Examining the Effects of Juice Fasting

Study Overview
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Brief Summary
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This study tests the effectiveness of dietary interventions that have the possibility to improve markers of gut health and improve general well-being. This study will allow healthcare professionals to learn how dietary interventions involving fasting can affect health. Food is increasingly recognized as a core component of preventive and ameliorative health care. Juice fasting has quickly become one of the most popular self-prescribed dietary interventions in the United States. A wide variety of juice fasts are available in the popular market; a popular variation is the three-day juice fast. The purpose of this study is to assess the effects of a three-day juice fast on certain markers of age-related disease and bio-markers of longevity. In particular, this study will assess certain epigenetic markers, which measure how the environment (including diet) can change the way that genes are expressed without changing the genes themselves. The study will also assess the microbiome, and inflammatory and glycemic markers.

Detailed Description
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Up to 30 participants will be enrolled in the study and will be randomized into one of the three arms: the juice fasting arm, the juice plus ad hoc arm, and the caloric restriction arm. Participants will come into the lab for an initial visit, during which they will complete questionnaires on their usual diet and demographics and will be informed about their assignment to one of the three arms. In all three arms, the three-day diet intervention will be preceded and followed by three days of self-conducted elimination diet. The pre-intervention diet will encourage participants to eat a healthy, light diet for three days (basic instructions: eat only fresh raw or cooked fruits and vegetables (preferably organic), whole grains and eggs; drink 8 glasses of water a day; avoid or eliminate alcohol, caffeine, sugar, processed foods, dairy, red meat, and gluten). The post- intervention diet will instruct participants to gradually return to eating solid foods, and limit strenuous exercise (basic instructions: follow a diet similar to the pre-intervention elimination diet; day 1 after the intervention: eat fruits & green vegetables, and drink 8 glasses of water; day 2 add in: nuts, gluten-free grains like whole oats, quinoa, or brown rice; day 3 add in: organic meats, fish, & gluten-containing grains). Biological samples and self-reported outcomes will be collected at four time points: baseline (prior to the first elimination diet period), pre-intervention (after the elimination diet and before the three-day intervention), post-intervention (after the intervention), and 14-day post- intervention. At each time point, participants will complete questionnaire on quality of life (PROMIS - Global Health Scale, which is an NIH measure on an individual's' overall physical and psychological well-being; see appendix) and collect their stool samples. Participants will be provided self-administered tool kits and be taught how to collect the stool sample at their first lab visit. At each of the four time points, the research assistant will coordinate the collection of cheek swabs, saliva samples, and blood spot samples. Biometrics will also be collected at each time point (weight, waist circumference, and blood pressure). Over the course of the study, participants will be instructed to keep a diet diary days one through nine to record their daily dietary intake. During the intervention period, the research team will also contact the participants for daily check-ins. Participants will not need to record diet data for the remaining 11 days of the post-intervention period. At the conclusion of the study, participants will bring back the final biological samples (stool wipe and saliva), provide the set of samples, and be debriefed about the purposes of the study. The biological samples collected will then be processed and assayed for microbiome, methylation, inflammatory markers, and glycemic markers.

Official Title
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Examining the Effects of Juice Fasting

Conditions
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Epigenetics, Microbiome

Intervention / Treatment
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* Dietary Supplement: Juice
* Behavioral: Caloric restriction via Plant-based meals
* Dietary Supplement: Plant-based meal


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Subjects considered as healthy by the investigator based on medical history and completion of the screening questionnaire. Subjects who, according to the investigator, can and will comply with the requirements of the protocol and are available for all scheduled visits at the investigational site. Healthy male or female aged between 18 and 35 (included) years 18.5 ≤BMI ≤ 30 kg/m² Ability to give their informed consent in writing Exclusion Criteria: Documented history of previous cardiovascular disease, including coronary heart disease (CHD) (angina, myocardial infarction, coronary revascularization procedures or existence of abnormal Q waves in the electrocardiogram (EKG)), stroke, syncope, and clinical peripheral artery disease with symptoms of intermittent claudication. Severe medical condition that may impair the ability of the person to participate in a nutrition intervention study (e.g. digestive disease with fat intolerance, advanced malignancy, or major neurological, psychiatric or endocrine disease including diabetes). Daily use of any prescription or non-prescription medication that has a high likelihood of impacting systemic inflammation (e.g. non-steroidal anti inflammatories or steroids), blood sugar control (e.g. medication for diabetes) or the human microbiome (e.g. antibiotics). Any other medical condition thought to limit survival to less than 1 year. Known immunodeficiency disorder Illegal drug use or chronic alcoholism or total daily alcohol intake >80 g/d. Difficulties or major inconvenience to change dietary habits Impossibility to follow an elimination or juice fast diet, for religious reasons or due to the presence of disorders of chewing or swallowing (e.g., difficulties to consume nuts) A low predicted likelihood to change dietary habits according to the Prochaska and DiClemente stages of change model (Nigg, 1999). History of food allergy with hypersensitivity to any of the components of the juice or diet Patients with an acute infection or inflammation (e.g., pneumonia) are allowed to participate in the study 3 months after the resolution of their condition. Dietary restrictions due to medical (including allergies), religious, or other concerns Any diagnosis of allergic rhinitis, eczema, asthma, or inflammatory bowel disease (e.g. ulcerative colitis or Crohn's) from a health professional

