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ANTI-AGING DRUGS AND SUPPLEMENTS
 
 3.7 SAFETY OF FASTING AND LOW CALORIE DIETING. PRECAUTIONS  
   
   
Cardiovascular safety
Gallstone formation, cholecystitis - take care: fast carefully
Safety of bones
Cautions in case of osteoporosis
Personal fasting stories
Prolonged fasting in human
Human evidence
Side effects of VLCD
Endocrine and chronobiological effects of fasting in women.
Electrocardiographic findings associated with very low calorie dieting.
Compliance, clinical effects, and factors predicting weight reduction during a very low calorie diet regime.
 
 
   
   
Cardiovascular safety
Int J Obes Relat Metab Disord 1995 Nov;19(11):817-9
Electrocardiographic findings associated with very low calorie dieting.
Seim HC; Mitchell JE; Pomeroy C; de Zwaan M.
Department of Family Practice and Community Health, University of Minnesota, Minneapolis 55414, USA.

To determine the safety of very low calorie diets (VLCD) in regard to their effects on cardiac function. EKG changes were analyzed for 126 women on a VLCD of 3349 kJ/d (800 kcal/d). EKGs were done when the diet was begun, after 3 months of dieting, and at a 6 month follow up after being off the diet for 3 months. Subjects were solicited through advertisements and charged $1,000 for participating after being screened for age, weight, and health status. MAIN OUTCOME MEASURES: EKG QTc intervals, PR interval, QRS interval, ST-T wave changes, and heart rate. RESULTS: Over one-fourth (27.0%) of subjects had normal EKGs at all three time points studied. Sinus bradycardia was the most common abnormality, observed in 60 subjects (47.6%) on at least one of the three EKGs. Fifty-eight (46%) patients had EKGs with ST-T wave abnormalities observed on at least one of the EKGs. Eight subjects (6.4%) had prolonged QTc (more than one standard deviation beyond the average for women) intervals on at least one EKG. None of these eight persons had significant untoward medical consequences. CONCLUSION: A VLCD diet of 3349 kJ/d (800 kcal/d) for up to 3 months is not associated with significant electrocardiographic abnormalities or clinical cardiac complications, provided the patients have low cardiovascular risk at baseline.

   
   
Gallstone formation, cholecystitis - take care: fast carefully
Int J Obes Relat Metab Disord 1998 Jun;22(6):592-600
Gallbladder motility and gallstone formation in obese patients following very low calorie diets. Use it (fat) to lose it (well).
Festi D; Colecchia A; Orsini M; Sangermano A; Sottili S; Simoni P; Mazzella G; Villanova N; Bazzoli F; Lapenna D; Petroni ML; Pavesi S; Neri M; Roda E.
Department of Medicine and Aging, University G D'Annunzio Chieti, Italy.

Dieting obese subjects are at risk of developing gallstones. A gallbladder motor dysfunction could have a pathogenetic role. The principal aim of this study was to evaluate the long term effects of two very low calorie diets differing in fat content on gallbladder emptying and gallstone formation in obese subjects. DESIGN AND SUBJECTS: Gallbladder emptying in response to meals (breakfast, lunch and dinner) in two different diet regimens (3.0 vs 12.2 g of fat/d) was evaluated by ultrasonography in 32 gallstone-free obese patients on different days, before and during (at 45 d intervals) one or two 6-month weight reduction diets (for the first three months: 2.24 MJ (535.2 kcal), 3.0 g fat/d vs 2.415 MJ (577.0 kcal), 12.2 g fat/d; for the second three months, the same low calorie diet of 4.194 MJ (1002 kcal)/d for both groups). In 10 subjects, bile analysis was also performed. RESULTS: Twenty-two (69%) subjects concluded the study, eleven in each group, and a significant weight loss was achieved by all subjects. Gallstones (asymptomatic) developed in 6/11 (54.5%) (P < 0.01) of subjects following the lower fat diet, but in none with the higher fat regimen. In the dieters during the first three months (very low calorie phase) the higher fat meals always induced a significantly greater gallbladder emptying than the lower fat meals. The cholesterol saturation index initially increased significantly and then decreased, without difference between the two groups. CONCLUSION: In the obese during rapid weight loss from a very low calorie diet, a relatively high fat intake could prevent gallstone formation, probably by maintaining an adequate gallbladder emptying, which could counterbalance lithogenic mechanisms acting during weight loss.

   
   
Safety of bones
J Nutr 2001 Mar;131(3):820-7
Energy restriction does not alter bone mineral metabolism or reproductive cycling and hormones in female rhesus monkeys.
Lane MA, Black A, Handy AM, Shapses SA, Tilmont EM, Kiefer TL, Ingram DK, Roth GS.
Laboratory of Neurosciences, National Institute on Aging, Gerontology Research Center, 5600 Nathan Shock Drive, Baltimore, MD 21224, USA.

