Fasting and Eating for Health (29 page)

In cases in which hormone replacement is essential (for instance, with panhypopituitarism or hypothyroidism), administration of the appropriate hormone(s) may be continued during the fast. However, blood parameters should be observed and the medication dose lowered accordingly, because these patients generally require much less medication during the fast than when eating. Thyroid medication, for example, should be tapered to about one half the patient's usual dose a few days prior to the fast and then periodically monitored with blood tests to ensure the correct dose is being given.

Patients taking drugs such as antidepressants, tranquilizers, or narcotics should not fast. Patients on anticoagulation therapy with Coumadin or chemotherapeutic agents should not fast. Aspirin and other NSAIDs should be discontinued prior to the fast because of the increased risk of gastric irritation during the fast.

Oral hypoglycemics must be discontinued prior to the fast and insulin should be tapered off in the type II diabetic. Type I diabetics should not undergo a prolonged fast.

Since fasting is so effective at lowering blood pressure, hypertensive medication should be stopped prior to or early in the fast. For patients with dangerously high blood pressure who require some medication in the early stages of the fast, a transdermal clonidine patch is usually tolerated well. The 149

patch is needed only temporarily, until blood pressure decreases to a satisfactory level. Nitrates are compatible with fasting as long as the blood pressure is not too low, and can be continued in patients with angina. Angina, however, invariably resolves with fasting, thereby eliminating the need for nitrates at some point in the fast.

Breaking the Fast

It is very important that the reintroduction of food after an extended fast begin very gradually. The body needs a period of time to stimulate the production of digestive enzymes that has been temporarily stopped by the fast. The fast is typically broken on one half of an orange or a piece of watermelon the size of a woman's fist every two hours on the first day. Over the next three days, the amount of food given is gradually increased and the interval between feedings is lengthened, so that by day 4 the person is able to comfortably tolerate three normal-size meals.

The foods eaten during this period are fresh fruits, lettuce, steamed vegetables such as zucchini and asparagus, and baked squash or sweet potato.

Other physicians who employ fasting in their practice often break the fast with fresh fruit and vegetable juice and then gradually introduce food. My reasoning for usually breaking the fast on whole food is to begin to provide some bulk to encourage peristalsis, thereby encouraging the first bowel movement to occur before the patient leaves for home.

The stomach is very sensitive after the fast so one must be very careful not to break the fast on fruit that may be too ripe. For example, if an overly ripe, partially fermented pineapple is eaten, stomach cramping and pain may develop. Overeating too early after the fast may also result in abdominal pain and vomiting. Spicy food, and condiments such as salt and pepper, taken soon after fasting could irritate and cause damage to the stomach lining because the normal mucosal defense barrier has been diminished by fasting and takes time to return to normal.

Typical Signs and Symptoms of the Fast

Most of the symptoms experienced on the fast are mild and harmless and require no intervention other than reassurance and encouragement. However, other symptoms that may occur later during a prolonged fast may be signs of electrolyte insufficiency or other complications that would indicate the need to terminate the fast.

Blood pressure gradually decreases during the fast for numerous reasons, as discussed in Chapter 5. Fasting is also mildly dehydrating. Due to the possibility of orthostatic hypotension, which is falling blood pressure upon standing, the chief risk or side effect of prolonged fasting is the chance of fainting and injury sustained in the fall. The reason I have never had a patient faint during a fast I supervised is because I give appropriate warnings of this possible side effect and instructions to be careful. My patients are told not to jump out of bed quickly. All fasters are also instructed to get off their feet and lie down 150

immediately if they begin to feel light-headed at any time. Men are told to sit down to urinate, especially when rising to do so in the middle of the night.

Occasionally, blood pressure falls to what could be considered very low levels. If this drop is pronounced and sudden, the fast should be broken.

However, if the patient is otherwise stable and the exceedingly low blood pressure has been reached gradually from a relatively low pressure at the start of the fast, it should not be of concern. In addition, I have noted that a narrowing of the pulse pressure typically occurs when fasting. For instance, a reading of 80 over 70 is not unusual, especially for a person who did not have high blood pressure to begin with.

