Fasting

Irttrc:nJiuc;li o n.

oc.

AJan Goto'harner,

l-U5tcry.
f lk!fs.i ol op.

Res.aoarch.
AppEmd1crtis.
Chemical Poi:sonung..
Ciin diov.asc-11lar Oisease,

Daabl!'tcs.
EpiPep!S_y, I . . . . . .
lm rnu11e a11d lnflam ltlatory

Obe~i~.

Palt(;f(!.atitis,
ApJILi&ati an .

.. .......................................................... .

Di~rd~~.'.s.-------------------------------------------------------------------------INITR.OOUCTION

General P.rin<: pies, H u.m::~n:s.. _u~Likc: c hhnp.a'?.i.C"t::'s . h.a....-t::" thC' .al:.~lhy to s~ r:-.1i,'C' on .,..,. :at:cT for e:x:t~~::nd.ed
l aborato.-y'Values pe'I"I,.,.Js of rune. 1 l b e p nm;J,-,. ~dolpmtion l:i rhe .\hshl:}' ro U5&: ketonc:o. from f;,Pi
A.dJilllC::ll!rl'fl care. " mc[:abo!isrn _<~..!> an "' LtC'~na te"" Ju.d for the:- Cc:"n t.r~l ~~~..,-o Ll_:' S)'l'l t~~::m . 2 Th r br;:au ry of t hJ
Call'tliaindicaliolls, adapr:u:~on , ,. th.ac durang Fa~t~11 g th r= bqd~ p r:toll'"tnzes furt catahtll rc;m . th e: m~!if con-

Side Effects
Coru:11U sJon.

t..<n ._.ft"d e<iJori ~n-c:- rgy rCS>our~: it." (4.) v.s 4 k...,.AJ fur ~:.uboh ,.J r.Hft"' il n J p ro<~.d 11). itfld
dnJS :~.af~uard:sc ...:awbu Lil'l-111 of e~sc n cia] ~(ii1UC r u<~r~:. ( ncrv.es, 1n u les. organ~, etc.)
u n ril .SI:c red adipes~ td s.suc 'is SC'Vc:: rd~r deplt: red- a ftc: r tas d ng !>C""\ic:: r.al weeks ro
J lon da:.. d peud iug on tin !'t tore::. as. wdJ
::- 1u e-( bo l ~c. - ne~ ,. and ac dvi ry I ., L. Howc:vcr, once th is.

rh ~.'iib ol d

is L:rosscd h't un.;JJUcndcd 13sting. st3 rv.1tion cnsuc.!O {r:hc:

n u:d. rc::lv i ng on .~,, r.tin ;.U. ;li m. jor fuel ~LH'>Ct::). fC'!I:Llh-

~'~"->Jiv LISC:.t;: c;<;;S.e('ll!'i~ I {l!'i-..'i:Lic foe.~

ng, in de..ah J uc lo org.1 n fai l u r~.'

Thcor::1pc::u tk f.as'Li ng is '\'"01un ta:ry, supe-rvised ab..c; t ine-nCC' from :~ II fOo d .1 nd d rl n k
lo!'l{C:.:pr 'W".ucr fol[ :a 'ip~ific rime . The he. h h promor1ng hcncn'" .. r du~: ro rh .: ma rs h 31llin.g of ou r m c:: t'"3 belie p ote-ntial :a..s L:ellu l.ar s yne rns m;J n:age- in tC'rnad ~.sou n:::~
more efficb::ndv. I he body ~hu!> c:an reuore ~tTucru rc:: .111d funcrinn i~ a w.t )' ~n.ln
gou.s lu rt=boo rln~ a cu rn p u [e r th:.1 l h as. 5 t u pplt"d v..orking. p !Upcrly. U n lj kll:' a m ;N.;h 1nc.
h o wc:vc:r, rhr body ClJl o1d.xp1t d ynamic,lly ro ~ H\1c::rnal e:nvi r o;nmrn"t, a llo vr..-lng rhC'
body ro d o w lu r i I[ d o .::,r;, b e.u. h .:::J~ I i C!'id f_
j

H IISTOIR Y
Through out h. i.stoll"y , people of ...-a r io u s t:u ltun ::s .and .-c="Ligion.s h. ~...-.:: R:"CO g:n izcod a. he:
V4Jh,.re t"'l f fills ri ng. Nurncrnll<; rcf'c:rcnoc:s . Pfl'C411T in rh e Bihlc.:. Kor-.., n, p..11g011n ...vn ri o~...

...-nJ \\t'hing;:.ofthc

Lutt..i~rH

Gn:

~."'bOn

of d1

r H~ [

J.o tor ro

u~

d1r:n1p Ul ti

f.as-ti ng J n the: U nited Sta n:s w:as Is.a.ac Jcnn i ng;; ( I 7 8 8 to l 87 4}. In I 82 2. JC'n nj np

:l b .,..,-J..:<J the

lJ"'

Hf ln tg.o- ;,1ncl. lhro"gh

lhc.\" infi11.1~n~

of P~s.hytcri~n pr..:ilch c:r

Sylvc:stc:r Grah am { 17 'J 1:0 18.;; 1). began :achoc,"Joling f~ting and. othc:F .:r.spcocts of
hYgieni-c rre.umern (~cger~ rL'ln d iet,. pu r e w.ue.-. ~un~h i !'le, clean air, o-crci!ie, emotio n-ill puhc:, -diJHl n'~ [ ) . Thj 1(11:almc:on L later .t.tnC' to be k.1o\.HJ .JJ!!. ... Jl, u.rr<tl ho,.g.ic:nC'.''"'-')
O rh~r docn:m. who follO'tllo~~::U iin [ht: h n;ienk tr.u..L hion WC'~ Jam~s
r;.a~.-k.-;11[1 ( 1 8 1 1
m 18 9 5). Rul'i.Sell r: ~r!l'";;]ll (1Rl.2: to m877). \Xli ll i.am A. A lcon (~7 98 l[o 18'59). Manr
Grove Nkhub ( 18 .LO (u 1884), Thurn ...: L. NichoJ ( l B I 'S m 19Cl l ), dwal'"ILI H.
De, c::y ( 1 8 3 7 to 1 9l)4). G.:: a rgc: H. Thy lor ( I :8 2 1 1:0 I 8 96}. H a rricr Au.sr.in ( I 82 6 to
~ 69 I ). Ch .-1
E. P. ge- ( I 8.tf rr rn 1q2 'i}, Em rncn .: r-..;;;mo (1 837 111 1 C) I L) . Hden
u~ n:!.rnOII"C' (:? to 1 9 04 ) . Susanna
D o dds ( 1 8 31J w 1 t) 1 5)' Fd LX Os:wa..k ( 1 8 '"i LO
T 906), Rohc:n: Wal ter ( LB4 1 Ito !921) . John H . l'iiJc:n (1 85 1 to 1 '94:0). and Gr:=or~
S. '\'(leger ( 1874 ro I ~.35) . "'o:~>I of rhese phys.k i.a.ns grmdtr a r~ '1.~ rnrdic.l] do.non:
(1Y1 D :!ii) from eclect:it: mc-dic..al .sr=h oo Ls and pub liliJ:Iic:d v.atriou s wo:r:ks on Li.fc.n}' lr=. dlc:: t .

w.

'
... 4
,asnng.
-

J J"
~ n.:;,1

The: hygiC'nlc l jncoag"l:' conun ut::d. i n t u r.ht:: .rni:.d- 1 YUOs, mdinJy du~~:: t o Hc:rb~rt ~1.