Energy restriction (ER) extends the life span and slows aging and age-related diseases in short-lived mammalian species. Although a wide variety of physiological systems have been studied using this paradigm, little is known regarding the effects of ER on skeletal health and reproductive aging. Studies in rhesus monkeys have reported that ER delays sexual and skeletal maturation in young male monkeys and reduces bone mass in adult males. No studies have examined the chronic effects on bone health and reproductive aging in female rhesus monkeys. The present cross-sectional study examined the effects of chronic (6 y) ER on skeletal and reproductive indices in 40 premenopausal and perimenopausal (7-27 y old) female rhesus macaques (Macaca mulatta). Although ER monkeys weighed less and had lower fat mass, ER did not alter bone mineral density, bone mineral content, osteocalcin, 25-hydroxyvitamin D, 1,25-hydroxyvitamin D or parathyroid hormone concentrations, menstrual cycling or reproductive hormone concentrations. Body weight and lean mass were significantly related to bone mineral density and bone mineral content at all skeletal sites (total body, lumbar spine, mid and distal radius; P: < or = 0.04). The number of total menstrual cycles over 2 y, as well as the percentage of normal-length cycles (24-31 d), was lower in older than in younger monkeys (P: < or = 0.05). Older monkeys also had lower estradiol (P: = 0.02) and higher follicle-stimulating hormone (P: = 0.02) concentrations than did younger monkeys. We conclude that ER does not negatively affect these indices of skeletal or reproductive health and does not alter age-associated changes in the same variables.

   
   
J Clin Endocrinol Metab 1995 Dec;80(12):3628-33
Decreased bone formation and increased mineral dissolution during acute fasting in young women.
Grinspoon SK; Baum HB; Kim V; Coggins C; Klibanski A.
Neuroendocrine Unit, Massachusetts General Hospital, Boston 02114, USA.

ABSTRACT: Severe chronic undernutrition is associated with decreased bone turnover and significant bone loss. However, little is known about the short-term effects of nutritional deprivation on bone turnover. To investigate the effects of short-term fasting on bone metabolism and the contribution of acidosis to these changes, 14 healthy women ages 18-26 (mean, 21 +/- 2 (SD years) were randomized to potassium bicarbonate (KHCO3, 2 meq/kg/day in divided doses) to prevent acidosis or control (potassium chloride, 25 meq/day) during a complete 4-day fast. Bone turnover was assessed using specific markers of formation [osteocalcin (OC) and Type I procollagen carboxyl-terminal propeptide (PICP)] and resorption [pyridinoline (PYRX) and deoxypyridinoline (DPYRX)]. Serum bicarbonate levels fell significantly from 27.0 +/- 3.2 to 17.3 +/- 2.6 mmol/L (P < 0.01) in the control group and were decreased compared to patients receiving KHCO3 [17.3 +/- 2.6 vs. 23.4 +/- 2.4 mmol/L, (P < 0.001)]. Serum total and ionized calcium increased significantly in the control group [9.1 +/- 0.1 to 9.4 +/- 0.2 mg/dL (P < 0.01) and 1.20 +/- 0.03 to 1.23 +/- 0.03 mmol/L (P < 0.05), respectively], but not in patients receiving KHCO3. In addition, serum parathyroid hormone (PTH) levels decreased from 32 +/- 17 to 16 +/- 10 pg/mL (P < 0.05) and urinary calcium excretion increased [86 +/- 51 to 182 +/- 103 mg/day (P = 0.01)] in the control group, but not in patients receiving KHCO3. Serum osteocalcin (OC) and procollagen carboxyl-terminal propeptide (PICP) levels decreased significantly after 4 days of fasting from 9.1 +/- 3.4 to 5.5 +/- 4.2 ng/mL (P < 0.01) and 121 +/- 21 to 46 +/- 13 ng/mL (P = 0.0001) respectively in the patients receiving bicarbonate, and from 10.1 +/- 3.3 to 4.0 +/- 2.9 ng/mL (P < 0.01) and from 133 +/- 22 to 47 +/- 19 ng/mL (P < 0.001) respectively in the control group. The decrease in osteocalcin and PICP during fasting was comparable in both treatment groups. By contrast, urinary excretion of PYRX and DPYRX did not change significantly in either group with 4 days of fasting. These data are the first to demonstrate that markers of bone formation decline significantly with short-term fasting, independent of changes in acid-base status. By contrast, these data demonstrate a direct effect of acidosis in stimulating calcium release from bone during short-term fasting and suggest that acidosis may increase mineral dissolution independent of osteoclast activation and PTH in this experimental model of acute starvation.

AAC comments: This paper give us a sound message that we have to implement alkaline, carbonate water intake during fasting days

   
   
Cautions in case of osteoporosis
J Gerontol A Biol Sci Med Sci 2001 Mar;56(3):B98-107
Calorie restriction and skeletal mass in rhesus monkeys (Macaca mulatta): evidence for an effect mediated through changes in body size.
Black A, Allison DB, Shapses SA, Tilmont EM, Handy AM, Ingram DK, Roth GS, Lane MA.
Molecular and Nutritional Physiology Unit, Gerontology Research Center, National Institute on Aging, Baltimore, Maryland 21224, USA.

