Features of a successful therapeutic fast of 382 days' duration (1973) [pdf]
pmj.bmj.com
pmj.bmj.com
[1]: https://latimesblogs.latimes.com/world_now/2012/07/cairo-the...
Although as others pointed out, Ramadan in Islam does not.
It's okay to sometimes cook bland food, or food that doesn't look that great. It's just food after all. And honestly we cook and eat so much. We don't need to consume as much as we do.
After gaining a few kilos last year I decided to stop following so many cooks and recipe channels. Suddenly my obsession with food was gone. Before, if I wasn't cooking, or eating a meal or a snack, or thinking about going to a restaurant, I was watching cooking videos or reactions to meals. After cutting it off, I only thought about food when I was hungry, and I could spend the rest of the day with more important things. After that I started counting calories and I was surprised how little food we actually need to survive, especially with a sedentary lifestyle.
There's a part of a Louie CK special in which he talks about what would happen if God came back to Earth and talked to Man about what he'd done to his creation. "Why do you need money for?" "I need money to buy food" "What do you mean buy food? Just eat the shit on the floor!" "Yeah, but it doesn't have bacon in it". And honestly we place so much importance on what the food is. It's just sustenance, eat some leaves and you'll be OK.
The pleasure you get is also different in that it doesn't create much of a crave feeling. And you rarely binge on salad or carrots.. your brain will naturally give up and say enough. When anything is sweetened you see yourself in a never ending loop.
Plus vegetables help digestion.
Anyways, raw is actually finer than it appears.
For me, food is first and foremost a social experience and something you share : everyday lunch with coworkers, dinners with my family, having two hours lunch with my extended family on the weekends. It would be kind of sad to eat bland food together while we could be enjoying something pleasant.
10kg in 9 days is likely about 3-4kg fat/protein and 6-7kg water roughly speaking.
First off, people with hyperthyroidism generally have increased appetite because of an accelerated metabolism, not reduced appetite. So half his symptoms already don't match.
Secondly, don't try to diagnose people over the internet based on half a symptom and today's weather. Suggest them to see a doctor and leave it at that.
Just because you happened recently read of one random disease out of millions doesn't mean everyone has that now. You'll cause more harm than anything.
I did not imply that.
> He only suggested him to have is blood checked.
He did not only do that.
I also very much dispute the oft-cited claim that "breakfast is the most important meal of the day" - my theory is that it came about as a marketing push for breakfast cereal companies looking to push their cheap carbs. It's become an ingrained, indisputable "truth" - hence some of the comments you got.
I remember being told as a kid that breakfast was really important, so I had "energy" and would be able to concentrate better.
I realise now that it's nonsense, at least if you eat a carb-laden breakfast. Eating carbs seems to start a cycle where you are going to feel hungry ~2h after eating (signalled by a blood sugar drop back to normal levels), regardless of how much you ate. I remember this from my school days too, not being able to focus because all I could think about was my next snack/meal!
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.
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
As mentioned from fasting you still get major benefits from autophay, sirtuin activation, longevity, low insulin variability.
Some of the top fitness and health practitioners who are big on fasting are very low body fat, incredible shape.
Leading figures like Peter Attia, Tim Ferriss, Ben Greenfield, David Sinclair, Kevin Rose to name a few, all pro fasting, all in top shape/low body fat.
> and you become very injury prone
No, you become temporarily weaker, and that's only if you're fasting multiple days. It's recommended you work out during fasts... your body remains anabolic to muscle (barring other variables like elevated stress).
In spite of jamming as much junk food down my throat as I possibly could, I struggled to maintain weight on the Appalachian trail. You can definitely outrun a bad diet. (Not that it's a healthy way to live either.)
Gary Taubes book “Why we get fat,” is a great read on this subject.
But, yknow, HYOH
I have lost weight like that before, but can't maintain a 2 hour a day exercise routine.
I imagine you can't stay on the Appalachian trail forever.