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 35 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Juice fast<br>In the juice fasting arm, participants will be given vegetable/fruit pressed juices and be instructed to engage in a three-day juice fast diet totaling 800-900 kcal-per-day. The specific juices will be assigned for each day in order to maintain the calorie level. | Dietary Supplement: Juice<br>* Participants will be drinking 800-900 kcal/day in cold-pressed juices.<br>Behavioral: Caloric restriction via Plant-based meals<br>* Participants' caloric intake will be limited to 800-900 kcal/day.<br>|
| Experimental: Caloric restriction via Plant-based meals<br>In the caloric restriction diet arm, participants will be on a whole-food plant-based diet totaling 800-900 kcal-per-day (matching the daily calories of juice fasting). | Behavioral: Caloric restriction via Plant-based meals<br>* Participants' caloric intake will be limited to 800-900 kcal/day.<br>Dietary Supplement: Plant-based meal<br>* Participants will be eating  900 kcal/day in pre-prepared plant-based meals.<br>|
| Experimental: Juice plus ad hoc<br>In the juice plus ad hoc arm, participants will be given the same juice for three days but continue with their usual diet in addition to the juice. For this arm, there is no restriction of caloric intake or restriction to liquid only. | Dietary Supplement: Juice<br>* Participants will be drinking 800-900 kcal/day in cold-pressed juices.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change DNA Methylation at Day 7 | The ratio of methylated signal to total signal and the M-value (log2 ratio of methylated signal over unmethylated signal) will be determined for each interrogated locus using Illumina's Infinium Methylation EPIC BeadChip | This outcome will be measured on day 7 of the study. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Baseline DNA Methylation | The ratio of methylated signal to total signal and the M-value (log2 ratio of methylated signal over unmethylated signal) will be determined for each interrogated locus using Illumina's Infinium Methylation EPIC BeadChip | This outcome will be measured on day 1 of the study. | 
| Change DNA Methylation at Day 4 | The ratio of methylated signal to total signal and the M-value (log2 ratio of methylated signal over unmethylated signal) will be determined for each interrogated locus using Illumina's Infinium Methylation EPIC BeadChip | This outcome will be measured on day 4 of the study. | 
| Change DNA Methylation at Day 21 | The ratio of methylated signal to total signal and the M-value (log2 ratio of methylated signal over unmethylated signal) will be determined for each interrogated locus using Illumina's Infinium Methylation EPIC BeadChip | This outcome will be measured on day 21 of the study. | 
| PROMIS Global Health self-report | The PROMIS Global Health measures assess an individual's physical, mental, and social health. The measures are generic, rather than disease-specific, and often use an In General item context as it is intended to globally reflect individuals' assessment of their health. and psychological well-being | This outcome will be measured on day 1 of the study. | 
| PROMIS Global Health self-report, repeatable | The PROMIS Global Health self-report, described in Outcome 5, will be administered daily during the active portion of the study. | This outcome will be measured on day 4 of the study. | 
| PROMIS Global Health self-report, repeatable | The PROMIS Global Health self-report, described in Outcome 5, will be administered daily during the active portion of the study. | This outcome will be measured on day 5 of the study. | 
| PROMIS Global Health self-report, repeatable | The PROMIS Global Health self-report, described in Outcome 5, will be administered daily during the active portion of the study. | This outcome will be measured on day 6 of the study. | 
| Baseline Blood Pressure | The investigators will measure systolic and diastolic blood pressure, which will be measured manually using a stethoscope and blood pressure cuff. | This outcome will be measured on day 1 of the study. | 
| Blood Pressure at Day 4 | The investigators will measure systolic and diastolic blood pressure, which will be measured manually using a stethoscope and blood pressure cuff. | This outcome will be measured on day 4 of the study. | 
| Change in Blood Pressure at Day 7 | The investigators will measure systolic and diastolic blood pressure, which will be measured manually using a stethoscope and blood pressure cuff. | This outcome will be measured on day 7 of the study. | 
| Change in Blood Pressure at Day 21 | The investigators will measure systolic and diastolic blood pressure, which will be measured manually using a stethoscope and blood pressure cuff. | This outcome will be measured on day 21 of the study. | 
| Baseline Waist Circumference | Waist circumference will be measured according to CDC guidelines: the participant will stand, and a tape measure will be placed horizontally around their middle, just above the hip bones. | This outcome will be measured on day 1 of the study. | 
| Waist Circumference at Day 4 | Waist circumference will be measured according to CDC guidelines: the participant will stand, and a tape measure will be placed horizontally around their middle, just above the hip bones. | This outcome will be measured on day 4 of the study. | 
| Change in Waist Circumference at Day 7 | Waist circumference will be measured according to CDC guidelines: the participant will stand, and a tape measure will be placed horizontally around their middle, just above the hip bones. | This outcome will be measured on day 7 of the study. | 
