Fasting: Fast Track to Control Plaque
If you're anxious to obtain faster control over your heart scan score and its causes,
then fasting is worth considering. Fasting is the quickest, most effective method to
"jump-start" a lifestyle that has suffered neglect and regain control over health.
Fasting is not some grim punishment for previous sins. It is not the same as starvation or anorexia, disease states from sustained undernourishment. Fasting can be a positive, enlightening experience that re-educates you and your body about what food and eating should feel like. It can be a process that readjusts the distortions your body has suffered from life's excesses over the years. It's the fastest method available that can put you back in control over coronary plaque.
Most people cringe at the thought of fasting because they immediately recall how they felt when they've missed a meal. Three or four hours after a meal, most Americans experience a deep, uncomfortable gnawing in the pit of their stomach. Some even become lightheaded, weak, and nauseated. Endure days of this? Pure torture!
But that's not what fasting means.
"Fasting is not so uncomfortable as many would think. Hunger typically goes away completely by the second day and the symptoms of withdrawal from food and toxins typically end quickly, usually by the second day of the fast. Interestingly, it has been noted by physicians conducting fasts for decades that true hunger is a mouth and throat sensation, felt in the same spot that one feels thirst. Gnawing in the stomach, stomach cramping, headaches, and generalized weakness from not eating or skipping a meal or two are experienced only by those who have been eating the standard American diet with all its shortcomings (those in most need of a fast)."
Joel Fuhrman, MD
Fasting and Eating for Health
If you've struggled to lose weight through healthy eating and exercise, or if you would like to lose the weight quicker, fasting may be a solution. Weight loss occurs rapidly while you fast. You can generally expect to drop 1 lb per day of fasting.
Beyond the physical benefits of fasting, the most profound benefit you'll experience is the new way you view food. Most people gain a renewed appreciation for food textures, tastes, and portions. Fasting helps you enjoy food more. Fasting also puts you in control over food, unlike the millions of Americans who allow food to control their lives. Critics of fasting say that it's better to just eat healthy. What they fail to recognize are the powerful lessons you can learn from fasting that go far beyond just the weight loss or other physical benefits.
What can you achieve by therapeutic fasting?
First of all, the world of fasting is filled with claims of physical and spiritual "cleansing", "detoxifying", and other scientifically suspect concepts. Perhaps these supernatural claims are encouraged by the natural "high" many people do indeed experience during fasting, particularly after 48 hours. Nonetheless, there are several genuine benefits to fasting.
Fasting is an effective weight loss tool. Many people who struggle to adhere to a healthy diet day in, day out, may do better by fasting for, say, five days, then resuming a healthy diet. Yet the weight loss benefits can still be obtained. It allows you to establish a new "baseline" to maintain. During a fast, you can expect to lose about 1 lb. per day. The first 24 hours of fasting may yield a greater loss, but some of this will be water loss. You'll find yourself urinating a lot at first, then it tapers off.
Blood pressure will drop dramatically within 24 hours of starting your fast. For this reason, we usually hold most blood pressure medicines (see below) during the fast and re-introduce them stepwise on breaking your fast. This may require the assistance of your doctor if you're on blood pressure medications, particularly if you're taking more than one.
"Many of my patients who have had difficulty controlling hypertension utilizing combinations of three or four different drugs have had their blood pressure decrease into the normal range through fasting. Moreover, blood pressure generally remains low upon the reintroduction of food if they continue to follow the recommended diet."
Joel Fuhrman, MD
Fasting and Eating for Health
If you're diabetic or pre-diabetic, blood sugars will promptly drop. This may also require the assistance of your doctor if you take oral blood sugar control medications or insulin. Many people return from their fast having rid themselves of pre-diabetic patterns, better control over blood sugars, or even curing themselves of diabetes (adult-onset).
You will be hungry. There's no way around it. The human impulse to eat is powerful and, especially in the first 24 hours, temptation will surround you. However, most people find that, by the second day, hunger dissipates and fasting becomes much easier. You may even lose the urge to eat entirely for the duration of your fast.