-hI; I mn. D c. N
( 1895 TO I 985) . who dc,~lo p.:;d ;,1 stric re:r r ro f.OCCI I to r f:a .ui n g
( w~ re r o"' ly; lf1 o ern-em 'JO ~t'! rci!'ie:. or m:re~"rmen t$;~ ., n d co ~ p IC:t<:: re.s:r . S he )Tn 11"1 he:gan
h a:s. .stud y of fa:stJng i n I')! 11 b~ tc."adi ng (be:- p o pular wrh.c."n o f h il'l- day~ S i n b .ir.
C::.u..-i n~n.

and \.1..J.cL:td.d~n. H e- snJdled

under da~ f a....:i.ug .d.u d .. orirli.:~ o hi-. lim~ 1 M ... F. d deJL Cul.h:gc: (C I:t.i -go, lll.),
Cr.1nc's .S.1n.am.r~um (E lmhurst. Ill.), .and C r..1.nda.ll"s- Hc:;J ith Sc!hoo l ( \ 'Ork . l:~oc.nn.) ..... 1 !
4AJnon g rhc: ~ r Uc:sr .l nng in. dnuions o t [hi!\1; rime were jndh hr' N<l.ir1H
LH'C:
s. Rl.fUor:i Litn~, il1 hJ.il1g rnc: jun~:;born
the< l.t.!>lf Qf'C'r.it~ by Bc-nc:d i [ Lu If. the
HaT.Ll.rd .

J-1-::u.k:d l, Lmul!'inmn .

I'"J...L~n .

TABLE 371

Moblllzable Fuel Reserves In a 70-kg Nan

Protein

Glucose/Glycogen
TISSUE (WEIGHT IN kg)
Bklod (10)
live< (I)

lntoslinos (I)
Brain (I 4)
Muscle {30)
Adipose (15)
Skin, lung, spleen (4)
rolal

'

15
100
0
1
300
10
13
450

kcal
60
400
0
8
1100
80
52
1800

'

100
100
100
40
4000
300
140
4880

Triglyceride
kcal
400
400
400
160
16,000
1100
960
19.520

'

5
50
0
0
600
11,000
10
12,695

kcal
45
450
0
0
5400
108,000
360
114,255

Oata front Elkeles RS, Tavill AS. Eioehemcal aspects of human disease. 8ostof: 81achwell Sciet~tific. 1983.

Utilization of Energy Reserves

foundc:-r of naturopathy in the United Stares, rhc MacFadden's

TABLE 37 2

H('<llthatorium, m~d che Tildel\'s He;~hh School.) 3 h) 1928. he

foundtd ,t fusting lnstittnion :md healfh school that pr<>vded ser

ENERGY SOURCE

RESERVE'

Clocose

Ih
4-8 h
12 h
48 h

vices for more th:u1 40 )C.U5,?

In 1949, Dr, Shelton along wi<h William Esser, NO, DC:

C hristopher Gian-Cursio, ND, DC: and Gerald lknesh. ND,
DC. formed rhe Amel'i;.-an N.nur:ll ll vgicne Society. nc:w. called
the Nation:tl He;alth Associ.Hion,7,l4 '' l.ty org.;mi2ation cledic;ucd

Digeshon

1.0 preserving the cene11 of hygiene. In 1978. :1 prorcuionul bmnch

w.1s formed (l nt~n.ulon,tl Assocl:nlon of llygicnlc l'~yslci:.ms
liAHPJ) to study and promote t1u:r.tpeutk f.Lst.ing. T tXJay. the
IAHP organizes dinictl train ing and examination. letding tO certi ~cation in therapeutic fasting. 1~

Protoln

fJ

PHYSIOLOGY

It has been suggest~ that humam;, like other species, have: evolved
special biochemk~l pathways (0 sttbsist for long periods without
food during periods of food scurciry (climate, injury, i!lnc.ss). 16
While f.l~ring. th(' hody primnrily us.e11 fiu srorcs from ad"osc ri!;
sue for enegy while recycling noneMencl.d tbsuc: for nMiulcmulcc
of' pivot.t.l sptcms. nl i&.stre:.unlining utili'l..c-s nonessenti.t.l protein
sources, includ ing d igestive and glycolydc enz.ymcs. mutcle contractilt" flbcrs, and othn c::onncctivc tis.suc. Rcscarch Ius d ctumined that :m average iO-kg man has rhe fat srores to mainrain
b.ulc caloric -cquiremc.11ts for 2 to 3 months of (;,~.ing 1 72t
(Tables 37~ I .md 37~2) . However, M rhis duc.shold .tppro.t.ehes,
rile bod y can no longer tffecrively or ~ffi ciend)' mobilil.e ftt store$
for fucl. and significant prortin GaC'dbolism again beconts neces-sary fn r energy production. 17
During feed ing, the COn V<'rsion o f fu rry :td d s co a"tyl COt'nZyme..
A (CoA) i~ regul:nc:d by thc t.wr..lil:biliry of t~glycerol 3 pho5phMe
(dei\'ed from glucolle 1hrough 1he g lycolytic p.uhw.y). As :he con
cemradotl of acetyl CoA rises. it is ruymhesized imo criglrcerides,
with L-glrccrol3-phospbatc serving as the accepter to which th~e
:lC)'I CoA groups <'I'<= anached (lh rough eslerificarion). Con\'tJ'$Ciy,
during f;uai ng, therc i.s in:lCicquruc glucosc to p uvidc thc nccdcd
glycerol rot' II iglyccride 5)'11 I ht'..~is, re~u lting in .~c:tyl {A)A level'I in
e>Ccess of the oxidative (:ap;~ciry of the Krebs cyd e. "Jhe t>Ccess is
then shunted into thc synthesis of kcto nc bodics. 22
RC$e.1rch using r~p i ra;o y quotienTand urinay nitrogen srudies
h:1s rcp<"atcdly shown that triglyccridcs a~ thc major fue, during
f1aning. 11-2J Inadequare blood glucose in f.1sring l>rompt'~ hyd roly
sis (lipolysis) of tl'iglyeerldes wit hill .u.Jipo<-ytes tllowing f.my adds
tHu.l gl)1rol to le;.we til< cell. 11H: f.Llt)r .tGids t\.rc tr.tn.spoHed in o

Glycogen
Amino acids

3 .ts (It prololn were tho only luol sed

fo gluconoogenesisl
24 wks (obhgalo'Y lm only)

Tngl)'cerides
These estimates ate btsed on 100% ut1hlalion of uch fuel.
Oata ffotn Sluts M( ,mdc~nnutr~bonln h11llh and dJJ8Uot, 9th td. Ph.Jiatttpflla: Lta &
reblge1. 19931 While A llan,ltl P. Sm1th CL P1inelptes ol btochemlttl)', 6th ed. Hew Yolk:
M:Graw.Hi11, 1978; Mont&ouery R. Dryer RL Conway nv, Spector AA. Biochemistry. t
caseOill!nled appcoach. 6th ed. Stlouis. CV l~sby,. 1996, riulritioo rme\ls' present
knowhtdge in nulnbon, 5th td. Waslungton, OC: Nulnbon Foundalwn. I981:439453.

