Clarifications and Concerns Regarding the Therapeutic Fasting in Type 2 Diabetes Mellitus Patients

Therapeutic Fasting and Vitamin D Levels: A New Dimension in Type 2 Diabetes Mellitus Prevention and Management—A Brief Report

We read the article by Nair et al with great interest.[1] In this observational study, authors reported significant improvements observed in vitamin D and B12 levels, fasting blood sugar, blood pressure, anthropometric measures, and overall quality of life among the 26 type 2 diabetes mellitus patients undergoing a 10-day medically supervised fasting. However, the methodological section needs more clarity on the operational definition used for the intervention “Therapeutic fasting,” as the operational definition of the same is not explained anywhere in the article. “Calorie-restricted diet” would have been a more appropriate terminology to use, rather than calling the intervention as therapeutic “fasting.” Fasting, by definition, is “abstinence from food or caloric intake” for a specific period of time.[2] However, the participants in the study were on a low calorie diet (1000–1200 kcal/day) for 6 days or on a very low calorie diet (400–600 kcal/day) for 4 days.[3] Though there are a few citations in the article on intermittent fasting, there is no mention of whether intermittent fasting was even prescribed to the participants alongside calorie-restricted diet.

Second, the authors have mentioned that the study was conducted at a residential complementary and alternative medicine setting. Fasting is a therapeutic modality used in the Yoga and Naturopathy system of medicine; however, it also includes various other treatment modalities such as hydrotherapy, mud therapy, massage, acupuncture, yoga, etc.[4] Did the participants engage in any other kinds of treatment modalities during their residential period? If no other treatments are given, we are interested to know on what types of activity the participants engaged in throughout their entire day apart from the meal times, in a residential set up.

Third, India has an estimated 74 million adults with diabetes, with China having over 140 million adults with diabetes.[5] Even while considering the prevalence percentage, Pakistan has the highest prevalence of 30.8% and India is not even in the top 10 countries.[5] Mentioning a nation (India) as the “diabetic capital of the world” without proper citation is highly unacceptable.

In conclusion, we appreciate the valuable insights provided by the authors[1] but recommend addressing these concerns to enhance the clarity and precision of the methodology section.

Publication History

Article published online:
24 December 2024

• References

• 1 Nair PM, Silwal K, Kodali PB, Tewani GR. Therapeutic fasting and vitamin D levels: a new dimension in type 2 diabetes mellitus prevention and management—a brief report. J Health Allied Sci NU 2024; 14 (04) 550-555
• 2 American Diabetes Association Professional Practice Committee. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2022. Diabetes Care 2022; 45 (Suppl. 01) S17-S38
• 3 Juray S, Axen KV, Trasino SE. Remission of type 2 diabetes with very low-calorie diets—a narrative review. Nutrients 2021; 13 (06) 2086
• 4 Maheshkumar K, Venugopal V, Poonguzhali S, Mangaiarkarasi N, Venkateswaran ST, Manavalan NJ. Trends in the use of Yoga and Naturopathy based lifestyle clinics for the management of non-communicable diseases (NCDs) in Tamil Nadu, South India. Clin Epidemiol Glob Health 2020; 8 (02) 647-651
• 5 International Diabetes Federation. IDF Diabetes Atlas. 10th ed.. Brussels, Belgium: 2021. . Accessed May 10, 2024 at: https://www.diabetesatlas.org

• References

• 1 Venugopal V, Maheshkumar K. Clarifications and concerns regarding the therapeutic fasting in Type 2 diabetes mellitus patients. J Health Allied Sci NU 2024;
• 2 Visioli F, Mucignat-Caretta C, Anile F, Panaite SA. Traditional and medical applications of fasting. Nutrients 2022; 14 (03) 433
• 3 Wilhelmi de Toledo F, Buchinger A, Burggrabe H. et al; Medical Association for Fasting and Nutrition (Ärztegesellschaft für Heilfasten und Ernährung, ÄGHE. Fasting therapy - an expert panel update of the 2002 consensus guidelines. Forsch Komplement Med 2013; 20 (06) 434-443
• 4 Wilhelmi de Toledo F, Grundler F, Bergouignan A, Drinda S, Michalsen A. Safety, health improvement and well-being during a 4 to 21-day fasting period in an observational study including 1422 subjects. PLoS One 2019; 14 (01) e0209353
• 5 Nair PMK, Silwal K, Kodali PB, Tewani GR. Therapeutic fasting and vitamin D levels: a new dimension in type 2 diabetes mellitus prevention and management—a brief report. J Health Allied Sci NU 2024; 14 (04) 550-555
• 6 Pandey SK, Sharma V. World diabetes day 2018: battling the emerging epidemic of diabetic retinopathy. Indian J Ophthalmol 2018; 66 (11) 1652-1653
• 7 Tripathy JP, Thakur JS, Jeet G. et al. Prevalence and risk factors of diabetes in a large community-based study in North India: results from a STEPS survey in Punjab, India. Diabetol Metab Syndr 2017; 9 (01) 8
• 8 International Diabetes Federation. IDF Diabetic Atlas 7th Edition. Accessed May 14, 2024 at: http://www.idf.org/idf-diabetes-atlas-seventh-edition
• 9 Wells JCK, Pomeroy E, Walimbe SR, Popkin BM, Yajnik CS. The elevated susceptibility to diabetes in India: an evolutionary perspective. Front Public Health 2016; 4: 145