Little is known regarding the effects of prolonged calorie restriction (CR) on skeletal health. We investigated long-term (11 years) and short-term (12 months) effects of moderate CR on bone mass and biochemical indices of bone metabolism in male rhesus monkeys across a range of ages. A lower bone mass in long-term CR monkeys was accounted for by adjusting for age and body weight differences. A further analysis indicated that lean mass, but not fat mass, was a strong predictor of bone mass in both CR and control monkeys. No effect of short-term CR on bone mass was observed in older monkeys (mean age, 19 years), although young monkeys (4 years) subjected to short-term CR exhibited slower gains in total body bone density and content than age-matched controls. Neither biochemical markers of bone turnover nor hormonal regulators of bone metabolism were affected by long-term CR. Although osteocalcin concentrations were significantly lower in young restricted males after 1 month on 30% CR in the short-term study, they were no longer different from control values by 6 months on 30% CR.

Personal fasting stories
   
   
J Hum Nutr Diet. 2002 Apr;15(2):121-7.
Five year results of a prospective very low calorie diet or conventional weight loss programme in type 2 diabetes.
Paisey RB, Frost J, Harvey P, Paisey A, Bower L, Paisey RM, Taylor P, Belka I.
The Diabetes Research Group, Torbay Hospital, Torquay, UK.

AIMS: To complete 5-year follow-up of an intensive weight loss programme in established type 2 diabetic subjects. METHODS: Forty-five obese type 2 diabetic subjects, Body mass index (BMI) > 30, expressed interest in an intensive weight loss programme. Group 1 comprised 15 who selected very low calorie diet (VLCD), Group 2, 15 selected intensive conventional diet and exercise (ICD), 15 failed to follow either programme. Group sessions of eight to 15 subjects continued weekly for 6 months, then monthly for 12 months with prospective recording at 3, 6 and 12 months and then annually of quality of life, BMI, waist/hip ratio, blood pressure, fasting blood glucose, serum fructosamine and serum lipids. RESULTS: Weight loss was slower in the intensive conventional diet group than in the VLCD group, but better maintained at 5 years: group 1, 4.8 +/- 6 kg; group 2, 8.9 +/- 4 kg. In the intensive conventional diet group, 5 year high-density lipoprotein cholesterol was increased 1.78 +/- 0.26 mmol L-1 vs. 1.10 +/- 0.32 mmol L-1 at baseline, and diastolic blood pressure reduced 74.5 +/- 13.3 vs. 85.5 +/- 13.3 at baseline, both P < 0.05. CONCLUSIONS: Out-patient VLCD treatment proved safe and effective in overweight diabetic subjects but those who chose conventional diet and exercise had a slower but more sustained weight loss. Diabetic patients willing to attempt VLCD may safely lose sufficient weight to allow major surgery, but weight regain is inevitable. Patients willing to undertake a long-term group programme of conventional diet can sustain significant weight loss for 5 years, but still require antidiabetic medication.

   
   
Int J Obes Relat Metab Disord 1995 Jan;19(1):46-9
34-day total fast in an adult man.
Garruti G, De Pergola G, Cignarelli M, Marangelli V, Santoro G, Triggiani V, Ciampolillo A, Giorgino R.
Clinica Medica, Universita degli studi di Bari, Italy.

The aim of this work was to investigate the changes of cardiac performance by both electrocardiography (ECG) and echocardiography (ECHOc), in addition to anthropometric and hormonal variables before, during and after prolonged total fasting (TF) and re-feeding in an overweight adult man. Physical examination, laboratory and hormonal measurements, ultrasonographic study of body fat distribution, ECG and ECHOc study were performed before during and after 34 days of TF and after 17 days of isocaloric re-feeding. The subject was a 52-year old Caucasian who was overweight with increased abdominal fat content (BMI: 28.6; W/H ratio: 0.95) and increased levels of arterial systolic and diastolic blood pressure (SBP, DBP). HPLC measurements of urinary catecholamine levels (HPLC), ECHOc study of cardiac performance, ultrasonographic study of body fat distribution were performed. The subject starved for 34 days losing 22kg, but after that time he was compelled to re-feed because of nausea and severe vomiting. A marked ketosis (ketonuria > 1200mg/day) was already present after 6 days of TF. After 17 days of TF norepinephrine (NE) and epinephrine (EPI) urinary levels showed a two-fold and nine-fold increase respectively, but they became undetectable at the end of TF. After 17 days of re-feeding catecholamine urinary levels were similar to those measured after 17 days of TF. After both TF and 17-day isocaloric re-feeding we found a decrease of visceral fat content and W/H ratio reached the normal values for age-matched subjects (W/H ratio after TF: 0.80, after re-feeding: 0.80).

   
   
Prolonged fasting in human

At one time, Paavo Airola, N.D., Ph.D., referred to fasting as the royal road to health and long life. Fasting is a popular method of detoxification for, rather quickly, the body can begin extricating the noxious materials, allowing the body to commence the healing process. Literally, fasting means to deprive oneself of food for a specific period, usually for therapeutic or religious purposes. Medical journals have presented articles that, therapeutically, support fasting as a means of ridding hazardous materials from the body. (Findings reported in American Journal of Industrial Medicine, 1984.)

