Fasting and Eating for Health (28 page)

The withdrawal symptoms of addiction to such drugs as alcohol, cocaine, nicotine, and caffeine are resolved quickly while fasting. Most people are amazed at how easy it is to quit smoking while fasting. Those who have fasted begin to respect their body in a new way that enables them to take better care of themselves in the future.

People often start getting the warning signs of chronic disease when they are young. Generally, they go to their physicians with frequent infections as children. As teenagers they develop acne and allergies, and often take drugs to suppress symptoms. Years later, they gradually become medically dependent, having to take medications for the rest of their lives. Fifty percent of our population over the age of 60 takes some medication.

If we teach our children from a young age that disease is not inevitable and not to be expected, and if we build good health into our lives, we will have a chance to have a healthy society.

This book illustrates and emphasizes a powerful philosophy, a revolutionary way of thinking about health and disease. It is not merely about fasting; it is about realizing that we have lifetime responsibility to maintain our health. If we protect our families and our children from the causes of ill health, we will prevent needless suffering in the future.

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A Chapter for Physicians and for

Readers Who Want More Technical Information
Training in Fasting Supervision for Medical Doctors
Fasting is such a safe and effective modality for a variety of medical conditions that the supervision of this therapy should become routine for primary care physicians. Medical students have spent their monthly clinical rotations with me to learn more about this modality firsthand. Another month's rotation as an elective during residency would be an ideal way for physicians to become adequately trained.

In this chapter, I will discuss possible side effects and complications of fasting, assuming that the benefits of fasting were adequately reported in the other parts of this book. This is not intended to be a complete treatise for the medical professional on all aspects of caring for the fasting patient. It is merely an overview, discussing some of the major points of interest.

A residency-trained medical doctor, with knowledge of internal medicine and electrolyte imbalances, and with an adequate nutritional background, should be able to become appropriately skilled to conduct fasts after one week of lectures at a conference set up for such a purpose. Presently, there are numerous conferences available for physicians to attend to learn more about various nutritional interventions for chronic diseases. Interested physicians can contact me at the following address for more information about such training: Joel Fuhrman, M.D.

Amwell Health Center

450 Amwell Road

Belle Mead, New Jersey 08502

Telephone: (908) 359-1775

Fax: (908) 359-2068

The International Association of Professional Natural
Hygienists

The IAPNH, an organization of primary care doctors specializing in the application of therapeutic fasting, offers certification for its members in fasting supervision. The members of this organization include licensed medical doctors, osteopaths, chiropractors, and naturopaths. Certification for fasting supervision does not occur unless the doctor has undergone at least a six-month approved residency with a certified professional to gain experience in therapeutic fasting.

A list of certified members of the IAPNH can be requested through their organization at:

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IAPNH c/o Attorney Mark Huberman

204 Stambaugh Building

Youngstown, Ohio 44503

The Necessity of Physician Supervision

Fasting is such a safe therapeutic intervention that many laypeople argue that daily supervision by a physician is not necessary. Although it is true that fasting is both natural and safe, all prolonged fasts
must
be supervised by a physician with expertise and knowledge. Fasting longer than two to three days should not be undertaken by patients on their own. It is important for a physician to dissuade a person who wants to undertake a prolonged fast without proper supervision.

A physician must monitor the fast to guarantee the safety of the patient. It is important to make sure the fast is terminated before an individual begins to develop low levels of electrolytes or other essential nutrients. Most patients can fast safely for 30 days or more. It is rare, but others, even after 10 to 15 days of fasting, may develop low levels of potassium and have to terminate the fast.

A trained physician should be able to distinguish a typical side effect or detoxification symptom of a fast from harmful symptoms that indicate the fast should be broken or that a blood test should be quickly run to make sure the fast is safe to continue. For example, a symptom such as dramatically increased weakness accompanied by a drop in blood pressure usually indicates the fast should not continue.

A similar situation occurs during childbirth. Most people understand that childbirth is a relatively safe and natural process. Occasionally, however, intervention by a trained professional is needed to optimize the outcome when signs might indicate a problem. The same is true for fasting.

It is reasonable for an otherwise healthy individual to fast for two or three days without medical supervision when suffering from an acute illness and decreased appetite. This commonly occurs. Even then, if unusual symptoms develop, such as vomiting, and there is the possibility of dehydration, medical intervention should be sought immediately.

The Biochemistry of Fasting

Fasting is not starvation, and -the terms should not be used interchangeably.

The fasting period represents the time one can safely abstain from food and typically varies among individuals, based on tissue reserves and body weight.

When a person abstains from all food and drink except water, the body utilizes nonessential tissues such as adipose tissue, digestive enzymes, and muscle tissue for fuel. Only when fasting is sustained and the nonessential tissue stores become inadequate to fuel the metabolic needs of the body does the body begin to metabolize essential tissues (e.g., vital organs) and starvation occurs: Even a thin individual has sufficient reserves to fast for approximately 40 days and not experience symptoms of starvation.

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Weight loss is most rapid early in the fast. On the average, fasters lose approximately 1 pound per day. They may lose 2 pounds or more per day early in the fast but this rate drops off to about a half a pound daily later on, so the average weight loss usually remains at 1 pound daily. Fasters lose more weight if they are overweight; thinner individuals lose less weight. The early fasting-induced diuresis (water loss) causes an increased initial weight loss from the increase in urinary excretion of water and salt, but these 1 to 2 kilograms are regained rapidly with refeeding.

In fasting, the body undergoes a series of hormonal and metabolic changes to conserve its body mass and draw selectively from its supply of energy in adipose tissue, sparing the breakdown of muscle or enzymes. For each individual the ratio of fat to muscle tissue lost differs, dependent on initial body conditions, especially the amount of body fat.