The pulse generally falls somewhat when fasting, reflecting the decreased workload of the heart. Any sudden change in vital signs, such as a sudden drop or rise in pulse, should be further evaluated by the physician to ascertain its benign nature, or the fast should be ended.

The hormonal changes that occur as the body attempts to conserve fuel on a prolonged fast frequently cause patients to feel colder than usual, and extra bedding is appropriate. I advise patients not to become too chilled or too hot as this wastes energy. I advise against sunbathing as the fast is already dehydrating, and the addition of sunbathing in hot weather may result in excessive and potentially dangerous dehydration.

Physiologic Side Effects of the Fasting

In a patient with a history of atrial fibrillation, the early rise in ketoacids and the reduction in serum bicarbonate produce a mild but compensated metabolic acidosis. This mild acidosis can precipitate a return to an irregular rhythm. This typically reverts back to normal with refeeding or giving juice to such a patient.

I terminate the fast if the patient does not remain in normal sinus rhythm.

Patients with a history of sustained ventricular tachycardia (a life-threatening, heart rate irregularity) should not fast. In patients I have fasted who have had frequent ectopic beats, the ectopy has either improved or remained unchanged.

If ectopy or abnormal ventricular complexes appear suddenly late in the fast, the fast should be broken immediately. This could indicate electrolyte imbalance or that the fast has been continued too long and starvation has begun. Occasional premature ventricular contractions may appear in the first few days of fasting; however, these typically resolve as the fast continues.

Patients generally do not have bowel movements during a fast. A typical patient fasting 10 to 30 days usually has one or none, until refeeding starts.

There is the occasional risk that the first bowel movement after the fast may be hard and require a lubricant or suppository for comfort. I typically prepare the patients' bowel for the fast by having them eat primarily raw fruits and vegetables for a few days prior to the fast, which helps prevent difficulty with the first bowel movement afterwards.

If there is a history of constipation or sluggish bowel, it would be advisable to 151

give a warm water enema during the first or second day of a prolonged fast to cleanse the bowel; this will ensure that there is no difficulty with the first bowel movement after the fast is broken.

Obviously, patients with inflammatory bowel disease may have multiple loose bowel movements during the early part of a fast. The bowel movements gradually diminish and eventually stop as the bowel heals from the effects of the fast.

Vomiting is an early side effect that occurs during the first few days in about 5 to 10 percent of patients who fast. This typically resolves with continuation of the fast. If the vomiting continues or is accompanied by diarrhea, the patient should be observed and treated appropriately for dehydration. In rare instances, dehydration from vomiting on a fast induces further vomiting, and the patient is unable to hold down any fluid or food, making it impossible to break the fast and refeed. This would be an indication for intravenous rehydration followed by breaking the fast.

Headaches are occasionally experienced by fasters early in the first day or two of fasting. However, most patients with a history of severe headaches or migraines are excited to observe that their headaches end as the fast continues. These withdrawal headaches should not be medicated during the fast as the detoxifying effects of the fast should be allowed to continue unhindered. If the fast is followed by a natural plant-based diet, the headaches can be cured permanently, as explained in greater detail in Chapter 4.

Insomnia is often experienced by fasters, but this varies greatly among individuals. Generally, the need for sleep is greatly diminished when we are not active and when our digestive tract is not at work digesting food.

Vitamin Supplementation During a Fast

Vitamin deficiency attributed to fasting is exceedingly rare. It normally doesn't occur on fasts less than 45 days in length unless the individual was depleted at the onset of the fast.4 Taking vitamins during a fast is unnecessary and can create unpleasant symptoms.

Many of the physicians who have fasted patients and reported their findings in the medical literature have given vitamins during the fast. However, there is no evidence that this in any way increases the safety of a fast. During a total fast the gastrointestinal tract is better not disturbed with vitamin supplementation.