If there were a down side to fasting, apart from dietary abstinence, it would be the caution required as pollutants are released from internal caches. During a fast, the concentration of toxins in the urine can be ten times higher than normal. After the toxic load is decreased, the body has greater latitude to concentrate upon the healing process.

A professional, who understands the detoxification process, best implements a fast. Many practitioners prefer a juice fast to a water fast, believing the juices expedite the process of detoxification and impose less stress upon the individual. (It is recommended that juices be diluted with distilled water). The nervous system is, particularly, vulnerable to the release of fat-soluble toxins.

Some individuals who fast report being energized, but usually this occurs after repeated short fasts have eliminated many of the toxins and the internal milieu is cleaner.

The initial fasting experience, in a toxic individual, most often produces a feeling of fatigue, as the body does battle with the poisons. For this reason, a working individual may wish to plan a short fast (with the aid of their healthcare professional) over a weekend, when the workload is lighter. The body is extremely engaged as noxious materials are being extracted. Conversely, the digestion of foodstuffs requires a tremendous work effort; therefore, a sabbatical from food, allows the body the energy for detoxification.

Starting a fast and breaking a fast requires special guidance that the cleansing effort is not lost by inappropriate binge eating. Fasting is not for everyone; a hypoglycemic often finds it extremely difficult to fast, even for short periods of time. A guided fast may, however, prove a valid therapy for some individuals, wishing to expedite the detoxification process.

   
   
Nutrition 2001 Feb;17(2):100-4
Changes in body fluid and energy compartments during prolonged hunger strike.
Faintuch J, Soriano FG, Ladeira JP, Janiszewski M, Velasco IT, Gama-Rodrigues JJ.
Department of Emergency Medicine, Hospital das Clinicas, Faculty of Medicine, University of Sao Paulo, Brazil.

Prolonged total food deprivation in non-obese adults is rare, and few studies have documented body composition changes in this setting. In a group of eight hunger strikers who refused alimentation for 43 days, water and energy compartments were estimated, aiming to assess the impact of progressive starvation. Measurements included body mass index (BMI), triceps skinfold (TSF), arm muscle circumference (AMC), and bioimpedance (BIA) determinations of water, fat, lean body mass (LBM), and total resistance. Indirect calorimetry was also performed in one occasion. The age of the group was 43.3+/-6.2 years (seven males, one female). Only water, intermittent vitamins and electrolytes were ingested, and average weight loss reached 17.9%. On the last two days of the fast (43rd-44th day) rapid intravenous fluid, electrolyte, and vitamin replenishment were provided before proceeding with realimentation. Body fat decreased approximately 60% (BIA and TSF), whereas BMI reduced only 18%. Initial fat was estimated by BIA as 52.2+/-5.4% of body weight, and even on the 43rd day it was still measured as 19.7+/-3.8% of weight. TSF findings were much lower and commensurate with other anthropometric results. Water was comparatively low with high total resistance, and these findings rapidly reversed upon the intravenous rapid hydration. At the end of the starvation period, BMI (21.5+/-2.6 kg/m2) and most anthropometric determinations were still acceptable, suggesting efficient energy and muscle conservation.

   
   
Conclusions:

All compartments diminished during fasting, but body fat was by far the most affected;
Total water was low and total body resistance comparatively elevated, but these findings rapidly reversed upon rehydration;
Exaggerated fat percentage estimates from BIA tests and simultaneous increase in lean body mass estimates suggested that this method was inappropriate for assessing energy compartments in the studied population;
Patients were not morphologically malnourished after 43 days of fasting; however, the prognostic impact of other impairments was not considered in this analysis.
Fasting even if it is a prolonged fasting is safe in itself. In a group of eight hunger strikers who refused alimentation for 43 days, water and energy compartments were estimated, aiming to assess the impact of progressive starvation. Measurements included body mass index (BMI), triceps skinfold (TSF), arm muscle circumference (AMC), and bioimpedance (BIA) determinations of water, fat, lean body mass (LBM), and total resistance. (Faintuch J. Et al. 19??) The results vere impressive: At the end of the starvation period, BMI (21.5+/-2.6 kg/m2) and most anthropometric determinations were still acceptable, suggesting efficient energy and muscle conservation. Patients were not morphologically malnourished after 43 days of fasting.

   
   
Human evidence
What is a Very Low-Calorie Diet (VLCD)?
VLCDs are commercially prepared formulas of 800 calories or less that replace all usual food intake. VLCDs are not the same as over-the-counter meal replacements, which are meant to be substituted for one or two meals a day. VLCDs, when used under proper medical supervision, effectively produce significant short-term weight loss in moderately to severely obese patients.

Who Should Use a VLCD?
VLCDs are generally safe when used under proper medical supervision in patients with a body mass index (BMI) greater than 30. BMI is a mathematical formula that takes into account both a person's height and weight. To calculate BMI, a person's weight in kilograms is divided by height in meters squared. Use of VLCDs in patients with a BMI of 27 to 30 should be reserved for those who have medical complications resulting from their obesity. VLCDs are not recommended for pregnant women or breastfeeding women. VLCDs are not appropriate for children or adolescents, except in specialized treatment programs.

