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Features of a successful therapeutic fast of 382 days' duration (1973) [pdf]

148 points| joak | 6 years ago |pmj.bmj.com | reply

154 comments

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[+] PretzelFisch|6 years ago|reply
I guess that's why the body stores fat in the first place. Having done some intermittent fasting and a little 2-3 day fasts, I have seen the longer the fast the less urgent my hunger pains felt. This story is probably great motivation for some redit subs. https://www.reddit.com/r/fasting/ and https://www.reddit.com/r/intermittentfasting/
[+] hyperdunc|6 years ago|reply
I did a nine day fast and the first three days were difficult. From day four I was not hungry at all but also felt noticeably weaker and couldn't do anything strenuous. After nine days I lost 10kg and six months later had only gained back 3kg. But the best thing about the whole experience was redefining my relationship with food. I appreciate and enjoy it a lot more now.
[+] xanth|6 years ago|reply
Having switched to eating once a day four days of the week with great results and no adverse effects I cant help but feel like there was a concerted misinformation campaign, to have us eat three times a day every day.
[+] ajmurmann|6 years ago|reply
I did intermittent fasting for a while and want to go back to it. I in essence just skipped breakfast and ate a little later. It was astonishing how easy it was and how well it worked. But also how many comments and even pushback I got about skipping breakfast. I constantly would hear from someone how breakfast is the most important meal. Anytime I didn't feel well, regardless of symptoms, friends and family brought up how this is likely because breakfast is so important and I keep skipping it. Skipping breakfast seemed upsetting to people. I also didn't take the comments well, because to me it sounded like unfounded folklore nutrition advise from my grandma en par with "an apple a day keeps the doctor away"
[+] jahewson|6 years ago|reply
Eating breakfast was historically seen as a sign of weakness; a meal for children and the elderly. This changed in the 1700s and the modern concept of three meals appears.
[+] stevewillows|6 years ago|reply
I've been on about one meal per day for several years now. If I do a full brunch/lunch and late dinner, I feel so heavy.

I typically do a scoop of chunky peanut butter or some yogurt in the morning with coffee, then nothing until dinner. If I'm cooking, then I'll also snack a little while I prep. Usually at some point after dinner, I'm having another scoop of peanut butter.

I don't think this is for everyone, but for me it's perfect.

Years ago I would fast on a regular basis. Typically 1 - 3 days. It's something everybody should do once, even if they don't hit their target.

Like jahewson said, breakfast wasn't always a thing for adults. I'm not a nutritionist, but unless I'm training for something (which I am not), I don't see how my body could put three meals to work.

[+] ngngngng|6 years ago|reply
I don't get y'all. I have to remind myself to eat and stuff myself at least 3 times a day just to maintain weight. If I want to gain, I have to set an alarm to eat a meal every 3 hours (minus when I'm sleeping, that's sacred time)
[+] kempbellt|6 years ago|reply
This really depends on what you are doing with your day.

If you're getting up before the sun comes up to plow the fields all day, you'll probably eat more food to account for the amount of calories you burn.

If you're waking up around 8 or 9 to start your remote desk job from home, you can probably get by on a couple small snacks per day, or one meal.

The concept of a desk job is relatively newish, historically speaking. We've been eating a lot longer than desk jobs have been around.

Calories in vs. calories out

[+] ianai|6 years ago|reply
Totally sounds like a 1950s post war thing. The stereotype Americana decade.
[+] not_a_moth|6 years ago|reply
Even if you're not obese, fasting appears to be one of the most healthy things you can do for your body. Low insulin variability, autophagy, clear out visceral fat on organs, yields extended longevity in lab mice, etc.
[+] WilliamEdward|6 years ago|reply
Been fasting on and off for a while now, maybe 1-2 days every week. The effects are immediately noticeable, on about day 3 i feel better. A week later i see the weight loss, better skin, etc. It's a good feeling that everyone should try at least once.

Disclaimer: I eat like garbage so it's more likely that not eating garbage is having these positive effects, not just fasting.

[+] rpmisms|6 years ago|reply
Unless you have low body fat, which is less common than it used to be. I maintain body fat under 7%, and I have to eat regularly or I will become very ill very quickly. If I'm to fast, I have to cut something from my diet, not cut my diet.
[+] diminoten|6 years ago|reply
In no way is fasting healthy for you if you rely on having energy, focus, or any ability to function as an independent adult while fasting for more than a day or so at most.
[+] siliconc0w|6 years ago|reply
I used to be a much larger mammal and lost a lot of weight (100+) through fasting and diet change. Longest I did was a 14 day fast with zero-calorie electrolytes, black coffee, and sparkling water. You get pretty low energy but the hunger just kinda subsides into background noise. I still try to do a 5 day 'reset' fast every quarter or if I hit 200. Diet change is really the most important factor but fasting is a nice tool to have because at least for me it's relatively easy and provides quick results compared to trying to maintain a sustained calorie deficit for multiple weeks. IF is, of course, likely safer so definitely start there if you're new to the game.
[+] lostmsu|6 years ago|reply
During these 5 day resets, are you as productive (important: not 'focused') as usual?
[+] crazygringo|6 years ago|reply
I mean, sure. I've done keto, I've fasted for several days, it's fine. I personally would have eaten some cruciferous vegetables since I don't trust multivitamins to provide everything, but sounds like he did fine.

