with apologies to Ayn Rand
Many of you will have heard some of my aphorisms. Part of the power of aphorisms is not their universal truth but the way they point to a truth with great concision and thus allow us to see that truth without the cloud of factual qualifiers.
OK. One of my favorite ones is: “Starvation cures disease.” It can sometimes cure disease; not all diseases ever, not any disease every time, but some diseases enough of the time to be of interest. Note I said ‘disease’ not mortality. Nothing this side of the miraculous can do that. So my remarks are addressed to those of us this side of the miraculous. “Starvation Cures Disease.” “The Body Wants To Heal.” “Sleep Is The Most Important Nutrient.”
Let me tell you a story and then you will understand something about starvation, and my real topic here, you will understand that fasting has a role in health. Fasting.
Many years ago, many, many years ago, while still an undergraduate working on my ‘pre-medical’ education I wondered if I would enjoy a life in medicine, in becoming a healer. So I sought out and obtained a job as a Diener. The word comes from the German word Leichendiener which translates as ‘corpse servant.’ At the University of Chicago the Diener not only was a servant to the Pathologist and did the ‘scut work’, menial, degrading, trivial, but also the actual gross dissection of the autopsies. I was a Diener. It might seem strange that I wanted to work in a morgue to test my profession as a physician but there it is: psychiatrists may have fun with that but I doubt it.
The experience of being a Diener taught me many things and is the source of many stories only one of which I here want to tell.
Clean shiny room of stainless steel, off white tile and unusual looking beds. A very skinny man; deceased. The Pathologist was boarded in pathology and internal medicine with a specialty in cardiology. He clearly had his own issues. He began his description of the deceased, we were friends but he was still ‘The Boss’, by telling me a little about what was then called “Lethal Midline Granuloma.” Our guest had Lethal Midline Granuloma. TMI, as they say, for here but the short version is that the middle of his face, the palate, nose and so on, kept getting eaten away and as a result he had several surgeries to his face and neck, none of which were curative and all of which left him deformed needing prosthetic eyes and more. He decided, during his most recent hospitalization, to starve himself to death. Thus he died, in some sense by his own hand, and few would blame him. No knife, no gun, no poison; no overt conspirators but it did happen in the hospital.
Now back to the unusual Pathologist: he had been involved in the man’s care when he had his heart attacks. Yes, wouldn’t you know it, the deceased, the poor deformed, the suffering man, my teacher in his death, had terrible coronary heart disease. Coronary angiography, looking at the living arteries of the heart, had only recently- late 60’s- been well described, at the Cleveland Clinic by the way, and my Pathologist friend had performed one on our cadaver when in life; by direct observation and history the man had the rattiest, stringiest, poorest coronary arteries you could possibly have and not die of heart disease. In fact most assumed this would end his life long before his Lethal Midline Granuloma would.
Alright back to the skinny man on the autopsy table. Big ‘Y’ incision, as I am finishing up taking out the big stuff, I won’t go into that, the Pathologist was carefully dissecting out the heart and its arteries; he was curious. It is not often the same man visualized someone’s Coronary Arteries and then performs an autopsy on that same individual a few years later. He, the Pathologist, yells, “come here, you have to see this!” Lying, neatly filleted in his hand, is the softest, smoothest, cleanest nearly baby like Coronary Arteries you, or I, have ever seen. They were perfect. By this time I had seen hundreds of filleted arteries and these were the cleanest either of us had ever seen. Hmmm.
You see where this is going don’t you and we both hope it’s not an autopsy table anytime soon? Unless you want to propose that his Midline Granuloma cured his heart disease or that anesthesia from his surgeries did so I think the conclusion must be something like ‘Starvation Cures Disease.’
I can give you a rational mechanism of this accomplished fact but I hope this image itself is vivid enough to interest you in the basic idea. Not starvation but at least ‘fasting.’
You Could Die! First a caution. In the past one of my medical associates was prone to over-emphasize the risks of antibiotics and other common therapies. I would see many a nearly hysterical Mother the day after my partner saw her child for a simple ear infection for which antibiotics had been prescribed. The Mother did not doubt my partner’s diagnostic skill, he was quite adept at that, but his admonishment about the risks of the antibiotics seemed to be somewhat over-the-top. Soothing Mom was my role in the drama.