Very little information exists regarding the usage of VLCDs in older individuals. Because individuals over 50 already experience normal depletion of lean body mass, use of a VLCD may not be warranted. Additionally, persons over 50 may not tolerate the side effects associated with VLCDs because of preexisting medical conditions or need for other medications. Therefore, a physician, on a case by case basis, must evaluate increased risks and potential benefits of drastic weight loss in older individuals. Additionally, people with significant medical problems or who are on medications may be able to use a VLCD, but this too must be determined on an individual basis by a physician.

Health Benefits Associated With a VLCD
A VLCD may allow a severely to moderately obese patient to lose about 3 to 5 pounds per week, for an average total weight loss of 44 pounds over 12 weeks. Such a weight loss can improve obesity-related medical conditions, including diabetes, high blood pressure, and high cholesterol. Combining a VLCD with behavioral therapy and exercise may also increase weight loss and may slow weight regain. However, VLCDs are no more effective than more modest dietary restrictions in the long-term maintenance of reduced weight.

Adverse Effects Associated With a VLCD
Many patients on a VLCD for 4 to 16 weeks report minor side effects such as fatigue, constipation, nausea, and diarrhea, but these conditions usually improve within a few weeks and rarely prevent patients from completing the program. The most common serious side effect seen with VLCDs is gallstone formation. Gallstones, which often develop in obese people, anyway, (especially women), are even more common during rapid weight loss. Some research indicates that rapid weight loss appears to decrease the gallbladder's ability to contract bile. But, it is unclear whether VLCDs directly cause gallstones or whether the amount of weight loss is responsible for the formation of gallstones.

Conclusion
For most obese individuals, obesity is a long-term condition that requires a lifetime of attention even after a formal weight loss treatment ends. Although VLCDs are efficient for short-term weight loss, they are no more effective than other dietary treatments in the long-term maintenance of reduced weight. Therefore, obese patients should be encouraged to commit to a long-term treatment program that includes permanent lifestyle changes of healthier eating, regular physical activity, and an improved outlook about food because without a long-term commitment, their body weights will drift back up the scale.

   
   
J Am Diet Assoc 1990 May;90(5):722-6
Position of the American Dietetic Association: very-low-calorie weight loss diets.

It has been well documented that a VLCD can produce large and rapid weight loss. A number of studies using appropriate levels of high biologic value protein, vitamin and mineral supplementation, and careful monitoring have shown that the VLCD can be safe. Careful monitoring by a physician experienced in such programs and by a registered dietitian is essential. The maintenance of weight loss must be of key importance throughout the program, necessitating the skills of a multidisciplinary team with medical, nutritional, and behavioral training. It must be recognized that the VLCD is only one part of a total weight management program. The complete program is needed for long-term success. Insurance reimbursement for the services of all members of the health care team, including dietitians, facilitates and supports the multidisciplinary team approach. Potential candidates for this program and health professionals must realize that VLCDs are not for everyone and can be harmful for persons who do not meet the following selection criteria: (a) at least 30% overweight, with a minimum body mass index of 32. (b) free from contraindicated medical conditions: pregnancy or lactation, active cancer, hepatic disease, renal failure, active cardiac dysfunction, or severe psychological disturbances. (c) committed to establishing new eating and life-style behaviors that will assist the maintenance of weight loss. (d) committed to taking the time to complete both the treatment and the maintenance components of a program. Dieters must receive careful medical and nutritional monitoring throughout the program and should continue with nutrition, exercise, and behavioral counseling after cessation of the VLCD until sound eating and life-style habits can be established. The length of time an individual is on the VLCD must be carefully monitored and the VLCD discontinued immediately if medical tests and/or weight loss indicate increased health risks to the client. Finally, potential clients must be adequately warned that there are limitations and risks involved with the VLCD. A VLCD is no magic cure. It requires considerable effort and commitment on the part of both practitioners and participants to ensure the program's success.

   
   
Absolute contraindications to using very-low-calorie weight loss diets
(Position of the American dietetic association 1990):
  • Malignant arrthytmias
  • Unstable angina
  • Protein wasting disease (e.g. lupus, Cushing’s syndrome)
  • Major system failure (e.g. liver failure, renal failure)
  • Drug therapy causing protein wasting (steroids, antineoplastic agents)
  • Pregnance or lactation


Side effects of VLCD
Some patients on a VLCD for 6 to 18 weeks report minor side effects such as fatigue, constipation, nausea, and diarrhea, but these conditions usually improve within a few weeks and rarely prevent patients from completing the program. The most common serious side effect seen with VLCDs is gallstone formation. Gallstones, which often develop in obese people, anyway, (especially women), are even more common during rapid weight loss. Some research indicates that rapid weight loss appears to decrease the gallbladder's ability to contract bile. But, it is unclear whether VLCDs directly cause gallstones or whether the amount of weight loss is responsible for the formation of gallstones.

   
   
Fertil Steril. 2001 May;75(5):926-32
Endocrine and chronobiological effects of fasting in women.
Berga SL, Loucks TL, Cameron JL.
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.

