Beyond Weight Loss: Fasting Mimicking Diet vs. Mediterranean Diet Showdown for Optimal Cardiovascular Health

Fasting Mimicking Diet and the Established Mediterranean Diet. Which one reigns supreme for weight loss, heart health, and diabetes control in obese adults with hypertension?

DR T S DIDWAL MD

12/24/20236 min read

Fasting Mimicking Diet vs. Mediterranean Diet for Heart Health: Unraveling the Dietary Divide in Obe

A study in NPJ Metabolic Health and Disease. compared the Mediterranean Diet (MD) and the Fasting Mimicking Diet (FMD) in overweight/obese hypertensive patients. Both diets improved health markers like weight, cholesterol, and blood sugar. FMD specifically lowered HbA1c and IGF-1, while MD decreased blood sugar and insulin resistance. FMD uniquely reduced RHI, a blood vessel dilation measure, but other factors suggest this might be related to positive changes. Neither diet significantly impacted arterial compliance. After 3 months, both groups continued weight loss, but the MD group additionally lost lean body mass. Both diets appear beneficial for cardiometabolic health, with FMD potentially offering additional benefits for blood sugar control and IGF-1 reduction.

Key Findings:

Both MD and FMD significantly improved various cardiometabolic risk factors, including weight, waist circumference, BMI, body fat, total cholesterol, and leptin.
FMD specifically reduced HbA1c (glycated haemoglobin, a marker of long-term blood sugar control) and IGF-1 (insulin-like growth factor 1, associated with aging and cell growth).
MD specifically decreased blood glucose, insulin resistance, and HDL cholesterol (good cholesterol).
FMD, but not MD, significantly decreased RHI (reactive hyperemia index), a measure of blood vessel dilation. However, considering the overall improved metabolic profile and other positive outcomes in the FMD group, researchers suggest this decrease in RHI might be related to vascular rejuvenation rather than impairment.
Neither MD nor FMD significantly impacted the large/small-resistance artery compliance (AC1/AC2).
During a 3-month follow-up, both groups continued to experience weight and BMI reduction. However, the MD group additionally lost lean body mass compared to the FMD group.
Importantly, no significant differences were observed between the FMD and MD groups in terms of any measured parameter at the end of the intervention period.

Overall, both the Mediterranean Diet and the Fasting Mimicking Diet appear to be effective in improving a range of cardiometabolic risk factors in hypertensive individuals with overweight/obesity. FMD might offer additional benefits for glycemic control and IGF-1 reduction, while MD might positively impact blood sugar control and HDL cholesterol levels. It's important to note that the decrease in RHI observed in the FMD group requires further investigation to confirm its specific meaning.

Additional Points:

This study was a single-center randomized clinical trial, meaning the results might not be generalizable to all populations.
The study duration was relatively short (4 months), and long-term effects need further investigation.
The specific FMD protocol used in the study involved 5 cycles of a low-calorie, low-protein, high-fat plant-based diet, administered for 5 days each month.
Consulting a healthcare professional before implementing any significant dietary changes is crucial.

The fasting-mimicking diet (FMD) is a 5-day, low-calorie (725–1,100 calories) plan designed to mimic the benefits of fasting while allowing some food intake. It involves consuming clear broths, vegetable soups, nuts, olive oil, specific vegetables, limited berries, and avoiding high-sugar foods. This approach aims for weight loss, improved blood pressure, and lower risks of certain diseases. However, the FMD is demanding, expensive, and might not be suitable for everyone. It requires an ongoing commitment to healthy habits for long-term success.

Background: Nourishing Vascular Health through Dietary Strategies

Healthy dietary habits have long been considered a cornerstone in safeguarding the vascular endothelium, the inner lining of blood vessels crucial for maintaining cardiovascular health. The study underscores that aberrations in the vascular endothelium, such as impaired vasodilation, can significantly contribute to atherosclerosis and hypertension. Building on prior successes, researchers at HTI demonstrated the safety, feasibility, and positive effects of a periodic five-day/month Fasting Mimicking Diet (FMD). FMD, a low-calorie, low-protein, high-fat plant-based diet, shares common ground with the celebrated Mediterranean Diet (MD), renowned for its cardiovascular benefits. Both diets are rich in monounsaturated fats (MUFA) like oleic acid and polyunsaturated fats (PUFA), including alpha-linolenic acid (omega-3), docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA), which hold promise for fortifying cardiovascular health.