Drinking plentiful water is crucial. Some have advocated drinking half your weight in ounces per day. For example, if you weigh 200 lbs, drink 100 ounces or 12 ½ cups per day. (Discuss this with your doctor if you are on a fluid or electrolyte restriction.) Another simple rule some fasting enthusiasts advocate is to drink an 8 oz. glass of water every hour while awake. The important issue is to drink plenty of water, more than you're accustomed. Most people live life chronically and mildly dehydrated. This is a good time to re-learn how to drink water for health.
Many people, on attempting their first fasting experience, report an unexpected clarity of thought and purpose, like a cloud being lifted. Most of us never learn to appreciate how bad we feel—mental fogginess, fatigue, low energy, lack of focus—as a result of the food we eat. Lifting the fog during the fast can teach you very persuasively just how bad a diet that contains excessive processed foods can make you feel.
Recovering from a fast can be an enlightening experience the first time you try it. You approach food with a renewed appreciation for taste, texture, and its effects on your physiology. After the initial hunger upon resuming eating dissipates, many people find that appetite is blunted and you're satisfied with less. Curiously, weight loss and adhering to a healthy diet is easier after fasting.
Unavoidably, during a more extended fast of three days or more, most people will not have the physical energy reserves that you have during eating periods. Your body has drawn from liver glycogen stores (stored energy) to maintain blood sugar in the absence of food. For this reason, fasting should not be conducted during a hectic period of high activity. Ideally, a fast should be conducted during a quieter period when you have the occasional luxury of resting. You should also not engage in strenuous exercise, though light exercise, such as walking or leisurely biking, are fine. Be realistic. For instance, don't start your fast on Thursday if you have a cocktail party or family barbecue on Friday. The temptation will be great and/or you will have to endure the strange looks and comments of everyone wondering if you've gone off your rocker.
How long should you fast?
There are many variations to fasting schedules that you can choose to suit your commitment, discipline, tolerance, and schedule.
Fasting can last anywhere from 24 hours to many weeks. However, any period of a total fast beyond three days should be discussed with your doctor and, ideally, conducted with their assistance. Unfortunately, finding a physician with experience in the quirks and peculiarities of fasting is difficult. There are chiropractors and naturopaths who have some expertise. It's a rare M.D. with experience. Nonetheless, if you're planning a more prolonged fast, professional assistance is important. Someone will need to help you monitor electrolytes, particularly BUN, creatinine, potassium, and magnesium during a prolonged fast that goes on for more than five days. Blood pressure and any diabetic medications may also need to be held or reduced.
Some people prefer to use short fasts of 24, 48, or 72 hours, and repeat the cycle every so often, say every 3–4 weeks. Brief fasts like this generally do not require the supervision of your doctor except to help you manage any blood pressure or diabetes medicines you might be taking. Shorter fasts are easier and can still be quite effective. You won't obtain the dramatic benefits that you might get from a more prolonged fast, since weight loss and other benefits really kick in after 72 hours. But you can still do pretty well and obtain substantial benefits. If you know, for instance, that you're going to lose around a pound per day, a 48 hour fast every two weeks can be an easy and tolerable way to get it done. In fact, resisting unhealthy foods and goodies is far easier after your fast. You may still find that losing weight is easier after you resume eating.
Types of "fasts"
The simplest fast is a pure water fast: eat nothing but drink unrestricted quantities of water. Hydration is crucial, even more so during a fast since you will excrete greater amounts of water during a fast. Such a fast can last from 24 hours to weeks. This is the method advocated by most serious fasting enthusiasts, who claim the true health benefits that have been attributed to fasting, such as relief of many chronic diseases like arthritis, indigestion, diabetes, high blood pressure, etc., develop only with a true water fast maintained for weeks at a time.
However, some people struggle with pure water fasts. For them, there are several excellent alternatives:
Juice fasts
This is not a really a fast, but a reliance on vegetables and juices that you've juiced yourself. Be careful not to overdo sweet fruits like apples and bananas, since they overload you with sugar. Ideally, rely more on juiced vegetables such as celery, spinach, carrots, green peppers, cucumber, and radishes, and add apple, pear, berries, or other sweet fruits for taste. Four 8–12 oz glasses per day usually works well. However, you should only follow this sort of regimen if you are already accustomed to juicing vegetables and fruits, since the sudden introduction of juiced vegetables will cause gas and diarrhea. Fasting is the worst time to have diarrhea because of the fluid shifts in your body. It can make an otherwise positive experience misery. If you are accustomed to juicing, then this is an effective alternative to a water fast.
