The #1 Rule of Fasting
As
we start the new year, many people are looking to lose weight. Fasting,
the voluntary abstention from eating is an ancient weight loss method
with a long track record of success. However, many people forget the
cardinal rule of fasting, or indeed, of any kind of dietary change — always make sure you are doing it safely.
I highly recommend a great new documentary now available for purchase/ rent online called Fasting — The Movie.
It presents the science of fasting and how people can lose weight and
even reverse many metabolic diseases such as type 2 diabetes and its
related conditions. Given the importance of these diseases in modern day
medicine, this is nothing short of revolutionary. However, taken to an
extreme, fasting can also have its dangers. This is true not just for
fasting but for anything. If you take veganism to an extreme, you may
put yourself in danger, for example, of vitamin B12 deficiency. If you
take the low fat diet to an extreme, you are at danger of vitamin D
deficiency. If you take salt restriction to an extreme, you may be at
danger of volume depletion. If you take exercise to an extreme, you may
put yourself at danger of rhabdomyolysis (muscle breakdown). Everything
must be done responsibly, with knowledge and with common sense.
Fasting
is no different. Because fasting is already more intensive than most
diets, taking fasting to an extreme can be problematic. The movie goes
into some of the dangers of fasting and explores many of the variants of
fasting that are popular and may be beneficial for people. Simply put,
fasting is a weapon to be used in the fight against obesity related
conditions and perhaps some aging related conditions.
But,
like any weapon, it has two edges. It has real power, and that power
can be used constructively and it can also, in the wrong hands, be used
destructively. It is all a matter of context and applicability. Much of
the resurgence of interest in fasting as a therapeutic option centers
around intermittent fasting
— generally of shorter duration done consistently and frequently. The
5:2 diet, popularized by Dr. Michael Mosley is 2 days of fasting per
week, but those ‘fasting’ days still allows 500 calories per day. Time
restricted eating such as a 16:8 schedule, allows you to eat during only
8 hours of the day, so 16 hours are spent fasting. Many of the patients
in my Intensive Dietary Management program use 24 hour to 36 hour fasts 2–3 times per week, and this is done under medical supervision with their physician.
Certainly
I use extended fasting as well, but generally limited to 7–14 days,
only in the appropriate person and with supervision. Clients are always
instructed to stop immediately if not feeling well, and we also check in
with them regularly. Longer fasts have more power, but more risk. To
me, there is no reason to fast for 30 consecutive days just for the sake
of argument. Why not do 4 separate 7-day fasts instead? It will have
roughly the same beneficial health effects with far less risk.
By contrast, in Fasting — the movie, director Doug Orchard
tells the story of a young lady who decided to join a 30 day water-only
fasting retreat. As far as I can tell, there was no medical
supervision, and there was no bloodwork being checked and there was no
professional who even determined whether this was appropriate. One of my
primary rules for fasting is that if somebody is underweight or there
is concern about malnutrition, then they should not fast. Underweight is
defined by Body Mass Index < 18.5, but for a margin of safety, I
don’t recommend that anybody fast longer than 24 hours if they have a
BMI< 20. The reasoning seems rather obvious. During the fasting
period, the body must survive on the nutrients and energy stored. If you
have lots and lots of body fat (stored food energy), then you should be
fine. If you do NOT have lots and lots of body fat, then it’s NOT fine.
It’s stupid.
People
get into trouble with extended fasts because they don’t follow common
sense. Many of these fasting retreats offer 30 day water only fasts. If
you become depleted of sodium (quite common), there are no doctors there
to monitor for warning signs. If you become very weak and unable to get
out of bed, there is very clearly something wrong, and you should not
continue fasting. This is common sense. In my IDM program, clients know
that they may feel hungry, maybe a little irritable, constipated
perhaps, but they should not feel UNWELL. If you are really feeling
poorly, you must
stop. There is no reason to continue, because fasting is free. It is
far better to stop and try it again (if you want) in a few days when you
are feeling better. The problem with these fasting retreats is that
people have paid money to be there and therefore they push on far beyond
the limits of good safety practice and far beyond the limits of common
sense.
Further,
people undertake extreme fasting without any kind of preparation.
Instead of undertaking shorter fasts and gradually extending it, they
immediately opt for a full on water-only extended fast. This is like a
rookie mountaineer that decides that he/she will tackle Mount Everest,
without oxygen and push on to the summit irregardless of weather. The
experience mountaineer would immediately recognize this as a death wish,
but the rookie has no inkling of the dangers and may come home in a
body bag. It’s pure stupidity. Yet fasting clinics promote this very
same idea. Taking the most extreme fast (water-only fasting, as opposed
to allowing some bone broth or some caloric intake), to an extended
period of time (30 days instead of 1–2 days), in anybody irregardless of
whether this is medically appropriate, without any adequate medical
supervision or access to bloodwork? I can tell you right now, that’s
pure stupidity.
[caption id=”attachment_8119" align=”alignleft” width=”270"]
Marathon[/caption]
A recent article in the New York Post “Is this the most dangerous diet ever?”
tells of a man who, in an attempt to lose weight, decided that he would
fast for 47 days. At day 5 he was feeling great. At day 28, he was so
weak that he could hardly get out of bed. NOT smart. This is NOT
something that I would advise. The Daily Mail shared similar concerns in its own article.
Consider
the story of the marathon. According to legend, in 490 BC the Greek
soldier Pheidippides ran approximately 26 miles from the battlefield
near the town of Marathon to Athens to deliver the news of the defeat of
the Persians. He shouted Niki! (Victory) and then promptly keeled over
and died.
Suppose
a sedentary, middle aged, out of shape man decided to run a full 26
miles at maximum speed tomorrow, without any type of preparation or
knowledge. He might very well keel over and die, too. Indeed, in 2014, a
42 year old man died after the London Marathon,
the event’s second death in 3 years. Later that year, a 31 year old man
and a 35 year old man died in a North Carolina event. Since marathon is
a relatively extreme event for most people, it takes some preparation
to do safely. That’s easy to understand so you don’t see hysterical
headlines saying “Running, the most dangerous thing ever”. If you want
to run a few minutes, that probably won’t kill you. Running a marathon
in an untrained state could very well do so.
So
the bottom line is that fasting, done properly and with knowledge and
experience is a powerful tool in the fight against metabolic disease and
obesity. But tools can cut both ways and can sometimes harm the user. A
chainsaw is a powerful tool for cutting trees. It may also kill you if
used improperly. But the proper lesson is not to abandon the chainsaw.
Instead, we need to learn how to properly use the tool. Fasting, used
responsibly can be a powerful force for health. Fasting, used
inappropriately can hurt or kill you. Fasting by starting out skipping a
meal here and there — good idea. Fasting by starting out 30 day water
only fast come hell or high water — bad idea. There’s a ton of free
information on fasting that I’ve written extensively on my blog. Just search for the 40+ posts I’ve labelled with ‘Fasting’. I’ve also posted free videos and podcasts, too. So cost is not an issue. Be safe, everybody.
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