physiCJ.I com1,ltx wi.h ulbum in m the liver. n1uscle, tutd o the th

sues. F.1tty t'cid oxid.t.tion re.~ou hs in l.t.rge quantities or ketones
secreted inro the blood stre'<lm, usu~lly noted on udn;dysis by d:ay
ducc.:H Thcsc kcronc bodie.s (acc(oacctic acid, a(elonc, and
~ h )droxybu ryric acid) are uriliud by the hearr and. ir f:asting, hy
the brain fo c11c:rgy production. 2 ~ctw~c: the ketone bodic~ 111-c:
acids. their entry into the p i .1 ~11H1 l'csu l l~ ill a l'i~e i11 hydrogen i01u.
't his change i.s buffer:d by the convenion ofbicarbon:ne into c.ubonk add and then to carbon d ioxide, which is (Xhaled . In
extended (1sts:, rhe bufFering CnJY.lcity is surpas~cd and the pk.sma
pH decrea.ses. Je.1ding tom ild metabolic :tcklosis with a oompe ~a
tOr)' incret.ue in rc~pil:uory r:arc wirh noted elc:ctrolytc imb.,l.lnCe. 22
n,c initial p hysio logic rcspon.sc to ftl5ting h fhc livds incrca~d
release g lucose tO maintain ad eqmHe b lood levels <'S \.llldigt.sced
calories a~ cxhaustd in 4 to 8 ho urs. After only 12 hours, the
livc's g lycogen srorrs become cxhausred, and b lood glucose is
maint:lined b)' gluconcogene,;is from criglyccl'idc gi)'Ccrol in F.n
l'e/iCrYC:5 :U well :.s from gluG(')genic aminO :.cids nnd r imrtrily from
l.u.. tatc (CoM) and _.L.aniuc cycle rrorn l'n usc les. 2~2 lr1tcrcningly,
muscles contain more g lycogcn than thc liver. but lack the enzyme
required tO converr glycogen tO glucose (o-glucose-6-phosp hatasc). llnough tl1e Cori cydc, storccl energy is shuttll as l:u:aate
ro the lh'cl' and then used by body 'ysrcmllllll glucose, where a..s in
lhc: feeding "t.ttc. it would (.Qm monl)' be shu ltled ba'k tO the mu~
cles 19 ( Figure 37-1). As the r.,n proceeds, rhc kidntys become

or

Uver
Glycogen ~

Glycerol

I
I
I
I
---t---

Blood

Glucose &P~ GJucose

"'t

J'

Pyruvate <Eo- lactate (

Urea
~
-HH

' - -

I
I
,J,
I
<E-I - - - - ~+NH2 1
I
Muscle

) Glucose--7 Glucose 6-P--7 Glycogen

Lactate

Pyruvate

Protein

catabolism

_,

Alanine

Alanine

Keto acids

FIGURE 31 -I MechaniSllls of glutose prodtiCtion during fastioc.

progressively mo~ important in th~ maintcn:maofblood glue~

and t -vencually, the renal cortex synthc.siz.es more glucose
from amino acids than d~s the lhcr. 16 Note:- that glucosc is also
req"Ckd bv the bn=:~Jc-down of blood ~lis in the livc:r.19Zl
Under ;10rmal f<.cding conditions, the energy requirement of
the mature brain is met almost entirdy by glucose. Because the
glycogen <:ontenc of d1e brain is '~ry low (0.1()(,). dtere is essen
cially no brain glucose n"SC'f\'c. Although the brain converts to oxidation of ~-hydmxybutyratc after 4 to 7 days. then- is still an
l~v~ls..

ob~gatory

need for approximuely 80 g!day of gluc:ose for the

brain. red cells, mwcks. a nd other tissue's (400 to 600 kcaJ/da~ of

glucose). 14 11 Approxinulfely 16 g of glucose is $yurhesb.ed f;om
triglyceridt' glycerol, with tht' rat of tb..- glucosc- rcquirt'mt'nt (and
rhe orher mectbollc process~ n=quiring :.'Imino acids, such as
eot.yme rurno'\Oer) bdng mer by tbe carobolism of 18 ro 24 glday
of protdn.
All am ino acids a~ glucogenic (with rh~ cxc-=prion of' kucin~.
which appears tO be- a regulator
prordn rurnO\'~r in musdt),!l
bur alanine plays a prominent rok analogous to laccne in rhe Cori
cyde. 2S.Z6 The alanin~ cycle provides the mcchanism for the ryding of a fixed supply of glucose and the ..-fftctive transportation
to the liver of amino acid nitrogen derived from muscle brcal::down. B:ause muscle, unJlke the li'-er, is incapable of synchesiz.ing urea, most of tbc amino nitrogen from pmtrin brt'akdown is
U'21\Sf~rro:l to pfruvate to form ahnine. The aJanine enters the
blood and is takt'n up by the lh:er. lht' amino groups art' rt'mo''C'd
to fonn Urt':l, and the n-sulcing pyruvate is comened to glucose.
lb~ newly synthesized glucose is secreted into the Mood, ukeo up
Ly d.c tuuo>o..lcu..J ~...nallvliJ.cJ tv pyau <.tlc tv to.ccd dtc .-.l.tuiuc
cyck.11
During physical activity and ac:rcise. there a.te' inCI"t'm~ntal
incre.ucs in rhe glucose requirement by the hcan and skclcral mus-ck th:at require protein Clmbolis:m. AJrhough much of the laccue
produced by anattObic metabolism of g luCO$t' and glycogen is
resynthesized to glucose by th~ li,~r via rhc Cori ~"Ck. the neal for
glucose is iJlCreascd, because there is 2 net loss due to urinary exc:retKtn oflactic :lcid and mc&lbolic indllciency. Com~rscly. th~ energy
for resting he<1rt and .skdcca.l musck is met primarily by oxjd:uion
fany acids <Uld aCCtO~Ct'late (ketone). 11H:ref'ore~ dudHg fasting.
annibalizcd. protein n"SC'rvcs att directly rcbtc-d to the dcgrcc of
physical .activity.
Spe-cific physical changc:s during Fasting include: dt"c:reascs in
body weighr, pulsc,l18l'9 nnd blood pre5sure (BP),3.J3.30,JI and ;a
drop in tht' basal mctabolic rate:- by about J9(, p<r day until s-tabi~
lizing at about 7)~ of normaLJ1 Ot.ht'r cardiac adaptations noted
on an dectrOClrdiognm pre5ent 2S sinus brndyardi:a, dee r~
QRS compl..-x and T-wavt amplitude, d ongation of tht' QT

or

or

inrerv:al, and shif'ts tO the right of th~ QRS and T-wa,e axes. 'These
change$ return ro normal with retum to food,J.l'9JU! similar to
those: animals that ha,c pn-scrilxd adapdw: m<ehanisms and
hikmarion cycles.

I'J

RESEARCH

Research into &sting has lxen r<'poncd since 1880, with the earliest record of thc ra~uric: fasting in the medical literature appearing in 1910. l1le earliest research was primarily obse:n... tional, as
physiologic and metabolic changes wcrC" rordcd while' an individu>l f.utcd-Tanner (40 days in 1880), jacques (30 da)'$ in
1887 and 40 days in 1888),J Penny (30 days in 1905),3> and
LeV'3n:~,in (3 1 davs in 1912). 111
_ln 1923. the da$Sk Fturing ami Umkrt1 utritit:m provided indt'pth analysis ofanimal and human physiologic changes and rc:acrions during &sting by ~torgulis :lr rhe Uni\ersity ofNebraska.JO
In 1950, Ancel Keys! at the UniV"ersiry o f Minne$0ta compiled
two volumes entitled 71N B1ology ofHuman SfdrtNlti.tm describing
rhe detailed observ:.nioos of 32 volunteers who f.asted for up to
8 months with comparisons (0 food deprivation observations
made during the Second World War. Perhaps the most important
observation was that fa.sMg did not cause vit~mil'l or mineral de6~
ciC"nciC".s. Related stan'ation rcSC"arch in dc\'d oping countri<'S noted
rhar th()SC who fasted completely lh'Cd longer t.ha.o dlosc on
protdn-dc6ci..-nt dic:u. 16
Sin~ these ground breaking works. published clinica.l stud ies on
ther.tpanic fascing h<n-e demon.srr.ued benefit in almost every
V'5"'' :~oplctu. 'Tltc fullvwius h,. p.ttti.d lht vf Jix-~ .-uJ .._uuJj

tions that :arc bene6cially influenced by bs-ring: chemical poisoning, cardiovascular di.sc:a.s-e and hyp<rt<nsion, d iabc:te:s. epilepsy,
obesity, pancrc.uitis. and immune/inAammatory condirio n.s (all
exp2nded upon), as well as asthma, lumbago. depression and psychosomatic d is~ascs~ ncurog~nic bladder, irritabk bowel S)'n...
d romc. dysorexia nenosa (impaired or d cr:mgcd appctitc),36
nemosis and schiwphrenia,37 par:uices,n duodenal ukers,3~ 1..1ter#
inc fibmids.-60 varicOSe" ukers~-i l thrombophlcbitis."H CCU'ma.JO
and psoriasis.JU.4S

