Intermittent fasting in diabetic retinopathy: microbiome modulation, mechanisms, and clinical insights

Intermittent fasting, a nonpharmacological approach, shows promise for controlling diabetic retinopathy but lacks concrete human evidence directly associating intermittent fasting with eye responses. This review highlights preclinical research insights about intermittent fasting and integrates emerging insights on intermittent fasting and its role as a complementary and alternative therapy with conventional diabetic retinopathy therapies. Animal models emphasize that intermittent fasting exhibits multimodal retinal neuroprotective functions and benefits primarily based on enhancing insulin and glucose metabolism, improving retinal mitophagy and mitochondrial functions, and reducing retinal oxidative and inflammation stress. Moreover, alternate-day fasting, 5:2 dietary formulas, and time-restricted eating plans have shown efficacy against acellular capillaries within db/db mice retinas. Simultaneously, intermittent fasting alters retinal gut microbial and bile metabolite responses and thus endorses a gut and eye relationship. These preclinical and emerging research insights thus project intermittent fasting and retinal therapies routed via intermittent fasting and bile acids modulation as retinal supportive and adjuvant therapies.