My only curiosity as a strategy for months or over a year is if the lack of any protein whatsoever has harmful effects.

I was under the impression that some level of protein intake was necessary to maintain muscles -- something that burning fat doesn't provide.

I'm wondering if he had any muscle loss problems? Or if his leg and back muscles were already so extremely overdeveloped to support his original weight (as is normal), that as they naturally decreased, their protein was made available for normal baseline muscular maintenance?

[+] heymijo|6 years ago|reply
We are firmly in conjecture-only territory here, especially discussing a 382 day fast.

Having said that, Dr. Peter Attia has some reasonable hypotheses/extrapolations on how one may maintain muscle on a prolonged fast.

> "I don’t think it’s out of the realm of possibility that you can “eat” a meal of protein that contains all of the essential amino acids during a fast. This may be one of the benefits of autophagy, which literally translates to “self-eating.” Your muscle cells may be dining off your skin cells, so to speak.

> "Obviously, the longer you fast, the more you drain your internal sources of food, and the more likely MPB will exceed MPS over time. (This may also suggest that the fatter you are to begin with, the longer you can eat yourself, and presumably maintain muscle mass for longer.)"

https://peterattiamd.com/can-you-maintain-muscle-during-fast...

[+] detaro|6 years ago|reply
The article mentions him being given vitamins and yeast, and "nutritional yeast" is a protein source.
[+] technotony|6 years ago|reply
He was eating yeast which is a solid protein source...
[+] tomhoward|6 years ago|reply
"without eating" != "without sustenance"...

> To compensate for his lack of nutrients, he was prescribed multivitamins to take regularly, including potassium and sodium, as well as yeast.

[+] floatingatoll|6 years ago|reply
Readers, please be very cautious when trying these things. There is research into "never hungry" eating disorders hinting that you can trigger a permanent (erroneous) negative feedback loop with fasting. If it works for you, hooray, but if you or your blood relatives have a history with anorexia etc., be very careful experimenting with fasting diets.

EDIT: The final page of the (1973) medical study about this patient has some rather specific warnings about testing certain blood and urine metrics to minimize risk of e.g. death. https://pmj.bmj.com/content/postgradmedj/49/569/203.full.pdf

[+] milesvp|6 years ago|reply
This. The dieter was on a multi vitamin. I saw reference some years ago to an eating disorder (anorexia I believe) being directly linked to low levels of some common trace mineral. Some proper dosing brought back an appropriate appetite. Which made it easier to deal with the remaining psychological aspect.
[+] judge2020|6 years ago|reply
The article does dedicate about 25% of its content to the "don't try this at home" section, but I understand not everyone will read it all the way before going to HN comments.
[+] paulcole|6 years ago|reply
This guy’s blood glucose being at 36mg/dL (2mmol/L) for months at a time is insane to me. I’ve had an ambulance called when mine was around 45 and I was so loopy I couldn’t form a sentence or stand up without falling right back down.

I’ve heard that long term low BG can lead to heart muscle damage which may have been what eventually did this guy in?

[+] virtuallynathan|6 years ago|reply
Ketones! When you are metabolizing fat, your need for glucose drops substantially. Only a few cell types require glucose. Ketones also spare muscle.
[+] fortran77|6 years ago|reply
This man was under medical supervision.

Many obese people believe the body will enter a "starvation mode" and make it impossible to lose weight under a certain amount of calories. This is simply untrue. Cutting calories to less than your body burns each day always leads to weight loss.

He needed vitamin and mineral supplements (potassium, etc) because not everything is produced when your body burns fat. But if an obese person eats, say, 1,000 calories a day of a balanced diet, he can probably continue this indefinitely until all the extra weight is off without any ill effects. (Of course, don't go below, say, 1800 kcal/day without talking to a doctor if you're obese or overweight.)