Appendicitis
A ca.sc: rC"port, publish~. in 20 I I. of a patient ad-.iscd o f majnsrream ue:umenr for appendicitis refused surgery tO try medically
n p<rvisc:d wattr~only fasting. Prc~fa.st.ing ultrasound confirmed
inflammatory d ilation of th~ appendix. which was found to be
rdie'\ocd posr~fasting by n~arive clin.ic:al :and ultrasound 6ndings
with no return of symptoms- a t 2~year follo w- up;46

Chcm i c~ l Poi ~oning

Anothc:r c:ncournging finding for the use of fas ting was published
in the Amertt"all joumal ofIndustrial Medic-ine in 1984. 1 h is srudy
involved patients who had ir)gested rice o il contamin<Hed with
polychlorinated biph("nyls. All patients reported improvement in
symp{oms, and some experienced "d t::lmalic" relief, after undergo
ing 7 to 10day fitsts.47 This ft'sc-arch supponed pa.st stud ies con
duned by lnamur.l with polychlorinated biphenyls poisoned
padents and st.gges~:ed a de10xi6carion effecc ofF<~sting.

Card iovascular Disease

Smdie5' of' rhe dfecrs of fasting on parienc..o; wirh hean disease
hcean in the early 1960s. Dunc.1n er al 44 norcd impmvemenr~ in
h y perl~nsion and chronic cardiac d isc.>as~. O dtC'rs also found fast
ing to be beneficial in he.1n disease: Gr~h:tm ,43 ~t wlor,4Z fmam
ma,47 and Vessby.-'" Improvements noted include.d reducdons in
serum triglyceride values, BP, atheromas, and to ttl cholesterol lev
els; increased ra.cio of highdeu icy lipoproc:ein. cholesterol co total
cholesterol; and alleviation of congestivt heart fa ilure.J.14.4S.5053
In the June 2001 issue of' the Journal ofi\tlanipu/aJj~ and Pilysi
q/ogit"ai71Jt>rrtpn1tict., Gold hamer e{ atH reponed on a sUJdy involv
ing medically supe r.,ised wateronly F..sting in the treatment of
h)'perrcnsion. ln this e'aJuarion of 174 >Jl.Secufive patients with
high BP, all patients w..-re able' to achie\'e BP suffic:i..-nt to eliminate
dtt' nd for medirotion, and more than 90% becamt' normoten
sive. In patienrs with St~ge Ill hypcrrensic>n (systolic BP gre.ue

kcmsis via F..sting dccre:t...o;ed rhe durarion, s.cveriry, and number of

seizures.

Immune and Inflammatory Disorders

The beneficial df("ct of fasting on ccrt:lin autoimmune di~es
was reponed in Lmr.c(t in 1958. The rese-arc..hers found rhat fasting
shorten..-d the early stagc.s of acute' glome.rulo nephritjs (reduC<'d
glomerular fi lrration rate, high BP, and edema}, thus improving
prognosis. Tltey condudcd 'hat "aU pa{ients with :acuce glomeru
lonephritis should t'ast."63 Oth..-r autoimmune dis..-asc:s that have
re-.sponded ro f.1sti ng are t'Osacca, sys-rcmic lupus eryrhematosus,
chronic urticaria, and colids.40.64.6S
lhe subject ofarr.hriris and f.ts ring has rccei,ed suhsramial arc<:n
rion in 1he !ieiel'uific li1er:uure. wirh mosr of 1he rese:.rch co mine
from Scandinavia. SciC'ntisa docum..-nted the a ntiinOammatOr)'
effectS of fasting wi rh o bscrv:uions of' decreases in the er)'thi'OC)'l<."
sedimentation race (ESR}, artl1r.algia, pain. S{Hfnt.ss, and need for
mcdicttion.-'3.6672 Consistent wirh rho.sc- fi ndings, a 1984 U.S.
srudy of 43 pacienrs wi{h dcfinire or classic rhetnta{oid archrilis
found significant irnprovt:ments in grip Str<ngth, pajn, sweiJjng of
proximal interphala ngeal joints, ESR, and funcrional activity after

a f.>S< of7 d)'"'

A strong link betwec'n arthrjtis and f'oo d intolerance has been
20S). 1be diminution
in symptoms of' rheumamid archrilis durin.g Fasting may b..-du..- to
the decrease: in gut permeability that accom panjC's fasting~6ll which
would -educe dte absorption of anrigenic molecules: inro the blood
~vea led duough f.-.sring (see also Chaprer

th :\n I SO mm Hc,) t:h<: av<:'rac,c reduction in ~}'<lltolic BP <:xttcd(:'d 60

from the &ut roin t<:3tinal tntct. In a l9S4 olltud.y in Bullctit~ em

poinrs. "rltis is rhe b rgesr d fecr ever publislned in rhe scientific lit
t raturt:. Nine monthslarn, Goldhanter t t aJ'.i'.i reported on a study
involving 68 consecutiv(" patient.o; with borderline high BP. 1lte
3\'er.lge ending BP in rhese subjeccs was 99 m m Hg S)'scolic/67 mm
Hg diastolic. Jn a leuer to the editor publis hed in }oumal t{Alkrnati~ and Camplnnmrary Mt'didne in December 2002, Gold
hamerS6 described initial results in 30 patients with high BP
participating in a residential he-alth cducatjon program that
inc.:luded the supervision of waceronly fasring for <lll a.,cr.;age of
14 days. BP. weight, and cost of U'(atmenc and medications were
compared for the ye-ar be' fore and the year after lasting. Pre' lim inary
d2ta demonsrra{ed .susmi1t<::d dinical improvemerl { in terms ofBP
n-duction and weiglt t reduction and an a\'e rnge n'duction in com
bined mcdic:tl and dng cosrs of almosr $2:700 per )'e:tr per .subjecr.