| Change in Waist Circumference at Day 21 | Waist circumference will be measured according to CDC guidelines: the participant will stand, and a tape measure will be placed horizontally around their middle, just above the hip bones. | This outcome will be measured on day 21 of the study. | 
| Baseline Weight | Weight will be measured using a digital scale and recorded in pounds | This outcome will be measured on day 1 of the study. | 
| Weight at Day 4 | Weight will be measured using a digital scale and recorded in pounds | This outcome will be measured on day 4 of the study. | 
| Change in Weight at Day 7 | Weight will be measured using a digital scale and recorded in pounds | This outcome will be measured on day 7 of the study. | 
| Change in Weight at Day 21 | Weight will be measured using a digital scale and recorded in pounds | This outcome will be measured on day 21 of the study. | 
| Baseline C-Reactive Protein | C-reactive protein (CRP) is a blood test marker for inflammation in the body. | This outcome will be measured on day 1 of the study | 
| C-Reactive Protein at Day 4 | C-reactive protein (CRP) is a blood test marker for inflammation in the body. | This outcome will be measured on day 4 of the study | 
| Change in C-Reactive Protein at Day 7 | C-reactive protein (CRP) is a blood test marker for inflammation in the body. | This outcome will be measured on day 7 of the study | 
| Change in C-Reactive Protein at Day 21 | C-reactive protein (CRP) is a blood test marker for inflammation in the body. | This outcome will be measured on day 21 of the study | 
| Baseline Interleukin-6 | Interleukin-6 (IL-6) is an endogenous chemical which is active in inflammation, and in B cell maturation. Besides being an immune protein, it is also a pyrogen, and is responsible for fever in autoimmune, infectious or non-infectious disease. | This outcome will be measured on day 1 of the study. | 
| Interleukin-6 at Day 4 | Interleukin-6 (IL-6) is an endogenous chemical which is active in inflammation, and in B cell maturation. Besides being an immune protein, it is also a pyrogen, and is responsible for fever in autoimmune, infectious or non-infectious disease. | This outcome will be measured on day 4 of the study. | 
| Change in Interleukin-6 at Day 7 | Interleukin-6 (IL-6) is an endogenous chemical which is active in inflammation, and in B cell maturation. Besides being an immune protein, it is also a pyrogen, and is responsible for fever in autoimmune, infectious or non-infectious disease. | This outcome will be measured on day 7 of the study. | 
| Change in Interleukin-6 at Day 21 | Interleukin-6 (IL-6) is an endogenous chemical which is active in inflammation, and in B cell maturation. Besides being an immune protein, it is also a pyrogen, and is responsible for fever in autoimmune, infectious or non-infectious disease. | This outcome will be measured on day 21 of the study. | 
| Baseline Insulin Level | A fasting insulin test will show fasting blood sugar levels. | This outcome will be measured on day 1 of the study. | 
| Insulin Level at Day 4 | A fasting insulin test will show fasting blood sugar levels. | This outcome will be measured on day 4 of the study. | 
| Change in Insulin Level at Day 7 | A fasting insulin test will show fasting blood sugar levels. | This outcome will be measured on day 7 of the study. | 
| Change in Insulin Level at Day 21 | A fasting insulin test will show fasting blood sugar levels. | This outcome will be measured on day 21 of the study. | 
| Baseline Leptin | Leptin is an adipocyte-derived hormone that is essential for normal body weight regulation. Leptin production is under neuroendocrine control so that serum concentrations vary directly with the amount of triglycerides stored in adipose tissue depots. | This outcome will be measured on day 1 of the study. | 
| Leptin at Day 4 | Leptin is an adipocyte-derived hormone that is essential for normal body weight regulation. Leptin production is under neuroendocrine control so that serum concentrations vary directly with the amount of triglycerides stored in adipose tissue depots. | This outcome will be measured on day 4 of the study. | 
| Change in Leptin at Day 7 | Leptin is an adipocyte-derived hormone that is essential for normal body weight regulation. Leptin production is under neuroendocrine control so that serum concentrations vary directly with the amount of triglycerides stored in adipose tissue depots. | This outcome will be measured on day 7 of the study. | 
| Change in Leptin at Day 21 | Leptin is an adipocyte-derived hormone that is essential for normal body weight regulation. Leptin production is under neuroendocrine control so that serum concentrations vary directly with the amount of triglycerides stored in adipose tissue depots. | This outcome will be measured on day 21 of the study. | 
| Baseline Gut microbiota | 16S rRNA amplicon library created for taxonomic annotation analysis. | This outcome will be measured on day 1 of the study. | 
| Gut microbiota at Day 4 | 16S rRNA amplicon library created for taxonomic annotation analysis. | This outcome will be measured on day 4 of the study. | 
| Change in Gut microbiota at Day 7 | 16S rRNA amplicon library created for taxonomic annotation analysis. | This outcome will be measured on day 7 of the study. | 
| Change in Gut microbiota at Day 21 | 16S rRNA amplicon library created for taxonomic annotation analysis. | This outcome will be measured on day 21 of the study. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Juice fasting; methylation; microbiome; caloric restriction