OK, I do not mean to overstate the risks of fasting but do want to make them clear before I further advocate the use of fasting. During World War II the US military solicited volunteers from the conscientious objectors for starvation and fasting studies. I have no idea what inducements were offered but the study was scientifically rich and fascinating but surely morally questionable as several of the volunteers died. An interesting, but not surprising, thing was found: different people’s bodies responded in very different ways to fasting. Some people’s bodies accessed stored fat calories and became slim, healthy and happy and other’s remained fat and died of a heart having been consumed by the body for calories to ‘survive.’ Yikes! Fasting is not a universal panacea; certainly if carried too far. Good for some; bad for others. At least to the level of control and observation of the WW II fasting studies.
Some of the known benefits of carefully done fasting: improved insulin sensitivity, up-regulation of testosterone(?!), decreased inflammatory markers, growth hormone spikes, triglycerides fall, LDL goes down- oversold as beneficial but still it happens and besides HDL goes down too- and there is interesting data on calorie restriction and longevity. More besides and almost all of it good. If done correctly and occasionally. As fasting entails discipline, like the use of any muscle, it increases dietary discipline in general.
Every World-Historical Religion has discovered the role of fasting in spiritual discipline. Part of the explanation of this is the change in neurochemistry that accompanies fasting. Fasting certainly improves my prophetic capacities: when I start a fast I can always predict that I will be hungrier tomorrow than I am today. Forgive the snarky remark: I am actually simply using this ploy to tell you that your mind and its perceptions change in a fasting state and this needs to be attended to.
Down to basics. Heretofore I’ve foresworn talking about fasting because its intricacies soon outstrip what can be done without dialogue and knowledge in a specific case so what will follow is very general, should be safe for anyone not on insulin, insulin analogues, stimulants or other energy or glucose altering medications or with underlying related diseases. This is not to say fasting is not for these people but that even rather generic guidelines might not apply. Talk to me or your own doc if you are interested in fasting.
General rules:
- Start with a short fast when you can afford to rest or take it easy for the duration of the fast
- First time in no case longer than 24 hours; in fact start with 24 hours
- Do not use a ‘juice diet’ as most of these are worse on insulin sensitivity than no fast at all
- Drink ‘lots’ of water; a good 100 oz.
- Do not over drink either; you can dilute your electrolyte balance by trying to ‘fill up’ on water
- Teas are fine as part of the fluid intake
- Do not consider that missed meal or snack as a fast as this is counterproductive in important metabolic ways; skipping meals is a bad idea
I am not addressing fasting with the sole goal of weight loss. This actually does require the proverbial ‘medical supervision’ and in my opinion is a terrible idea. Long term strict fasts are a great way to become ill.
However as part of a long term strategy to improve metabolic markers of health and to improve dietary discipline fasting is a wonderful part of an effective nutritional armamentarium. Portion control is often much easier after a cycle of fasts. Experiment with a single 24 hour fast every two weeks for a cycle of three and if tolerated this can be increased to weekly fasts of 24 hours. Very few need ever pursue fasting more than one 24 hour cycle per week; those who follow this modest discipline are very likely to experience enhanced health and an improved sense-of-well-being.
One final anecdote. Several years ago I was asked to address a group of dedicated calorie restrictors; there were about 60 of them. Now I came to tell them that most if not all of the positive effects they felt they experienced could be obtained with a low insulinogenic diet and to discuss the physiology of calorie restriction. In any case what struck me then and what lives with me today is: as I looked out over the group of pale, thin, nearly lifeless faces, one of their member stood after my talk, stood very slowly by the way and with thin, long, straggly hair hanging limply at his temples, his sallow nearly blue face devoid of expression and with a faint but emphatic voice he told me “I’ve never felt better in my life and I know I will live a very long and healthy life by living this way.”
No thanks. Be reasonable.
Smile and God Speed,
Dr. Mike