Soy milk fasts
This is our favorite method. In addition to unrestricted water, you can add four 8 oz glasses of soy milk. This provides a significant quantity of protein of around 25 grams per day with a low load of sugar and fat if the lighter versions are used. Look for the brands like Silk® "Light" or 8th Continent® "Light". Plain or vanilla flavored is preferable, since flavored varieties like chocolate have more sugar.
Herb tea fasts
Herbal teas come in a dizzying array of choices. You can drink these (unsweetened, of course) in unlimited quantity, though beware of some that can cause mild intestinal irritability and diarrhea if overdone.
What to expect
You will be hungry, particularly during the first 24 hours. After the first 24 hours, most people find themselves curiously free of hunger, or only occasionally hungry. Keeping your mind and hands busy is crucial. Many people turn to food out of boredom, and this can still happen during a fast. Avoid activities that you associate habitually with food. For instance, if your morning routine is to sit at your kitchen table, read the newspaper and eat breakfast, break the routine. Do something different.
Bowel movements will cease during a fast. This is normal. Since you're taking in little or nothing, a single movement may come a day or so into your fast, then usually ceases altogether. This means your bowels are being given a well-deserved vacation. However, when the fast is broken and eating is resumed, the bowels "wake up" gradually. It's therefore important to resume the fast with healthy vegetables and fruits to provide roughage to allow normal bowel function to resume. Don't break your fast with a plate of pasta, bread, and other processed foods. Not only will you be miserably constipated, you'll also feel awful and regain weight you lost during the fast.
Many people feel cold, particularly in the first 72 hours of the fast. Chilling at night is a common complaint. You're body is trying to conserve energy and yields the sensation of cold. For this reason, some people find it easier to fast in the warmer weather or during a vacation in warmer weather. Consider dressing more warmly than usual while fasting, including in bed.
Some people experience peculiar symptoms like achiness, a coated tongue, or tremulousness. These feelings generally result from prolonged fasts of five days or longer. Fasting enthusiasts attribute these peculiar phenomena to "clearing toxins" like pesticides, heavy metals, and food preservatives from the body. Though it probably has a more mundane, less magical explanation in real life, there presently is no scientific explanation for it. If you experience any unusual symptom during your fast, first think dehydration. If water replenishment fails to correct it, speak to your doctor or consider breaking your fast.
Avoid strenuous exercise during a total fast, since your reserves, particularly of glycogen, will be depleted. If you're accustomed to jogging several times per week, a walk or light jog should suffice. If you ordinarily walk, ride a bike, or engage in similar levels of exertion, continuing these light activities is fine, even preferable. But your fast is not a time to attempt new heights of endurance or extreme effort. You'll just frustrate yourself and maybe even feel lousy.
Fasting purists insist that caffeine should be avoided during a fast. We disagree. Complete avoidance in someone accustomed to drinking coffee or tea every day will often cause headaches and other "withdrawal" symptoms, which can disrupt your fast. It is important, however, to limit intake to no more than two cups or so per day to avoid an excessive diuretic effect. Alcohol should be avoided; your body will be more susceptible to its ill-effects during a fast, and it often erodes commitment to the fast. It's best to avoid it altogether.
All in all, fasting is a lot easier for most people than it sounds. Like anything, the more you do it, the better you will get at it. Many fasting enthusiasts, in fact, look forward to their fasts as a time for "cleansing", meditation, and regaining mental clarity and physical energy.
Will fasting reduce your heart scan score?
There is indeed circumstantial evidence that fasting or calorie deprivation can facilitate reversal of coronary atherosclerosis. For instance, during periods of starvation, heart attacks are rare. During World War II, for instance, heart attacks essentially ceased when food became scarce. (Other health problems arise, of course, from the sustained malnutrition that lasts for months or years. This is not what you are trying to achieve.)
Since fasting is a short-term strategy and not something you could undertake for a year (the usual interval between heart scans), we have no specific information on whether fasting directly facilitates a reduction in heart scan scores or coronary plaque.