OBJECTIVE: To determine whether fasting in women would suppress GnRH/LH drive in a high- versus low-gonadal steroid milieu. DESIGN: Case-control study. SETTING: Academic clinical research center. PATIENT(S): Eleven eumenorrheic women and eleven women taking combined oral contraceptives. INTERVENTION(S): Seven of the eleven women in each group underwent an acute 72-hour fast. Blood samples were obtained at 15-minute intervals for 24 hours before the fast and during the last 24 hours of fasting. MAIN OUTCOME MEASURE(S): Twenty-four-hour profiles of LH, cortisol, and melatonin were assessed. Ovarian activity was tracked with estradiol and progesterone levels, and metabolic responses were gauged by measuring thyroid hormone and beta-hydroxy-butyric acid levels. RESULT(S): Fasting increased beta-hydroxy-butyric acid and reduced free thyronine. Fasting in the midfollicular phase had no effect on LH pulsatility or on FSH, estradiol, or subsequent luteal-phase progesterone levels. However, fasting elevated cortisol and resulted in a phase advance in melatonin secretion of 81 minutes in both the midfollicular and luteal phases. CONCLUSION(S): Fasting in women elicited expected metabolic responses and apparently advanced the central circadian clock without compromising reproductive function.

   
   

Int J Obes Relat Metab Disord. 1995 Nov;19(11):817-9
Electrocardiographic findings associated with very low calorie dieting.
Seim HC, Mitchell JE, Pomeroy C, de Zwaan M.
Department of Family Practice and Community Health, University of Minnesota, Minneapolis 55414, USA.

OBJECTIVE: To determine the safety of very low calorie diets (VLCD) in regard to their effects on cardiac function. DESIGN: EKG changes were analyzed for 126 women on a VLCD of 3349 kJ/d (800 kcal/d). EKGs were done when the diet was begun, after 3 months of dieting, and at a 6 month follow up after being off the diet for 3 months. SETTING: Subjects were solicited through advertisements and charged $1,000 for participating after being screened for age, weight, and health status. MAIN OUTCOME MEASURES: EKG QTc intervals, PR interval, QRS interval, ST-T wave changes, and heart rate. RESULTS: Over one-fourth (27.0%) of subjects had normal EKGs at all three time points studied. Sinus bradycardia was the most common abnormality, observed in 60 subjects (47.6%) on at least one of the three EKGs. Fifty-eight (46%) patients had EKGs with ST-T wave abnormalities observed on at least one of the EKGs. Eight subjects (6.4%) had prolonged QTc (more than one standard deviation beyond the average for women) intervals on at least one EKG. None of these eight persons had significant untoward medical consequences. CONCLUSION: A VLCD diet of 3349 kJ/d (800 kcal/d) for up to 3 months is not associated with significant electrocardiographic abnormalities or clinical cardiac complications, provided the patients have low cardiovascular risk at baseline.

   
   

Scand J Prim Health Care. 1995 Mar;13(1):13-20
Compliance, clinical effects, and factors predicting weight reduction during a very low calorie diet regime.
Hoie LH, Bruusgaard D.
Norsk Legesenter, Oslo, Norway.

OBJECTIVE: To study compliance, clinical effects, and factors predicting weight reduction in obese patients treated with a very low calorie diet (VLCD) regime. SETTING: A general practice in Oslo, Norway. SUBJECTS: 253 obese volunteers, aged 15-72, with a mean body mass index (BMI) of 33.4 (25-51) kg/m2. DESIGN: Open, non-comparative trial. Patients used a VLCD for eight consecutive weeks to achieve weight loss. The following were recorded every second week: weight, blood pressure, anthropometric measurements, compliance, side-effects, and patient acceptability. Blood parameters were tested before and after the trial. RESULTS: VAS-measurements showed that patients found it easy to comply with treatment, and 87.0% completed the study. Mean weight loss was 13.2 (2-33) kg. Blood pressure, serum lipids, and anthropometric measurements were significantly reduced. Side-effects were few and occurred mainly during the first two weeks of the trial. Main factors predicting weight reduction were gender, initial weight, initial BMI, and age. There was no correlation between weight loss and duration of obesity or reported number of weight reduction attempts. By VAS-measurements good acceptability of satiety and taste was recorded, and patients reported improved physical fitness and better quality of life after weight reduction.

 

 
Possible complications during fasting therapy and indications for its stopping.

Ketoacidose (noncompensated) with heavy growing complications.

It happens in 2-5% of the patients, usually, during the first fast. It accompanied by vertigo, sickness, vomiting, general weakness. In this case alkaline mineral water should be prescribed or sodium hydrocarbonate (2-3 g every 2-3 hours). If there is no effect during 12-24 hours fasting should be dropped. Sodium hydrocarbonate must be taken, oxygen inhalations and re-feeding nutrition. But if the patient is strongly willing to continue fasting, the fasting could be continued in 2-3 days (fractional fasting method).