So eventually a bad diet will lap us.
> According to the doctor it's because we're not supposed to keep a full schedule while fasting.
That's a standard answer that likely does not draw on his medical knowledge. People pass out even when not fasting (women more so than man, something to do with vagus nerve IIRC), and thousands of people do long wet fasts while keeping a full schedule with no ill effects.
Highly active is something you can be when you're at or approaching a healthy weight; the causality is IMO almost backwards from what you've described.
My wife and I are long distance hikers. That means carrying 10-15kg up and down mountains for 10-14 hours per day every day for 3-6 months.
It also means literally counting every calorie--because you have to plan it in week-long intervals and also optimize it for minimal weight and sufficient nutrients.
Sounds like a perfect recipe for weight loss right? Enter 'hiker hunger.'
Appetite is completely elastic. Your ability to perform depends on your brain's ability to produce happy endorphins and satisfaction signals etc.
That's where intermittent fasting is crucial. You exercise your body's regulatory functions. It's not just some belief or willpower or placebo I mean: at a chemical level you transform the function of your neurochemistry to improve your metabolic process.
Would you be able to use IF during a thru hike? I suspect that the answer is no. The weight gain problem for distance hikers is after the hike is finished and we reduce activity significantly. I've solved that by training for distance races when I'm not hiking.
Zach Bitter, the current 100 mile record holder, put it in a way that makes a lot of sense to me[0]. For a mere mortal, fasting for 6 hours puts you in the hole for about 700 kcal. A world class athlete like him is at more like a 2000+ kcal deficit. It's impossible to catch up once you get that far behind, and you end up losing weight and injuring yourself. I only burn about 800 kcal during training on an easy day, but I still find it nearly impossible to catch up if I miss a meal. I'm already eating 5x a day. It's hard to cram 5 full meals into a few hours.
[0]: https://zachbitter.com/blog/2014/04/06/intermittent_fasting_...
And weight gain is not contained to "after the trail"
And weight loss is not guaranteed.
It's great that you've found something that works for you. Like I said, it works for me too.
Bodies are different though.
"I've hacked around this problem" != "This problem is illusory"
Are you talking of this kind of thing, low body fat makes even this difficult, or are you talking of multi-day fasting?
Although there are other benefits to IF, the weight loss is principally from calories in, calories out, because it’s much harder to cram an excess of calories into a small time window unless you purposefully eat beyond satiation.
Is it? Study [1] claims "Mice fed an FS [fat and sugar] diet ad libitum (FSA) consumed the same amount of calories as mice fed within a 9 hr window of the dark phase (FST) [fat and sugar, time restricted] (Figure S2A, i), yet the FST [time restricted] mice gained less body weight"
and then "to investigate the therapeutic potential of TRF [Time Restricted Feeding], we tested whether TRF could reverse or arrest body weight gain [..] Within a few days the mice were habituated to the new feeding paradigm and continued to consume equivalent calories (Figure S2A, iv). The 13:12 FAT mice showed a modest drop in body weight"
[1] https://www.cell.com/cell-metabolism/fulltext/S1550-4131(14)...
From related work of https://www.salk.edu/scientist/satchidananda-panda/
I think "it has to be calories in/calories out because it's just common sense" is not nuanced enough for biological systems.
Fasting, to me, begins when all previous meals are digested
I successfully lost 50 lbs a few years ago doing keto and brought myself to exactly the middle of normal BMI.
While I was losing the weight, keto was easy -- I always had energy (more than ever before), felt great, wasn't getting sick.
But once I hit my target weight... all of a sudden keto became miserable. I had brain fog all the time, except for about the window of 2-4 hrs after each meal when my digestion seemed to peak. I started getting colds all the time.
Once I switched back to eating carbs, I felt great.
My theory is that your body burns fat proportionally to the amount of fat you have... and that it's fine to fuel yourself until you just don't have enough fat anymore to keep it going to even things out between meals.