However, fasting clearly accelerates many of the same processes that we usually try to improve through nutrition, exercise, nutritional supplements, etc. Fasting corrects many of the causes behind coronary plaque: reduction in blood pressure, often dramatic; reduced blood clotting factors like fibrinogen; drops in LDL and triglycerides and rises in HDL (though not immediate; there may be a lag of weeks to months, curiously); reductions in blood sugar and reversal, full or partial, of pre-diabetes and adult-onset diabetes. If significant weight loss results from fasting, benefits are even greater.
While we don't know if fasting itself reverses coronary plaque, it certainly helps correct the multitude of causes of coronary plaque.
Breaking your fast
If you fast for, say, three days, then break your fast with dinner at the all-you-can-eat buffet, you will destroy whatever benefits you obtained. You'll feel awful—cloudy, sleepy, you may experience severe abdominal cramps, you may vomit. You will be likely experience constipation or diarrhea, and you will regain the weight you lost. Forcing too much food, especially processed foods, too soon will overwhelm a "hibernating" digestive tract and stir up a storm of chaotic bowel activity. Be warned: do not resume eating with a shock-to-your-gut heavy meal. It is unwise to break your fast at a restaurant, where temptation may get the best of you.
Instead, resume with small meals of vegetables, fruits (preferably berries, citrus, apples, pears, but not tropical fruits like bananas and pineapple), and lighter protein-rich foods like low-fat yogurt, cottage cheese, soy products, egg whites, etc. Light soups work well, also. Avoid oily foods like salad dressings, fried foods, greasy meats, mayonnaise-based foods. The oil will overwhelm your gastrointestinal tract and you'll be plagued with cramps. After an extended fast of two or more weeks, you may need to limit your foods to light choices for the first 24–48 hours before resuming your more usual fare.
Some people, upon resuming food after fasting, do so with an intense appetite that seems to get worse after you begin eating. You must resist this temptation. Eat a little. Then go do something: go for a walk, go shopping, play tennis, play golf—something that takes food off your mind. Fasting should not be used as justification for binging.
Most people recover from a fast with smaller appetites than before the fast. They also approach food with a renewed sense of taste and appreciation. Gobs and handfuls are no longer necessary to satisfy appetite. This may be the greatest reward from a fast: the education you draw from your experience that allows you to more easily adhere to a healthy diet.
"Monitor yourself: watch your appetite disappear. Observe your mind without its preoccupation with food. Watch the feeling of emptiness return to your gut. . .When hunger first starts, it is subtle and can easily be ignored or confused with something else. There is a fine line between emotional/mental desire and physical hunger. Watch your attitude changes. Monitor any anger or resentment you may have about not eating. That is your signal to stop fasting. On the other hand, a positive attitude about the fast keeps you going for along time."
Steve Meyerowitz
Juice Fasting & Detoxification
After breaking your fast, refrain from having your lipids or lipoproteins assessed for at least 4 weeks, perhaps 8 weeks. For unclear reasons, improvements like increased HDL and drop in triglycerides do not develop immediately. They may require weeks to "catch up". You might even see an initial drop in HDL of 5 mg/dl or so. This carries no implications and is temporary.
Before you start fasting. . .
Some precautions before you undertake a fast:
* If you are diabetic or if you take medications to reduce blood sugar, such as Actos®, Avandia®, glyburide, glipizide, Byetta®, or insulin, speak to your doctor first. In our experience, it is best to stop oral diabetes agents during the fasting period, but do so only under your doctor's supervision. Because of the significant drop in blood sugar during fasting, insulin doses will need to be adjusted. Your blood sugar will need to be monitored during the fast to avoid extremes of low or high values.
* Speak to your doctor about any blood pressure medications. Ideally, your doctor will stop blood pressure medications during your fast because of the marked drop in blood pressure that occurs within the first 24–48 hours of fasting. The only medications that we do not stop are the beta blockers such as metoprolol, Toprol®, atenolol, labetalol, nadolol, and Coreg® (carvedilol). If you're on several blood pressure medications, or if you have had very high blood pressure that has been difficult to control, it may be unsafe to stop all of your medications at once, and only one or two might need to be held; you must discuss this with your doctor.