Rlmmuttic Disemes, Panush73 proposed the fo llowing theories: ( I)

nucrit.ional mod ification might alter immune responsi"end'.S and
thereb) affect manifesc:uions of rheumatic diseases, and (2} that
rheum:nic d isease m:t)' be a manifesra rioJt of a food allergy or
hypt rsc:nsid vit)'
f..lsti ng, in conjuncrion wirh f'ood challenging. is now being
used as a djagnostic {eS{ ro de{ermine food intolerances. Patieots
fast f'or a minimum. of 4 days, and then individual foods arc given
to determioe whecher a reacdo1l occurs. llt is me1hod correbtcs
well with skin pridk a1td ra.dioallergosorbe.nt tesri ng. A leuer itl a
1984 Lanut issue start's, "\Vhen food avoida nces prevent head
:.tches, [irrirnble bowel synd rome], arthralg ia and depression. his
more' df..-ctivC' and less costl)' than traditional treatment a nd th..observ:nion also rhrows light on rhe etiology ofrhe di$0rder."' 1"

Diabetes

Obesity

Guelpa r~orded the btndlts of fasdng in typt- 2 diabetes and gout

as well as in inRammation and after ~u rgery. 57 'fhe tre:trmenr of
diabetes with fas ting was fu r1her explored by Allen i l't 1915. He
noted chat rest nnd fasting usually stoppe-d glycosuria, and he also
observed improvements in gangrene and carhundes.S3 In l950,
Keys aJso noted improvement in diabetic patienu.J Over the last
25 )'cars, type 2 d iabetics have succC'ssfUIIy fasted, with subsequent
l'(ducrion or elimination of required medic.::ltions {hrough success
ful longtcrm fo llowup. given appropriate' lif'estyl..- maintenance'
posrF.t.sting.S9

Fasting fo r o bt"Sity has prObably n!'Cctivtd mor~ attc:nrion in the

scienrific lit<'r:lture than any other aspect. 1 he earliest sn1dies
wel'e conducted by Folin .-u~d Denis, SO who i1) 19 15, advocated
short F..sts as a safe and efftive way to lose weight. Bloom/5
Du ncan et ai,44.4S Drenick er ai,SI,76 and Thompson et n JS ~ pub
lished numerous works on the use of short and long fasts in obe
sity. Perhaps the most fa mous study on obesit)' appeared in the
Postgnuiuat~ Mt>dicill journal of l973, whi<:h reponed rhe ex peri
ence of a 27yt'-arold man who fasted without complications fo r
382 da)'s and losr 276 p<>unds.Sl
In genentl, initial weigln loss during -..sring is a.pproxima{el)'
0.30q.~ of body weight per day, with a grad ual decrease: to 0.10%
per day afrer 30 d:.ys. 1he initial weight l-ost is primarily rhar of
water, glycog..-n. and sah. For evC'ry pound lost, the' body IO$eS
approximately 140 g of protein and 250 g of fa r.14
Although fasting. is very effec6ve for weigh t reduction. fasting
alone, without counseling and oth..-r lifestyle modifications. does

Epilepsy
Tlte treatment of sdzurf!S th rough fasting b<'gan in the early 1900s
in l~rance by Gudp:a and 1VIarie.60 In 1924, Hoeffd and Moriarry61
described fasting's bene6ci:a1 eff'ecfS in epilepsy. In 1928. concur
ring with othC'r rf!Searc: h..-cs, Lcnnox62 found that the induction of

nor <"nsurc long- t<.'rm m:tinrenanc<.' of rhe lower body weighr. Thi5'
fact is well documented in a Sh.dy of 12l obese parjenC$ who were
monitored for 7.3 y~a rs after Fasts tl1at averaged 2 monchs. After 2
ro 3 ye:tu, 50% of patients returned tO their pre-fast weights, :md
by the end of d1e study, 90% weighed! the sanu: as before th-eir
f.tsts. 77

Pancreatit is

ill a 1984 t<lnd omiz.ed dinical trial {n 88), fasting was determined to be the treatment of choice fo r patit'nts with acute pancre:niti.s. llle resear<:h<"rs s1ggesred th:tr "filsting :tlone be in itia lly
used as the simpler and more economical therapy." They found
rhar "'neirher n::.5Qg:anric sucrion nor cimetid ine offer ::.ny :td vanrage over f.1.sring alone in rhe rrcarmcnr <f miJd ro modct':ltc acute
pancreatitis of any etiology."73

Unfortunat<"l), determining opTim:tl f.tst length i5' d ifficulr ro

pred ict and includes many factors, it\Ciuding size of resel'ves, individual metabolism, financial Hmic.uions, work schedule, S<v~rit}'
of d isease, age, a.nd sex. This dision is h:u<."d on ::.II facto~, especially the patient's mental srace. Experiti.Ce shows that exrending a
fast herond a healing crisis (or notewort:hr d etoxific::.tion reaction)
provides signi6ca.nt clinical benefit where stopping midcourse
ruppressc;os healing until thc;o .sam<.' symptomatology appears, albeit
c:;~rlier, in the COutS<" o f a subsequent fast. Ovcr.~.ll, "lthej doctor
will look for good pr~ctic-al recovery where patient is symptom
fn-<.' and .signs of rc;ogc;onerarion ar<.' prcst'll.t."]\)

General Princip les

h is important to recogniu- chat thc;orap<udc fasting can b<.'

viewed ro h::.vc: rh ree sr:agc:s or phase$. Stage { fas ring (also called
early o r turbu lent fit.sting) lasts up to 7 days. as rhe body adapts to
f.tsting physio logy with the: common symptoms of excessi\e cellular waste or slowed dim inarion-mabhe, head::.ches, and musde aches-that are generally transitory, but can be d isconcerting.
Only the most genetiCllly Clpable detoxifiers or the lc::.st roxie
individuals glide comfortably th rough this stage. After passing
th rough th is period. it is more .,the mind" rather than "the body"
d1at continually obsesses on eating. Stage II, or balanced fasting,
is the nost significatu fasting stage, as ~temodeling of tisstes promotes healing. lt nn l:ast fo r wc.ocks to months. Patients oft<.'n
experienc-e one or more ''healing crisis:" (w he ~ cluonic conditions/symptoms bc;ocomc;o acutc;o) and/or go through less significant
d etoxi6cacion reacTions. St:tgc Ill f.1sring is often called depleric:m
fasting (or simply "starvation") as the body c-an no longer eff~c.
ti\'dy or d licic;orutly mobiliuo F.u stoft's. Although many o ld t<xts
refer tO "fasting TO completio n" (i.e., c.xhausrion of nutrient
rtsen'ts), this prac-dce is now uncommon and not usually ne~s-
s.uy/' :IS serial f:a ning after ap propri:ate refe<."ding appe::.rs to be= :l
safer <~lternative.
\Vhcn we fast, we recreate the natura] occurrence of our ancestors when :1 " late spring" meanr depleted food r<'-servc-s followed by
unintentional fast ing while waiti ng for the snow ro melt and the

lhe use of a low salt, vegan, high fiber, low f.-u, low protdn, and
low sugar d iet b-efore and aftc;or fasting has been found beneficial
::.nd :tvoids com~lications of fasting. This d ic:r ::.Iso promo res p rt:fast bowd movtJnent:s and Stb~uent post- fast bowel movements
rhat art: sooner co C"\'OI\'e, easier to pass, and less p roblcm::.tic. (To
commenc-e f~stilg, boweJ mow;rnent f1-equency rnust be at least
d aily.) Using broth or fruit and ocher juiCt$ art examples of
restrictcd d iets. The)' d o not initiate f.tsting met:lbolic processes
since they contain carbohydrates, protein, and/or fat. Nonetlh.elc-ss. nostricted diets arc often usefUl b<forc and after f.tsting :;~nd for
patients in whom a hea)jng crisis develops d~ i ng :a fAst o t when a
fasl is conlraindicat... 80 (n most cases. a fasr is supc;orior to c:he
restricted diet because {1) hunger almost totally d isappears,-'44
(2) ketosis Q<:curs more quickly and efficicndy,3-'4 {3) film ine
edema does not occur~:l {4) sodium diu~sis is more pronounc<!,75
{5) weight loss i.s more dmmatic :and is from f.n u rher rhan protein stores. {6) healing time is shorter~ and {7) patient strength
m:l)' be greater.8 1
Individual var-iarion (predomin:tnll)' d ierand lifcsry lc: hisTory)
dt'ttrmines t he Bevel of com fore experi-enced through the mobi ~
liution process of fasting from the ini ti::.l tr::wsition of utilizing
energy scores frorn digestion and stored glycogel't to rhe energ}'
gcner::.tion from gluconcogcncsis :and the P-oxid:ation of tr-iglyccrides.
Rest is a most import~Jlt aspect of the faSl a11d patientS may na.p
th roughout the day. Less sleep is common at night, possibly owing
(0 the decreased d~ily activity and the inc~se in d<l)'time rest.
Exc;orcisc;o while fasting is discouraged. Fuel conservation is ne"Cessary ro :tllow m:tximal hc:::.ling and rhe avoidance of unnecm:uy
gluconrogenesis.3 1.8 2 1l1e body u tilites ~rcain muscle prOtdns
early in a F.m, thus initiating th<.' natural rt'.-slTiction of activity.
Shorr walks or Hghr srrerching is permissible, but intense execise
inhibits repair and eHmination. In serious c-hronic diseas~. an
excess o f activity h:as been suspted :IS c:ause of dearh d u ring f.uring.83 Even moderate ac1ivicy can double caloric ttilitation.M
Sunlight is imporunt for gencr:al health d u ring f.tsting, and
patients should rtry to obt:ain 10 TO 20 rn in/d::.y. Sun dehydration
does proll\ote orthostatic hypotensioi. and sub~ueH injur}'