Early in the fast, glycogen reserves in the liver are broken down to maintain glucose levels. The liver stores only about 100 to 125 grams of glucose as glycogen, however, and this stored glucose is rapidly depleted, usually in the first day of the fast.

When the. fast progresses beyond the depletion of these glycogen reserves, the body muscles and internal organs (e.g., the liver and heart) obtain their energy predominantly from fatty acids derived from adipose tissue. However, fatty acids cannot supply all our energy needs. Small amounts of glucose are still needed to fuel the brain and red blood cells, which do not have the ability to be fueled by fatty acids. During the fast, the brain demands almost 80

percent of the rested body's fuel requirements, about 180 grams of glucose per day, and must continually receive an adequate supply.

From day 2 onward, the body manufactures the needed glucose through two metabolic pathways. The first source is glycerol derived from adipose tissue.

However, the fat-triglyceride-glycerolglucose pathway alone cannot produce sufficient quantities of glucose once the liver stores of glycogen are depleted.

Thus a second, predominant source of glucose is obtained from the catabolism of muscle tissue. Some muscle loss is obligatory as the body utilizes amino acids from muscle tissues to synthesize glucose.

The fasting individual would need to catabolize over a pound of muscle mass a day to meet his or her glucose requirements. By the third day of the fast, however, the liver begins generating large quantities of ketones. As the level of ketones rises in the bloodstream they compete with glucose as a substance that can be used for energy in the central nervous system, thereby greatly diminishing the body's need for glucose, sparing protein, and preventing further acidosis caused by tissue catabolism. Through this inherent survival mechanism, the brain, muscle, and heart begin to use ketones instead of glucose as fuel. Muscle wasting at this time decreases to less than 0.2 kg per day. This is known as
protein
sparing. In this phase, muscle is conserved and the maximum breakdown of fatty tissue and removal of atheromas and toxins occur.

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Ketosis develops within 48 hours in fasting females and 72 hours in males.

However, ketosis in the fasting individual differs from that in diabetics. In uncontrolled diabetics, the levels of ketones produced reaches such high levels that the acid/base balance may be overwhelmed. In the fasting individual, the body maintains control of the levels of ketones produced as a fuel source.1,2

The unique nutritional adjustments that occur during a total fast, including the adaptation to ketone nutrition, apparently have long-term beneficial effects on brain function, improving psychological health as well as physical well-being.

When EEG (electroencephalogram) data and endocrine parameters are measured during and after fasting, it appears the homeostasis mechanism of the body significantly improves in the central nervous system.3

Fasting Supervision and Contraindications to Fasting
It is the job of a trained physician to be able to distinguish those patients who are proper candidates for fasting from those who are not. It cannot be assumed that every individual can fast safely for a prolonged period of time—or at all.

Occasionally it is necessary to end the fast many days before the patient wants to or the doctor intended to.

A physician should evaluate the patient on a daily basis. He must monitor blood pressure, pulse, and any other parameter that may be appropriate for that individual. Blood tests should be monitored at least weekly to assure adequate electrolyte balance and reserve as well as to check hydration status.

With the appearance of sudden weakness or persistent vomiting, additional laboratory work is appropriate to assess electrolytes and hydration status.

Rarely, a patient may be encountered who cannot fast. For instance, some people have an enzyme defect called MCAD (medium-chain acyl-CoA dehydrogenase) deficiency, and it would be unsafe for these individuals to fast.

MCAD is one of the enzymes needed for the oxidation of fatty acids. A deficiency in this enzyme is one of the most common inborn errors of metabolism. Since fatty acid oxidation is required as an alternate energy source during fasting, this disorder may go undiagnosed until a person attempts to fast. Even though this condition is exceedingly rare, respiratory failure, extreme weakness, seizures, coma, or death may ensue if the individual continues with a prolonged fast. This disorder is recognized by vomiting or extreme lethargy early in the fast; in addition, the urine does not show ketones as in a normal person who undergoes food deprivation.

Proper supervision also involves a blood test prior to the fast to ensure adequate liver and kidney function. I do not recommend fasting for patients with laboratory findings of significant liver or kidney disease. Extremely weak and debilitated patients generally should not fast. Nor should patients with severe anemia, severe nutritional deficiency states, porphyria, or pregnancy.

Patients who are severely malnourished, such as those with advance stages of cancer or AIDS, should not fast because fasting will likely contribute to their malnourished state and perhaps to an earlier death.

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Generally, medications should be tapered and discontinued prior to the fast whenever possible. Normally, I taper medication as the patient adopts a healthy diet and postpone the fast until it is safe to discontinue most medication.

Frequently, I encounter patients taking multiple chemotherapeutic agents, such as oral gold and methotrexate, who desire to fast. I do not fast these patients until they can be stabilized with less toxic medication. This is because of my concern that certain drugs when combined with fasting can potentially cause toxic insult to the kidneys. If these patients cannot reduce their dependency on such agents through appropriate dietary and nutritional management prior to the fast, they are not desirable candidates for a fast.

Clearly, a list can be made of hundreds of medications that should not be combined with therapeutic fasting. It would be inappropriate to compile such a list here. Suffice it to say that, except in rare instances, a patient should be stable enough to be able to stop all medication either before a fast or within a few days after the fast has begun, or a fast should not be entertained.

Extreme caution is necessary when fasting a person who has taken oral steroids for a prolonged period in the recent past. Even if the individual has been slowly weaned off the drug well in advance of the fast, adrenal gland suppression is still possible. As a result, fasting could cause an excessive loss of sodium, low blood volume, and rapid heart rate. These parameters should be more closely monitored in such patients. The fast may have to be discontinued at the onset of such signs or symptoms.