Ortostatical collapse (syncope)

More often this undergo in patients suffering from hypotonia (AP is under 90/60 mm). If it occurs, patient should be in horizontal position with his legs up, flow of fresh air should be ensured, a tampon with liquid ammonia is under his nose, (in rare cases inject caffeine or cordiamine). If syncope repeats fasting should be dropped. As prophylactic measures it is recommended to avoid sharp movements, getting up from the bed quickly.

Malignant arrthytmias, unstable angina

Is very rare to happen and show as extracistolia. In its base lays hypocaligistia, caused by ketoacidose and breach of activity of K+-Na+-AT Phase. If the patients complains on tachycardia, aches in the heart area, urgent electrocardiographia should be hold. Preparations of potassium (panangin, asparkam, etc) and ß-adrenoblocks (obzidan) should be prescribed. If there is no positive result within 12-24 hours fasting should be stopped. Prophylactic measures consist of do not alowing persons that suffers from breach of cardiac rhythm in anamnes to go long-term fast. In this case fractional fasting method could be implemented (1-2-3 days of fasting).

Kidney and bilious colic.

Could be at patient with nephro-stone and gall-stone diseases. If colic begin, fasting should be dropped, spasmolitics and analgetics in normal therapeutic doses should be prescribed. Prophylactic measures: adequate drinking regimen in the process of fasting (no less then 1- 1,5 l per day).

Acute erosive-ulcerous changes of gastroduodenal zone.

Happens rarely (in 2-5 %). In case of stable epigastral aches, heart burning, eructation, phibrogastroduodenoscopy should be hold. Presence of acute erosive-ulcerous changes of mucous membrane of the stomach and duodenum is an indication to discontinue fast. Antacides should be prescribed (Almagel, Vikalin) or Venter (Surralfat), As usual, epitelisation of the ulcer and erosion happens within 10-14 days of fasting.


Convulsions.

Is very rare to happen, usually at long terms of fasting (over 20-30 days). Tonic convulsion of calf muscles, finger and chewing muscles are developing. The reason is water-electrolit shifts. For internal use 1% solution of sodium chloride 20-30 ml 4-5 times per day.

Syndrome of "food overload".

Occurs during first 3-5 days of refeeding period if prescribed regimen of nutrition (overeating) and ration are broken. It causes sickness, vomiting, overloading in epigastry, disorder with stool. It is necessary to lavage the stomach, to give salted laxative, and to recommend food abstinence for 1-2 days (full fasting). Prophylactic measures: keeping the dietetic regimen of the refeeding period of fasting therapy.

"Salt" oedema.

Happens during refeeding period if the diet is not kept (use of salt, herring, butter, cheese, etc). It causes oedema under eyes, headache, weakness, increase of mass of the body (up to 1,5-2 kg). Oedema passes independently within 1-3 days if the diet does not contains salt. Diuretics (hypotiazide, etc) or laxatives help to vanish oedema. Prophylactic: absolute exclusion of salt and saltcontaining products for all rehabilitation period (3-4 weeks).

Indications for discontinuance of fasting:

  • categorical rejection of patients to continue fast
  • heavy process of ketoacidose, that cannot be treated by bi-carbonates
  • repeated ortostatical scollapse
  • stable disorder of cardiac rhythm
  • symptoms of growing insufficiency of circulation of the blood
  • stable sinusoid tachicardia (110-120 beats /min and more)
  • atacks of kidney and bilious colic
  • marked bradicardia (50 beats/min and less)
  • increase of content in the blood AlAT, AsAT and/or direct bilirubin 2 times beyond the norm
  • acute erosive-ulcerous changes of gastroduodenal area.
   
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FASTING / LOW CALORIE PROGRAMS
on the Adriatic Coast
The Anti-Aging Fasting Program consists of a 7-28 days program (including 3 - 14 fasting days). 7-28-day low-calorie diet program is also available .
More information
    The anti-aging story (summary)
Introduction. Statistical review. Your personal aging curve
  Aging and Anti-aging. Why do we age?
    2.1  Aging forces (forces that cause aging
     
Internal (free radicals, glycosylation, chelation etc.) 
External (Unhealthy diet, lifestyle, wrong habits, environmental pollution, stress, poverty-change "poverty zones", or take it easy. etc.) 
    2.2 Anti-aging forces
     
Internal (apoptosis, boosting your immune system, DNA repair, longevity genes) 
External (wellness, changing your environment; achieving comfortable social atmosphere in your life, regular intake of anti-aging drugs, use of replacement organs, high-tech medicine, exercise)
    2.3 Aging versus anti-aging: how to tip the balance in your favour!
 