n~w shoots

volunrnry :md 'ltt~ndC"d

from fulls. An incr.ose in hem rate of 10 to IS boots/min may

ther:tpeuric fasting provides the oppol't:unity to mobilizc: or p~el

back th c;o layers ofour .structural and fun<:tional adaptations within
and betwttn cells rhar arc no Ionge rcq uired or beneficial. lhc.refore,likc an onion that may have a superficial bruise, during a fast,
tl1c;o body "peds tht' onion" by deconstnoeting the buttressing ("the
d ise:tse") hack tO a healthy vital core or f>Otmd::.tion rhar health e~n
be buih upon. Thus, a health promoting diet is pivotal to growth
::.nd maintenance ofhe:tling, ::.nd further, even with shortcrannu::.l
fasts, allows less syrnpromatology and tile ability to rerajn vitaliry
throughout the year.S9

indieoHe excessiv.c sun exposure.

Pure watC'r {distilled, fi ltenod, or re,<rsc;o osmosis) is nocomm<"ndc:d.81$ZRt:5earcher$ of f.tsdng obe~ indhiduals of'ren re<:o;mmend 3 Llday,2:4 -and 64 to 96 oz/day is commonJy adequa:tc,
although upwards of 160 oz. is common ly ingested without affecting senun sodium St:ltu.s. Although iflcrc:~scd ware inrake will
allow for l<ss detoxification r<actions during days of gr<at<r mo bi~
li7.:tTion, excess consumption will e:tuse elecrrolyte depressions rb::.t
are eHnicaJI} significant and require refetding. PbysiologicaHy, t:he
body is able to modulate ''available water" through reduced

~ APPLICATION
ll1erapeutic Faning is best conducted under supervision at an
inpatienr Facility. Such fadljties will exercise care in terminating a
f.tst and super.ising post-f:ast recuperation, monitor b bor.ltory
vaJues in light of fasting physiolog}' review imaging as necessary,
and d<.'monstratc.- prudence when using adjunctive th<.'rapies during f.1.sting. Scvel':ll facilities now exist in rhe United S!<lt>CS,
Canad a, England, and Australia, and chese cc;onters fo llow the
standards of cal'(.' and p rinciples of ethics established by the

IAHP."

to risco for

susr~n:lllCC'. Today.

obligonory water exc~rion (owing to lower o:cretion of urct, rhe

maJor o.smotic: solut~t) and by accw to released water from catabo~
liud fa t. 16
Laboratory tests such as a compkte blood count a nd ~rum
ch~tmis ny &erttn a usually p~trformed weekly aftd othea are per~
formed as necessary. Regubr u ri ne teSts a~ performed and ''ital
signs .arc checked daily.n.ss
Upon n.-fttding the:re is a sudden shift from a low insu1in. f.nbuming mcttbolism to a high insulin, glucose-based nate. As the

indicating mobiliution of ti.o;suc stores. Post-fast value.o; often show

a docrQSC: from prt:fast va.Jues,..,-'1.91 but lipid panels will noc show
a new base lin<' value until4 to 6 "'eeks post~ fast. lhe St"rum prOtein
V'.lluc usually de:dincs with fasting. Pancrenic lipase and amyi3.SC
values also usually drop with Wring.as
A rise- in blood urC3 nitrogen (BUN) w luc may occur, but
$0me authoridcs have observed a decrca$e.J.6Z.-4l The $erurn creatinine' ''alue may be <'k,ated 49 .15 or may r~main scable,9> and
depression require's prompt retesting or fast termination. Closely

pbsma insulin rises. potassium, phosphote, and rngnt$ium ore

moni10r crea1inine for

d ri,C'n intracdlularly and sodium exttacdlularly, acting to e-xpand

;and dilute rhe circul:ning ''Oiumc. Sod ium restriction during
ref<'t'<IJ ng th<'n-fo te should b.: emphasized to not pr:ipitat<' di lu~
rion. edem::t, or acute heart bilurc.16

renal

~ LABORATORY VALUES
MO$t labor.uory values for body fluids du ring fasting do not fo l~
low speci6c panerns, but :tre unique to rhc individual and the
d i.se.ase proccss.J2,S2 .AssessmcJH of a fasting patient's ptogrcss is
based not on a sign or symptom, but on the tocal clinical pJc ..
rurc. Although spific prcdiions of labomory values during
fa.scing are not possible, some geoer.al observ~uions have been
made.
Urinalyses may be d ifficult to inrctpter during f.ucing, bcause
the body discards considerable: wast<' ''ia th<' kidneys. n [t is not
uncommon ro ~e various type-s or casts, n.-d blood cells, white
blood cdls (W BC), bilirubin (+I ro +2), prorein (rraee, +2), ond
k<'tones (4). and, if liver diS<'.ase is p re-sent, urobil.inog<"n dC'va
rion. 1~rncc leukocyte:s and blood arc common incidenral 6ndiny. particularly in wome-n. Speci6c gnviry is commonly
ckv.ued (possibly to 1.035), a finding that may rcAcc:t inadequate
hydrarion.11
Complete- blood counts usually .show no sig.ni6c:ant change-. 77
low hemoglobin and hematocrit values have b~n obscrvM;U..SS..$1
requiring rule out of he1nolysis or hemorrbage, 85 whereas dc:'\a ~
tions in hematocrit. hemoglobin. and~ bk.od c~JI count usually
indicate reduced hydtatioo.n ...8S.I9 \VBC count$ 2J'e uSU2Jiy
unchanged or decrease sligbd)1 with fasting; howlt'-er, il'tfcccion
m.ay cause om incl'eOLSC'. Funhcr, \VBCs may incr('3S(', particularly
if levels <He low before F.lsting.88
All o f the dectrolrtes ha ..e reductions O''<'r tht' long term a.s the
body's mobilb.ed StOre$ ate lost, bur it is signHlcant ro note rhe
ability to n:distributc- store$ C""ven with o nly d.istHied water during
extende'd Fasts. &rum dtrolytt' l<''ds arC' not good indicators of
ri.ssu~ stores. but they :He considered the mo$t import:tnt blood
va.Ju~s during tasUng.u because the-y usually do not c hang< sig~
niflcantly during f.tsri ng unle..o;s there is :a concern that needs
rnanagement.
The total body store of sodium is 83 to 97 Jt (of wh ich 65% is
cxch:.mgeabk), and th-at of pot3.S.Sium is 115 to 131 g (of which
98% is exchangeabk). TI1e ()'pial daily dieta.ry intake of sodium is
3 ro 7 g, and or potoassium. 3 to 5 g.90 During carl}' Wring, the body
lOS<$ ISO ro 250 mEq (3.5 to 5.8 g) of sodium and 40 to 45 mEq
(1.6 to 1.8 g) of potassium a day; latC'.r, theSC' 'oalues drop co 1 to 15
mEq (0.02 ro 0 .35 g) ond 10 ro l 5 mEq (0.4 10 0.6 g). r<specmdy.
Serum pocassium U5U<tll)'dccrcases (but may ~me dC"oated) and
values less than 3 mEq/L or above' 6 mEq /l orten R'qUirc brea..king
of rb f.t$t lb tl..:rml)t-s ulciu1n and chlorid ,,.. U$UJly sub!.
but IC"\els often diminish. <'spially if ''Omiting is prest":n t.48
li\'cr eOZ)'IJllC \':tluc:s m:ay increase considerably if Ji,"Cr disease is
pre5o(nt and may rise even if .livC"t disease is not present.. Triglyceride.
cholesterol. and urk add bds usu~ly riS< during fasti ng.I S3I.92