Sufficient vitamins, minerals, and macronutrients are released in appropriate proportions from tissue stores during the fast. Other physicians than myself who have fasted thousands of patients do not find vitamins of any value during this period.5 This is confirmed by the observations of other researchers, who noted that vitamin deficiency due to involuntary fasting was very rare among famished populations-during World War II, and reported only problems from vitamin supplementation during fasting.6

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The body's own vitamin reserve more than meets the body's requirements while on a moderate-length fast. It has been proposed that fasting increases the ability of tissues to absorb and utilize nutrients.7 From my experience, it is clear that we need not worry about the issue of vitamins in a fast of moderate length. I have found that the results of blood tests for vitamin and mineral levels change little during the fast; tests are expensive and unnecessary.

Blood Tests During the Fast

For patients undergoing prolonged fasts, blood tests and urinalyses are performed at approximately weekly intervals. This is necessary to help the physician decide how long to continue the fast. Some changes in laboratory parameters are normal, such as an elevation of uric acid. Other abnormalities, however, could indicate the fast should be concluded: Sometimes, moderate abnormalities in the blood tests or the patient's clinical status necessitate more frequent monitoring of these laboratory parameters.

Fasting almost always elevates the patient's uric acid level, frequently to very high values, but this does not cause gout and should be of no concern. The elevated uric acid levels are due to the increased breakdown of purines as well as the decrease in their elimination in the kidneys.

Some investigators have warned against fasting patients with a history of gout due to their concern that fasting may precipitate an attack. I believe that these fears are usually unfounded. What I and other physicians regularly employing fasts have observed is that even patients with a prior history of gout do not usually have attacks of gout on their fast. It is true that uric acid levels in the blood always rise to high levels in the fasting patient. Even with ,extremely high levels of uric acid, however, I have never seen an attack of gout on a fast. Other investigators report similar findings.8,9 Dr. Shelton, who reported conducting more than thirty thousand fasts, asserted that never once did he see gout develop in a fasting individual, in spite of high levels of uric acid.

This illustrates that an elevated uric acid level is not the only cause of gout.

There are reports in the medical literature of patients with acute attacks of gouty arthritis who have normal serum uric acid levels;10 this illustrates that hyperuricemia and gout are often separate phenomena. Some other mechanism may be involved in gout besides the uric acid elevation, or the biochemical changes that occur in the fasting state may mitigate against the formation of uric acid crystals in the joints. Amazingly, even with supersaturation (uric acid levels rising to 18), episodes of gout are generally not experienced. There is a report of fasting precipitating an attack of gout in a patient Nvho had frequent prior attacks.11 My opinion is that even patients with a history of gout can fast safely if they follow a low-purine, vegetarian diet for three to six months prior to the fast and lose weight before the fast. This will resolve the gout condition before the fast begins.

Hemoglobin levels usually rise slightly during a fast, reflecting the 153

hemoconcentration that occurs with a fasting-induced diuresis. If the hemoglobin value is too high, especially when accompanied by a relatively high BUN (blood urea nitrogen) level and high urinary specific gravity, the patient usually is not drinking enough water and must increase his or her water consumption.

Due to the body's built-in survival mechanisms, the amount of water needed while fasting is minimal. The desire for fluid diminishes and may be nil in some fasters. To minimize side effects and assure the safety of all patients, however, fasters need to be encouraged to drink water to prevent dehydration. One quart of water per day is usually sufficient for most individuals, but some need to be encouraged to drink two or more quarts, depending on their laboratory parameters.

Dehydration does not generally occur in the overweight patient. Rather, it is seen more frequently in the thin patient. If considerable dehydration ensues, the patient should be fed. Because dehydration due to fasting is secondary to electrolyte depletion, it is possible that increasing the amount of water given the faster will not be sufficient to correct the abnormality. Therefore, if serious dehydration results, the fast should be broken with an appropriate food such as fresh orange juice, vegetable juice, or watermelon.