* Continuing nutritional supplements is optional. Fish oil, for instance, is more likely to provoke nausea during a fast. Temporarily stopping supplements is perfectly fine for the duration of your fast.
* If nausea, excessive or persistent lightheadedness, or unusual fatigue develop, dehydration is likely. Drink plenty of water—at least four 8 oz glasses—right away. This usually relieves the symptoms. If not, stop fasting and speak to your doctor.
* If you've recently recovered from a complicated illness such as cancer, a major infection, a surgical operation, traumatic injury, or have heart failure or other processes that may cause you to be malnourished, this is not a good time for fasting. Fasting is best done when you're suffering over-nourishment that plagues most Americans, or are generally healthy and want to improve your health. You should also not fast if you are pregnant or breast feeding.
* If you're already at your ideal body weight, fasting is still safe, even for days or weeks. However, the weight loss will be less. The more overweight you are, the more weight you will lose and the longer you can tolerate a fast.
* Tolerance for exercise or sustained physical activities varies widely during a fast. However, running a marathon, vigorous exercise, or heavy physical labor is not advised during your fast. You're best restricting yourself to walking or other lighter activities.
Is it really worth it?
Fasting, as simple as it seems on the surface, can achieve a number of goals.
First, fasting is a "fast track" to regain health you sacrificed by going to McDonald's with the kids, the all-you-can-eat pizza nights, or the many hamburger and French fry lunches at work. Or, the overindulgence of too many business dinners, or bowls of snack food in front of the TV. With several days (or several weeks, if you've really overindulged) of fasting, you can establish a new baseline to start your plaque control program.
If you've developed high blood pressure, pre-diabetes, or adult-onset diabetes along with your heart scan score, fasting is a powerful method to reduce or eliminate these problems. Pre-diabetes, for instance, is a ticking clock; you can be pre-diabetic for only so long and then deteriorate inevitably to diabetes—unless you reverse the pattern. Likewise, the risks associated with hypertension are not removed with blood pressure medication, only reduced. You can completely dissolve the risks of hypertension by not being hypertensive through your fast.
Second, fasting is the quickest path to weight loss available. Fasting is easier than dieting, since not eating at all can be much easier than stopping once you start eating. That's seems counter-intuitive, but a curious aspect of fasting that many people are unaware of. It is true that some people struggle to fast more than a few days at a time, but even that brief period is enough to achieve enormous gains. On an excellent diet restricted in calories, it's tough to lose more than a pound or two a week. Compare this to a fast: around 1 lb. per day.
Third, fasting is about regaining control over your life. Far too many of us allow food to control us. We give in to the temptations of a bag of chips, the clever marketing ploys of food manufacturers, the smell of cinnamon buns in the mall. With fasting, you've rejected temptation and seized back control. It's like the alcoholic dumping bourbon into the sink and vowing to never drink again. Of course, you will eat again—but you'll approach food with a renewed sense of taste and appreciation, and a reawakened perception for the effects, good and bad, that food provides.
Additional resources:
Fasting and Eating for Health, by Joel Fuhrman, MD. This is the number one reference for fasting written by a physician who has personally assisted thousands of patients on prolonged fasts. His experiences from witnessing the transforming power of fasts is helpful and inspiring. However, the book was written in the mid-90s and is therefore a little dated, particularly with regards to its dietary advice. The book was written during the popular low-fat craze and he does focus a bit too much on this. Otherwise, Dr. Fuhrman's book is an indispensable reference for anyone considering a fast.
Dr. Fuhrman also makes weekly webcasts that you can listen to at A recent webcast was entitled Nobody Should Die of Heart Disease, which is definitely worth listening to.
Juice Fasting and Detoxification, by Steve Meyerowitz. Helpful for its observations on fasting and for the recipes for various juice fasts, such as vegetable juices, fruit juices, fruit/vegetable blends, as well as teas, nut milks, and others. However, the book is filled with pseudoscientific talk about "cleansing" and "detoxification", phenomena that have little biologic basis.
Fasting Retreats—The website, www.retreatsonline.com, lists fasting retreats that provide pleasurable accommodations for your fasting experience. Look for "Fasting" under "Subject Guide to Retreats".
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