[+] Cougher|6 years ago|reply
It's funny that everywhere we see the discussion of weight loss, there's so much insistence that this "one way is the only valid way" because of "this irrefutable process that science proves is real". Yet millions of people have used any number of ways to lose weight. I've used three ways successfully and they all have one thing in common: I consumed fewer calories than I burn. And the one weight-loss method that actually prepared me for the long-term weight maintenance that must come after we reach our goal is the method that wasn't some form of dietary ostracization: eating fewer calories than the number that made me fat.
[+] fyp|6 years ago|reply
I wonder if it's the same process that bears go through when they hibernate?
[+] rpmisms|6 years ago|reply
IIRC, that's a specific metabolic state that's seasonal. Maybe this guy was able to replicate it? I'm not seeing any special considerations he took.
[+] cable2600|6 years ago|reply
It reminds me of when the Buddha fasted for a long time, sitting in the same place all day. Everyone worried that he might die.
[+] Cougher|6 years ago|reply
Spoiler alert:

He's dead.

[+] scarejunba|6 years ago|reply
How did he avoid stomach ulcers?
[+] olingern|6 years ago|reply
I find not eating to be a nice way to implement calorie control and also work on executive control. In my case, I've done it for the greater part of of the past three years. A typical fasting cycle would be 2 months of 20/4 intermittent fasting and 1 week of "normal" eating. I have an unfounded theory that re-sensitization helps sustain the benefits.

Initially, I did find great benefit in the cognitive benefits [1] of fasting but found it came at a price. This price was mostly strength at the gym later in the day and some added stress during the workday (_not eating is sort of a stress of its own_). It also led to me yo-yo'ing (5-7 lb fluctuations [2] ) a bit with weight because I would be so hungry that I would overeat. I should mention that I paired my fasting with ketosis as type II diabetes runs in my family. I saw a lot of improvement with how I deal with insulin (shakiness, irritability, skin issues, bonking[3]).

If anyone is thinking about fasting, here are my beginner recommendations:

- Contrary to what this link suggests, I think the key is to start slow. There's no need to even do a 24 hour fast, in the beginning. Your body is not going to change over night. Build up to daily 10 - 12 hour fasts and build confidence that you can accomplish the fast. There are a lot of benefits to prolonged fasts, but I would suggest building up to them and learning how your body reacts instead of getting to a place where you feel faint-ish and don't know what that means for your body.

- Fasting on keto feels like cheating, so I think it's a great tool for facilitating more frequent, longer fasts. For me, it seems that ghrelin is highly suppressed by being in a keto induced state. I don't feel well after 72 hours and noticed abnormal heart rhythms, most likely sodium or potassium imbalance.

- Practice saying 'no' or at least make note of social obligations where you have to eat or knock yourself out of your fast / ketosis. 1 day here and there doesn't make a big difference, but how your overall diet quarter to quarter and year to year is what really matters.

- Don't listen to the popular IF / keto sentiments of, "I don't have to track anything! It's magic," if you're below ~18% body fat. This is what I listened to and it led to overeating and reaching 10-12% body fat and quickly jumping back to 15-18%. No matter what your diet is, you should know your caloric intake and ( in general ) what keeps your body at maintenance.

- Not sleeping makes fasting so much harder[4]. If I sleep less than six hours it's definitely an uphill fight.

____

None of this is "fun" per say but it's a process of getting to know yourself and observing how time, age, and environment affect your body.

1 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3670843/

2 - I know salt and water retention play a big role here, but these changes were more than just looking / feeling bloated.

3 - https://en.wikipedia.org/wiki/Hitting_the_wall

4 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3763921/

[+] tus88|6 years ago|reply
> His body began to adapt to the lack of food by burning its own fat stores for energy.

Yeah that's called metabolism and happens whenever anyone loses weight.

[+] samatman|6 years ago|reply
This process, while a part of metabolism, is specifically catabolism.
[+] noobermin|6 years ago|reply
"It works" doesn't appear in the article, it might be editorializing.
[+] geocrasher|6 years ago|reply
Comment deleted by author. Shouldn't have hit submit.
[+] tapland|6 years ago|reply
This guy was under (some) medical supervision with some supplements and with regular testing. Your situation sucks, but this man is not doing what is happening to your wife and you shouldn't be offended by a story about the worlds most extreme outlier case of dieting.
[+] crazygringo|6 years ago|reply
My god, I'm so sorry.

I know you say she's tried every treatment (un)known. I'm just curious, since you shared this with us... why hasn't feeding through an IV worked? [1] It obviously hasn't, I just didn't know there were situations where that wasn't an option of last resort.

Again, so sorry.

[1] https://en.wikipedia.org/wiki/Parenteral_nutrition

[+] anaisbetts|6 years ago|reply
I'm so sorry for your wife. Please focus on the time you have with her.
[+] nwienert|6 years ago|reply
You did genetic testing? That’s what found my similar case.
[+] GhettoMaestro|6 years ago|reply
My friend I am so sorry to hear of your spouse's medical condition.
[+] moltar|6 years ago|reply
I fasted for 3 days and it wasn’t that horrible. Once you are passed a day mark it gets easier. I was doing all my normal activities and working.