elel'~lions,

p21ticulrly in 1hose wi!h

compromise'. Blood g.luco.sC' value's drop in most

pricntS,O.Si.6l.6' po$Sibly below 30 mgldL. If rhe blood glucose
valu<' is low b.:fore fasting. il may ri.k' aft<'r fu ting. ESR and
C-reacti,<e protein uswlly d rop :afrer f::tsri ng, :althoug h they may
rise d uring the fas:t.6S."1U~
Hormonal changes during fastin g typical!)' con.si.st of decrcase.s
in in.sulin 16.20.lJ.U.9-4 and tfll'roid ho rmone levds.~.323S Increased
level$ of growth hormone.1-?.Ju~ oortiso1~8'9 glucagon,l6.!0 pla$ma
norcpincphrinc,96 serum melatonin,96 :a.nd certain prosctglandins
(in animals) u.suaUy occur.,7 ln contrast. a decrease in growth hormone: is usually found in o be.se individuals) 2 In one study c:onduc:tcd in I 0 ponmenop;~usal women who underwent shon -tcrm
f.u ts, no signi6ca1n changes in adrenal hormones. androgens.
serum and urinary estrogens. plasma epinephrine, or dop:.tmitlC'
were rccotdcd."
After 3 4<1 day fast, the following changes were noted in less
commonly ordered b&oodwork-clevations: cortisol. somacostarin, iruuli;t-ljke growth f2c ror-binding protein I; very k.w levels:
k ptin, ghrelin. insulin like g rowth factor J; nonnal ..alucs: p<pride YY. agourirdated pcptidiC'., Cl-mcbnocortin-srimula.ring hormone. neurOpcptide Y, and pro--opiomelanocortin.98
4

Adjunctive Care
Some medical studies ~commend s.upplcmencnion with vitam ins, fruit and ' egetablc j..ic.c:s. acaloric 8uids (coffee, tea~ etc.).
and drugs whik the patient is ._f.ts ting. These practices have nor
been sbown to produce any advanuge, and s.erlous problems h3vc
sometimes occ:urred, especially when nonessential medica lion was
pcrmined.

Dietary Supple,.ents
Loss of minet:als or vitamins is u.su:.lly nor :a concern, and ddicicncies during fa$ting are ra~. Problems such as nauka and indiges.tion \\('f'C' reporud wbC'.n mineral and vitamin supplem<'nts wc:n.raken during Ea.sring.76..'J 1:ot cx:ample. it is weU known that nicotinic acid suppkmc:ntat.ion inhibits the- rdc-all<' o( free buy adds
from 3diposc tis.suc.24 In o ne parie:nt in w hom vitamin ddlcicncy
was RpOrled io the Jnedicallit't'rature, the actual fasting protocol
was not described; in addition. the patient's phrsiol activity Vlo'3.S
not restricted and oral medicuion for intercurn.-m illness: wa s
maintained during fasting.76 Vitamin and mineral excretion
becomes very low after I 0 days.
Enemas
Enemas 2re not U$uall~ necc.ssarr and do nor ge:neraiJy offer any
added bcnefh during &ning.66 Some :audtoridc:s h:ave found that
C'nt'mas also cause d iscomforc.11 To hdp pn-\enc constipation, pn.--

f" mt1ls of only frtsh fn1ir nd v.g.rbls for., ltsr 2 d)'$ will
assis-t in establishing proper climinadon before dte fast is initiated.
Lack of bowel movement 3 to 5 days post-f.ut (particular!) on
longe-r f.uts) may point to the nd for stewed pru nes with meals
until resolution or an enema bC"C..m~s nC'CC'$s:try.

Hydrothrapy

Constitutional hydrocbnapy and sitt baths have bn im ple~

mc.-nced Ytirh F..sring. Strong t~atmc.-nts. both in Frequency and/or
fC' In pcr:UU~ intC'f'V:ll lli::t.e. to.hould be li mit~

tO

~rly r:aning.

rr.sume.8 1 Although f.tsring is conside red inappropriate in renal

insufficitncy,Z4 w(" ha,e srtn patients with 659(, tC"nal function
n:-tum to normal as a result of fasting and di<"tary managem~nt.
With ~aard to fucing co nt~indK:atio n~: in sei'~Dt Bunon..,

Stated:

Intravenous

Tb~rapy

lorravenous admini$t.ra0oo requires much a.re: and is bCSl avoided

entirely. c.-:tC4!'pt fo r emergent cond itions. Saline should be a\oided
due ro pbsma expansion ::and odc:ma, which has prcdpit2tcd acute

he<lrc fitilurc. Glucose, in COIHrast, should be ;a~mpanied by vita

min 8 1 and 8 6 coadministration to on"Oid acute thiamine defi

ciency and betic acidosis."

Pharmaceuti cals
l11e primary concern off.asting medkated patients is pOtentiation

of pharmacc:udc action during fasting physiology. SpcdficaJiy

rroubling is rhe potcnri:arion of rhc known mechanism of acrion,

urinary/hepatic metabolism. as well as known side effes and

adverse C\c:ms. Appropriatdy Kmoving phannaceuriols allows fo r
ease of clinical assessment while ensuring patient safety. Successful
fasting hou hn con tinually repc'ated whik maintaining .some hormo nal medications (insulin, thyroid, and reproductive orp.n hor

mones. often at reduced dosage), but not";tb.adrenaJ maincenance.

~ CONTRAINDICATIONS
Concr:aindiarions tO fasting are few, and each case mun be judged

individuaUy. because no fYo"'O cases arc alike. For example, an inex

p<ri t:nc~ practition~r may as:sumt: thac ~maciar~d patients should
nor f.ur. but :about th is issue Shehon3 1 had the fo llowing to s~y :

"'Extreme emaciation: In .such cases a &ong fast is impossibiC'. A

r;hon f.ut of 1-3 d ayr; may be found b.enc:6cial, or a series of such
shon F.tsu with &o~ger periods of proper feeding inter,-e:ning may
be found advisable::.''
Comr.1indicacions to f.uting include SC'\"C':re anem i~, porphyria,
:.u)d serio'" malnutricion. lndivid uaJs wid\ a rue fatty acid de:6~
c ie ncy of the e nzyme medium-chai n acyi-CoA dehydrogenase

should also a'coid fasting.10

Tl~e f.utiu5 uf .._]~ j )J~CU .t.~.J .II C!)U.t.U t 'WVUieU b \.UUltVVCtlli...l.
Although a shon f.tst is appropriate for the sick child who does not
w.tm {0 eat. f...sring in a pregn:ant wom-an may be srrongly conua
ind icat~d ; k<tosis in p~n.ant diabetic women is kn own to be asso
dared with feal d:tm:a.ge. Alrhough rhis :a.s.sodarion is common ly
~oogni2:c:d, th~ fact that this information has GOm~ only from
re-search of diaberic pregnant wo men is nor as widely lcnown. 100
lhe ~ appear h) be no srudies of rhe dfa:u of lOndiaberic: kerosi$
on fetal d('dopmc::nt. Doctors (e.g.. Shehon, B~n~sh. Sich,ha. and