I was pretty bummed actually to discover that keto doesn't work for me anymore, when I'm already at a healthy weight. I just loved the constant energy. But for however my body's built, it's just not an option for me anymore.
Disclaimer: I eat like garbage so it's more likely that not eating garbage is having these positive effects, not just fasting.
I've fasted for up to 5 days before, and I felt just fine - especially on days 4 and 5, I actually feel like I have more mental clarity and drive than usual.
I guess this is always my question of anyone who has a positive experience with fasts. Personally, I have been at the mid-upper range of healthy bf%/weight for years and exercise frequently (running 30+ minutes 7 days a week for a few years, cycling 60+ minutes 2-3 a week this year) and find much shorter fasts (say, 20h) excruciating and completely draining mentally and physically. And I'm not at 7% body fat like that other guy. Lowest I got was maybe 14% while I was running daily; while I'm up to 18%ish now, fasting hasn't gotten any easier.
(Even if I skipped exercising, just the mental effects made my mood significantly worse by the end of the day, which makes it harder to work effectively in a collaborative environment.)
What's your non-fasting diet like? Fasting is the quickest way to get into ketosis. If you're used to eating a carb-heavy diet, the switch into ketosis can be brutal. So if you either ease off carbs leading up to the fast, or just all the time, it'll be easier.
The other thing is electrolytes. Your body doesn't store them, so you (IMO) have to supplement. If you start to feel like crap, have 1tsp of salt in about 1L of water and see if it fixes it. I also supplement with magnesium and occasionally potassium.
I'm sure Dorsey isn't the only high profile/ functioning CEO who does multi day fasts each week.
"Not only are we deeply wired to function for long periods of time without food"
So the body doesn't collapse after x number of hours without fuel. Your body also has the ability to generate its own heat when it's cold. Does that mean that it's desirable or ideal that we deliberately use these abilities? Does it mean that there is no harm or risk in doing so? I'm not saying that there is or isn't; I don't know.
"but when you haven't eaten in a while your mind becomes focused and alert"
This is sort of like the focus that you get when you're being chased by a wild animal or falling out of a tree. I don't know that seeking focus from sources like this is a great idea, but YMMV.
"since your body thinks it needs to find or hunt food."
So maybe your body is telling you that fasting isn't such a good idea?
"I'm sure Dorsey isn't the only high profile/ functioning CEO who does multi day fasts each week."
I don't do multi-day fasts and I've lived for years longer than Dorsey.
The evolutionary angle isn't the reason why I believe fasting is a good idea - it's just a rebuttle to "there's no way you function well while fasting"... of course you can, it was likely the MO for millions of years of modern human evolution (or 100+ M years for mammals). It's as natural to fast as it is to fornicate.
Rather, my reasons for fasting come from the scientific literature, centered around autophagy, insulin control, sirtuin activation, visceral (organ) fat depletion, and troves of clear lab test results of benefits (albeit most on non human mammals).
Based on many comments here I think folks just haven't caught up with the longevity research of the last 3-4 years.
https://greatist.com/live/autophagy-fasting-exercise#definit...
A thread about this from 2018: https://news.ycombinator.com/item?id=16941097
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?
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...
> To compensate for his lack of nutrients, he was prescribed multivitamins to take regularly, including potassium and sodium, as well as yeast.
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
I’ve heard that long term low BG can lead to heart muscle damage which may have been what eventually did this guy in?
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.)
A very good friend of mine in the UK officially requested his death certificate.
The causes of death, if I remember correctly, were:
Stomach bleeding, something else (sorry), and obesity.
We were trying to understand if they put obesity on there just because he was obese decades before, or if he was obese again at that time. But we're pretty sure he put the weight back on. He died in Warwick
Fasting for 382 days as a medical intervention isn't learning how to actually live with a stable healthy relationship to your food environment. The behavioral patterns leading to the intervention initially will very likely resume afterwards.
