFPB, the U.S. Department of Education has brokered a deal to keep these schools in business, to be run by the Zenith Education Group, a subsidiary of ECMC Group, Inc. This action comes less than 3 months after the Education Department sent a letter to Corinthian denying its recertification application for federal student loans because 
“Everest Decatur [one of Corinthian’s colleges] created false placements and misrepresented Everest Decatur’s job placement rates to its accreditor in an attempt to maintain its eligibility for Title IV, HEA program funds.” 
About the takeover by student loan company ECMC, the New America Foundation’s Ben Miller, an expert on education policy, commented:
“You're talking about creating one of the 10 biggest nonprofit colleges on the fly with no educational expertise in place and doing so with an infrastructure of questionable quality. This type of transformation is unprecedented. Look at the biggest charter networks like KIPP. They started with one school and it took them years/decades to get bigger. So turning over something right away to operate at scale with such a vulnerable population and so-so educational offerings is an incredibly tough path to head down.”
Even if ECMC can run this operation, Corinthian and its various for-profit campuses have not demonstrated that they're worth saving. The U.S. government’s own Consumer Financial Protection Bureau has already sued Corinthian for over $500 million “to protect current and past students of Corinthian students …[and]… to halt these practices.” U.S. Congressman Steve Cohen (D-Tenn) called the deal with ECMC "a misguided use of federal funds," and added,
"When a school like [Corinthian] that has a checkered history is on the mat, throw in the towel. It's over." 
Well said. We don't need another mediocre, for-profit university recruiting students with promises of federally-subsidized loans and jobs that fail to materialize. Rather than propping up this failed enterprise, the Department of Education should simply let it fail.