    3.1 Caloric restriction and fasting extend lifespan and decrease all-cause mortality (Evidence)
      Human studies
Monkey studies
Mouse and rat studies
Other animal studies
    3.2 Fasting and caloric restriction prevent and cure diseases (Evidence)
        Obesity
Diabetes
Hypertension and Stroke
Skin disorders
Mental disorders
Neurogical disorders
Asthmatic bronchitis, Bronchial asthma
Bones (osteoporosis) and fasting
Arteriosclerosis and Heart Disease
Cancer and caloric restriction
Cancer and fasting - a matter of controversy
Eye diseases
Chronic fatigue syndrome
Sleeping disorders
Allergies
Rheumatoid arthritis
Gastrointestinal diseases
Infertility
Presbyacusis
    3.3 Fasting and caloric restriction produce various
      biological effects. Effects on:
        Energy metabolism
Lipids metabolism
Protein metabolism and protein quality
Neuroendocrine and hormonal system
Immune system
Physiological functions
Reproductive function
Radio-sensitivity
Apoptosis
Cognitive and behavioral functions
Biomarkers of aging
    3.4 Mechanisms: how does calorie restriction retard aging and boost health?
        Diminishing of aging forces
  Lowering of the rate of gene damage
  Reduction of free-radical production
  Reduction of metabolic rate (i.e. rate of aging)
  Lowering of body temperature
  Lowering of protein glycation
Increase of anti-aging forces
  Enhancement of gene reparation
  Enhancement of free radical neutralisation
  Enhancement of protein turnover (protein regeneration)
  Enhancement of immune response
  Activation of mono-oxygenase systems
  Enhance elimination of damaged cells
  Optimisation of neuroendocrine functions
    3.5 Practical implementation: your anti-aging dieting
        Fasting period.
Re-feeding period.
Safety of fasting and low-calorie dieting. Precautions.
      3.6 What can help you make the transition to the low-calorie life style?
        Social, psychological and religious support - crucial factors for a successful transition.
Drugs to ease the transition to caloric restriction and to overcome food cravings (use of adaptogenic herbs)
Food composition
Finding the right physician
    3.7Fasting centers and fasting programs.
  Food to eat. Dishes and menus.
    What to eat on non-fasting days. Dishes and menus. Healthy nutrition. Relation between foodstuffs and diseases. Functional foods. Glycemic index. Diet plan: practical summary. "Dr. Atkins", "Hollywood" and other fad diets versus medical science
     

Vegetables
Fruits
Bread, cereals, pasta, fiber
Glycemic index
Fish
Meat and poultry
Sugar and sweet
Legumes
Fats and oils
Dairy and eggs
Mushrooms
Nuts and seeds
Alcohol
Coffee
Water
Food composition

  Anti-aging drugs and supplements
    5.1 Drugs that are highly recommended
      (for inclusion in your supplementation anti-aging program)
        Vitamin E
Vitamin C
Co-enzyme Q10
Lipoic acid
Folic acid
Selenium
Flavonoids, carotenes
DHEA
Vitamin B
Carnitin
SAM
Vinpocetine (Cavinton)
Deprenyl (Eldepryl)
    5.2 Drugs with controversial or unproven anti-aging effect, or awaiting other evaluation (side-effects)
        Phyto-medicines, Herbs
HGH
Gerovital
Melatonin
      5.3 Drugs for treatment and prevention of specific diseases of aging. High-tech modern pharmacology.
        Alzheimer's disease and Dementia
Arthritis
Cancer
Depression
Diabetes
Hyperlipidemia
Hypertension
Immune decline
Infections, bacterial
Infections, fungal
Memory loss
Menopause
Muscle weakness
Osteoporosis
Parkinson's disease
Prostate hyperplasia
Sexual disorders
Stroke risk
Weight gaining
    5.4 The place of anti-aging drugs in the whole
      program - a realistic evaluation
 
    6.1 Early diagnosis of disease - key factor to successful treatment.
      Alzheimer's disease and Dementia
Arthritis
Cancer
Depression
Diabetes
Cataracts and Glaucoma
Genetic disorders
Heart attacks
Hyperlipidemia
Hypertension
Immune decline
Infectious diseases
Memory loss
Muscle weakness
Osteoporosis
Parkinson's disease
Prostate hyperplasia
Stroke risk
Weight gaining
    6.2 Biomarkers of aging and specific diseases
    6.3 Stem cell therapy and therapeutic cloning
    6.4 Gene manipulation
    6.5 Prosthetic body-parts, artificial organs
        Blood
Bones, limbs, joints etc.
Brain
Heart & heart devices
Kidney
Liver
Lung
Pancreas
Spleen
    6.6 Obesity reduction by ultrasonic treatment
  Physical activity and aging. Experimental and clinical data.
        Aerobic exercises
Stretching
Weight-lifting - body-building
Professional sport: negative aspects
 
  Conclusion: the whole anti-aging program
    9.1 Modifying your personal aging curve
      Average life span increment. Expert evaluation.
     
Periodic fasting and caloric restriction can add 40 - 50 years to your lifespan
Regular intake of anti-aging drugs can add 20-30 years to your lifespan
Good nutrition (well balanced, healthy food, individually tailord diet) can add 15-25 years to your lifespan
High-tech bio-medicine service can add 15-25 years to your lifespan
Quality of life (prosperity, relaxation, regular vocations) can add 15-25 years to your lifespan
Regular exercise and moderate physical activity can add 10-20 years to your lifespan
These approaches taken together can add 60-80 years to your lifespan, if you start young (say at age 20). But even if you only start later (say at 45-50), you can still gain 30-40 years


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    9.2 The whole anti-aging life style - brief summary 
    References eXTReMe Tracker
        The whole anti-aging program: overview
         
       

       
     
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