This reminds of a personal experience, story time:
<anecdata>
An obese friend of mine visited the ER for a persistent respiratory issue. Through negligence of the hospital staff, he found himself in an emergency abdominal surgery with a perforated colon.
What started as a relatively casual ER visit turned into an extended many-month ordeal under hospital care, mostly bedridden. As the months ticked by his weight dropped to fairly close to normal. He was still a bit overweight, but easily over a hundred pounds lighter with only hospital food in controlled portions to live off of.
I clearly recall visiting him in the hospital in the days approaching his release, and how proud he was for the weight loss. He was so ignorant about his relationship with food and how significant a factor it was for the hospital's control being responsible for his weight loss vs. his own chosen lifestyle. I didn't say anything at the time, but was already a bit nervous about what would happen when he left the hospital's care, with a severely compromised abdomen still recovering.
Fast-forward to a year later, and he had become more obese than before starting this ordeal. No doubt his eating problems were exacerbated by the depression of his life situation. The last I heard he needed abdominal reconstructive surgery, and had developed an intestinal hernia from the substantial size increase while still recovering. Apparently he couldn't have the procedure done until he lost the weight again.
</anecdata>
He's dead.
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.
Yeah that's called metabolism and happens whenever anyone loses weight.
It is unclear why OP associates this man's anecdote with his wife — the man of the article was not reported to lose GI function because of his fast. He was just morbidly obese, and stopped eating until he was at a relatively healthy weight.
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.
2. It's no going to be easy
1. Cut out sugar and most other carbs (potato,bread,pasta,biscuits,fruit, etc), not counting fiber as a carb). Have a modest amount of protein and as much fat as you want. There are multiple diets such as Keto and Paleo that play with ratio of fats protein and carbs, but they all amount to pretty much the same thing--cutting out sugars and carbs as much as possible.
2. Eat as much as fills you up of everything else.
3. Body learns it needs to use fat for its energy.
4. Get to target weight, reintroduce yourself to carbs in moderation and leave sugar for special occasions.
The hardest part is sugar withdrawls for the first couple of weeks. There's also possible problems with a lazy bile duct due to the body not being used to a high fat diet, but can be dealt with by taking a modest dose bile supplements for a period of time.
Other than that, pretty damn easy. Compared to giving up cigarettes or coffee of which I've done both, it's a walk in the park.
It's funny that you end your comment with "a walk in the park", because my experience suggests that walk in the park may help more than eliminating carbs.
Even with ketosis (a real thing), 99% of its dietary weight loss effectiveness is because fat is filling.
This is pretty easy to disprove. It's not at all that fat is more filling.
Once your body starts to burn it's own fat you no longer feel like you're starving. Anyone whose fasted could tell you that, never mind been on keto.
The starving feeling comes from the period in between where your body is waiting for more carbs before finally switching to fat burning mode.
So it's not that fat is filling. Carbs are filling, too. It's just that when carbs are burned, there's nothing to replace them with, but when the fat you've consumed has gone through your system, and your body is already in Ketosis, it doesn't feel bad because there's weeks and months worth of food already on your body to burn.
If I eat a meal comprised of fat and protein (2 fried eggs with some cheese, for example), I'll feel sated and won't feel hungry again for up to 5 hours.
On the other hand, it I eat a bowl of pasta, I'll feel very full immediately after eating, but am guaranteed to feel hungry again in ~2h.
I firmly believe that fat and protein are more "filling" than than carbs, and many people have shared similar anecdotes.
Carbs are not bad for you in moderation, but if your body is drowned in them you can easily develop blood sugar problems, especially if you're predisposed to it. Otherwise, if you're highly active and aren't constantly eating more calories than you burn then of course you will have a healthy weight.
I'm not being anti carb or anything. It's just waaaaaay easier to cut them out, lose a bunch of weight, then reintroduce them in moderation, than to try and burn off an excess of calories each day via intense exercise.
> 2. It's no(t) going to be easy
> Not at all
Self righteous nonsense.