Unravelling the Study: FMD vs. MD in Obese Adults with Hypertension

In this groundbreaking RCT, 44 participants embraced the FMD, while 40 counterparts adhered to the continuous MD for four months. The study's primary focus was the assessment of endothelial function, gauged through the reactive hyperemia index (RHI) and arterial compliance (AC1/AC2). Intriguingly, both diets showcased their unique prowess in navigating the intricate landscape of cardiometabolic health.

Dietary Interventions: Tailored Approaches

Participants in the FMD group strictly adhered to the provided dietary regimen, tailored to individual weight. The FMD ensured a caloric intake ranging from 1000–1100 kcal on day 1, gradually tapering to 700–800 kcal on days 2–5 during the periodic cycles. In contrast, the MD group received guidelines aligned with the validated Mediterranean Diet but had the flexibility to deviate.

Results Unveiled: Dichotomy in Effects

The FMD group exhibited a reduction in RHI, potentially indicating an impact on endothelial function. However, neither group manifested improvements in AC1/AC2 measures or changes in abnormal RHI (< 1.67). The subtle correlation between RHI and age at baseline suggests a nuanced relationship worth exploring further. Beyond the realms of endothelial function, the FMD group showcased a trend towards reduced biological age, heart age, and scores on the Protein Unstable Lesion Signature (PULS) cardiac test, assessing the five-year risk of stroke. Notably, this reduction in RHI was framed as a rejuvenating effect rather than impaired endothelial function, beckoning for additional investigations.

Metabolic Symphony: Insights into Diabetes and Body Composition

During the three-month follow-up, the FMD group witnessed decreased insulin and HOMA-IR levels, hinting at improved insulin sensitivity. In parallel, the MD group experienced a substantial decline in diabetes prevalence, a noteworthy feat considering their higher baseline incidence. The divergent impact on body composition unveiled another layer of complexity. The FMD group exhibited a marked decrease in trunk fat mass without compromising lean muscle mass. In contrast, the MD group faced over two pounds of loss of lean muscle mass, signalling potential concerns about increased frailty in the ageing process. The study postulates that the continuous MD might have led to decreased protein and essential amino acid intake necessary for muscle growth, a concern circumvented by the periodic FMD.

Results

Main finding: Both the Fasting Mimicking Diet (FMD) and the Mediterranean Diet (MD) effectively manage weight and reduce cardiometabolic risks in obese adults with hypertension, but each has unique strengths and weaknesses.

Focus: The study compared the effects of FMD (5-day cycles per month) and MD (continuous for 4 months) on endothelial function, body composition, and diabetes prevalence in obese adults with hypertension.

Key Results:

Endothelial function: FMD showed a trend towards improved RHI (a marker of endothelial function), while MD did not.
Body composition: FMD preserved lean muscle mass while reducing trunk fat, unlike MD, which led to some lean muscle loss.
Diabetes: MD significantly reduced diabetes prevalence, likely due to its long-term adherence.
Other benefits: FMD showed trends towards reduced biological age, heart age, and cardiovascular risk score.

Implications:

Tailored approach: Both diets are effective, but individual preferences and needs should be considered.
FMD strengths: may improve endothelial function and preserve muscle mass.
MD strengths: reduce diabetes prevalence and improve long-term adherence.
Future research: diversify the FMD menu to improve adherence and explore long-term effects.

Conclusion: This study highlights the importance of personalized dietary strategies for managing cardiovascular health. Both FMD and MD offer distinct benefits, and further research is needed to optimize their effectiveness.

To Summarize

FMD vs. MD Study: Explored effects of Fasting Mimicking Diet (FMD) and Mediterranean Diet (MD) on obese hypertensive patients.
Improved Markers: Both diets enhanced various health markers, including weight, cholesterol, and blood sugar.
Unique Effects: FMD reduced HbA1c and IGF-1, while MD decreased blood sugar and insulin resistance.
Endothelial Function: FMD uniquely lowered RHI, possibly linked to vascular rejuvenation, while MD had no significant impact.
Body Composition: FMD preserved lean muscle mass, whereas MD led to lean mass loss over time.
Diabetes Management: MD notably reduced diabetes prevalence, highlighting its long-term adherence benefits.
Future Directions: Calls for personalized dietary strategies, emphasizing the need for further research to optimize effectiveness and adherence.

Journal reference:

Mishra A, Fanti M, Ge X, et al. (2023). Fasting mimicking diet cycles versus a Mediterranean diet and cardiometabolic risk in overweight and obese hypertensive subjects: A randomized clinical trial. Npj Metabolic Health and Disease. doi: 10.1038/s44324-023-00002-1. https://www.nature.com/articles/s44324-023-00002-1

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