Burron) with consider:tbk experience of F.asring pregn..1nt women

during aU three trimester$ have found no ad'\erse effecu with fas-ts

of a f~ days to 2 to 3 weeks. Although rhe f.tst ing of prc:gnam
women appears from cllnk:al observo:ation robe s:afe. definitive pronoui\Cement ea.JHlOt be made 1.uuil card'ul research is performed
{such as a controlled Kuospecrive analysis of existing cases).
Fa.su for child ren and prcg~unt women should be s.honer :and
should be mC"ciculously SUpc'rvised by an nperienccd doctor. In
11,~ Stinru anJ Fin~ An fFmring, Shdton 11 wrore, "FC"W inf.ln rs
~uin- more: than 23 days of fasdng.... I haYt> nev~r hc:.sitatcd to
p<rmit a sick infant to f.ut and I ha\'~ ye t to S o nt> harmed by it."
Re~rding pregnancy he ~=lid, " 1he author would object ro a long
fast in chronic 'disc:as<' during lhis pniod. The-~ can, ho"<'' 'er, b~
no objecrion ro a short f.w."
h is well r<>gnized that f.asti ng during lactarion is not gen("raUy
advised. bccau5e milk Row is halted by fasti ng a nd is difficult to

I h~tve found frw bcah/, probkms wbieb are nbuJ~~t< Nmtrairuli

f.uti"t /11 my L'Xfl'rintu, 1/ tlu 11uJ is n~idem, th'
tm/y gmuilu ctmrramdicarion 1s .foar. . . . A.s for tiN orlur cond,.
ti-Dnt ofim mmtion.t'd, <"K k;J,q JisetiJe, burt impnirmmt,
~miom to

/tubtTm!osis/. nr., rJuy mt'"/y rrquirt' tXtrmu cnMtion, b<"cnm'

f the lim ill im~ hy pathef#t.T. but tiJty a" 1utt inexombk
~Dntrnindiratiom.

Supervir;ed f.tsring as a therapeutic procedure is ge:nerally safe and

df:tiw:. 'I he incidtnce of ddth :u f:u-ring in.srirucions is low, a f.Kr
that is promising becaust> many of the patit>nts ha'"<' SC"rious chronic
disr::tSe:s 2nd havt o:hausted oth~r therapeutic oprions. O f the hun d.ttds of cases of fasting de$Cribed in the scientifi<: liter3curt, only
SC''\"'C'O cases of death weK reported lx-:forc 1 985)6.tl,I OI 1 ~ In :a.ll

the patienu had serious chronic disease before &.sting, and in

6'-e of the seven cases, drugs were given to the pati~n ts whiJe fast~
ing; in the other tYi'O, no d escription o f protocol v.--a.s provid ed.
There is oo evidence in c.he scienci:6c Uteratu.re: to suggest that f..st
ing itself can be considered a ou.sc of death . Death duri ng &sting
lndicates lh.;.r me remedi:l) effortS of rhe body ha'\"'C' been 0\'erpow~n:d by th~ patbologk pl'(.)(:<'ss. This situation occurs in S(rious cJis..
C'aSC', whether the patient is eating o r F.ts-ting. In examining thcfalbcy of :tnribucing the cause ofdcu:h to fasting, Srew2n a,nd Fleming105 wrott>, "Fasting short of ~maciatio n is not hazudous; if dath
rewlu, reasons other than rh~ of the fast should be conr;iden=d
b<fo.-e roncluding that all supervised f..sts should b< discouraged."

cast:$.

f'J

SIDE EFFECTS

Side eA-"ects of F.asring are randy serious, but f.uting may u nCO'\"'C':r
disease and rcvc:al weaknesses that were previously subclinical.41
Discomfort during fasting may be due to withdr.tw.al from stimubnu.. hypoglycemia. acidosis, elimination of W:I.S(C$, -and enhancement of repair. r .uicnu may e-.pe-ricn"e hc~d<~.;ha., in&Omn.i<~, ~kin
irritations, d izziness. nausea, coated to ngue. body o d o r, aching

limbs, palpit:oations. mucous d iscM.rge. and visual and bearing disturbanc~s. Hair growth is u~ually am:"sted . and slcin may become
dry and scaly. Mosr signs and symptoms a re uSU2lly brief as rht
body works to n:mo"e the:: disea.Jo~C.
In certain casc:-.s.. complicadons occur that m ay nC'Cesshatt> breaking rhe fast early. Example$ o f such conditions are :as follow$:
A wdden drop in BP (possibly due lO pedph<ral cin:ulatory
collapse)
Ddiri u m
Prolonged hypothermia
IUpid, .slow, ferbk, or irregul2r pulse
E.xtKme weakness
Oyspne.t

Vomiting and diarrh~ leading 10 dehydradon

Gasuoint~scinal bleeding
Hepuic d ecompensation

RenaJ h)suffi.ciency
Se\ere gout
Cardiac arrhythmia$
Emotional d.istrcss
Fasting ele-..".lte:s seru m uric :acid \'Aiues and uric :acid excretion,
and if Au id intak(" is insufficient. gout or renal .stones may be pre~

dpitatt>d.l<I.I06

A few studies have d iscussed rhe development of \'(/ernicke

encepha_lopathy during prolonged fasting, bm bcause h mrcly
oc::curs during tl~trapeu tic lasting, it is difficu lt to d etermine: whech~t r
the condition is reb ted ro method ology. It i. <> importtnt, however, to

acknowledge the importance of utilizing 8 via..n1in.s, especially thia

m ine, when any F.tst is broken with inmveno us gluco.sc.107,I08 The
de<:ision to termin:ne rhe fast should be based on the complete clinical picture and l'l Ot on an i.solated sign or syrnpton

~ CONCLUSION
llle ,~~sr pOtemiaJ of rhernpeudc F.tsring is only beginning ro be t'C:'lliz..-d, although n~suhs have hn rt'COrddl sine..- the ~rly 1900s.IO.,..l l4
Consid~trabl..- <'mpiric sn1dy has been accomplished, and fasti ng is
gene1':lll)' a safe, econom iCll, ;llld effective rhempy. xtensive rc.<ie:lrch
reve1lod per\'asive a1ld imporranr effects, including the eoh:mcement
oi immun..- sysr..-m function.70.S?.II5 118 Unfortunately. a lot of preju
d ice exisL<>. \'(/hen we fast or a.<>sist another in &sting. perhap s the

deepest human instinct is str~ock at depth--our need to eat, to sur

vive, to exist. Th is o ften prevcntli otherwiSC": intelligent an d openminded indi-viduals from considering the &cu regarding fa.sting :.\1\d
its unique bene6ts to huma1\ evolution and eve1\ health. l l1ere have
bttn trag ic d~uhs from f.lSting (almost e xclusively inappropriately

n pel'\'ised), but fasting is nor synon.ymous with sc-.;.rvation as our

" instinctual SC"lr woukl like' to hav~t us bdiC've. lnd i"idual c<"ntC'rs
ha"e succe$Sfully supervised rhe f.1sts of ove 7000 people without
fataliti~ 0\'t'r the 1-a.st 27 y~rs,59 a nd as mo~ apprccialt' th~t "'h~-aling
pow..-r of naturt'," this therapy will bccom..- molt' mainstram.

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