It does matter. I would suggest, that it would be compelling to stop with the deterministic statements that are equivocations to fit your own narrative. What "less" means or what "starvation" means, is information that would be helpful. Given the multiple vectors that compose the general term "nutrition", we can be sure that less intake is more effective for losing weight. Then going on to say "pretty damn easy" is insulting. Most people aren't informed enough to make measured political decisions (many state initiative cycles in the US have shocking consequences), choosing what to eat and how much is an impracticable behavior.
Good points. When you're on a high carb diet you can feel like you're starving when you're not, because of the speed at which the energy is dumped after eating. Actual starvation is when you don't get enough calories over long enough time so that your body starts to feed on its own fat, and then muscle, and then you die. But that takes a while to kick in.
> Given the multiple vectors that compose the general term "nutrition", we can be sure that less intake is more effective for losing weight.
Firstly, nutrition: Like the article says, the guy kept up his nutrition by taking vitamins, yeast, and electrolytes. A food can be highly energy dense and have little nutritional value. Nutrition is important. One can have good nutrition and be overweight, and one can be overweight and have bad nutrition. Nutrition is a very broad subject that has little to do with straight up calories, energy, and fat burning/storage.
Secondly, let's say you're a regular sedentary American. The amount of calories your body needs will be surprisingly little. It may even feel disturbingly little.
So lets say you eat just enough to meet your body's requirements (which is different for everyone, depending on genes and activity). If you don't exercise and still eat lots of carbs and sugar, this will seem like a shockingly small amount and you will feel like you are periodically starving after your body has burned the carbs into energy, but you won't actually be starving, because it takes a decent amount of time for your body to flick over to fat burning mode. So you go through this bumpy starvation feeling diet, where you only feel satiated a short while after eating.
And still you body won't burn fat, because it's still sporadically getting enough calories from carbs, but your energy levels will be all fucked up because carbs are so easily turned into energy. You will feel high when you eat, and fucking exhausted when all that energy is burned up.
Actual starvation is when you don't get enough calories for long enough that your body is forced burn its own fat.
This feels fucking awful. It's hard. It sucks.
However, by eliminating carbs but keeping fat in your diet you can get your body to switch into fat burning mode without feeling like you're starving. So now, lets say you have a good meal, and you feel full. Maybe you've had too much. Whatever. What happens when you've burned all that energy? Instead of your body panicking and feeling like its starving, it's already in fat burning mode, so it simply goes to its own reserves without panicking. You won't get that 2pm sleepy feeling of lacking energy because your body will be happily start burning its own fat.
Over time your weight will come down. Combined with modest fasting (skipping breakfast for example) you will lose weight even quicker, and you won't feel like you're starving because your body will not have to wait for you to stop feeding in carbs before it switches over to fat.
> Then going on to say "pretty damn easy" is insulting. Most people aren't informed enough to make measured political decisions (many state initiative cycles in the US have shocking consequences), choosing what to eat and how much is an impracticable behavior.
Which is why we are having this dialogue I guess.
You do not need to starve yourself for your body to use energy stored in fat cells. You need your body to use up its immediate stores of glycogen, after which it will use fat or protein. With a caloric target set for a lower goal weight, the carbs you eat will be used up quicker, so your body will then go for the fat (and possibly protein). You therefore can eat carbs, burn fat, and lose weight.
It should not be understated that the best way to speed this process is with light cardio and resistance training, as it speeds up glycogen use and builds muscle, which increases rate of energy use. At no time do you need to remove carbs for this to work.
"Eat as much as fills you up of everything else."
. . . that sentence should never be a part of it.
For the purposes of weight loss, exercise is absolutely overrated, especially the low intensity cardiovascular type that most individuals trying to lose weight engage in. The actual number of calories burned for the mental effort/discipline is garbage and that effort would be better spent on better dietary discipline.
High intensity training and weightlifting have better results due to increasing metabolic rate for a long period after the activity, but the key to weight loss is diet.