4 ms·

I found this study from 1973 interesting where an extremely obese individual performed a supervised fast for about a year and dropped from 456 to 180 pounds. >

by bko 8y ago

I found this study from 1973 interesting where an extremely obese individual performed a supervised fast for about a year and dropped from 456 to 180 pounds. > A 27-year-old male patient fasted under supervision for 382 days and has subsequently maintained his normal weight. Blood glucose concentrations around 30 mg/100 ml were recorded consistently during the last 8 months, although the patient was ambulant and attending as an out-patient. Responses to glucose and tolbutamide tolerance tests remained normal. The hyperglycaemic response to glucagon was reduced and latterly absent, but promptly returned to normal during carbohydrate refeeding. After an initial decrease was corrected, plasma potassium levels remained normal without supplementation. A temporary period of hypercalcaemia occurred towards the end of the fast. Decreased plasma magnesium concentrations were a consistent feature from the first month onwards. After 100 days of fasting there was a marked and persistent increase in the excretion of urinary cations and inorganic phosphate, which until then had been minimal. These increases may be due to dissolution of excessive soft tissue and skeletal mass. Prolonged fasting in this patient had no ill-effects. > During the 382 days of the fast, the patient's weight decreased from 456 to 180 lb. Five years after undertaking the fast, Mr A.B.'s weight remains around 196 lb. I don't know why I haven't seen more studies where extremely obese individuals just stop eating. [0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2495396/pdf/postmedj00315-0056.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2495396/pdf/pos...

johnkpaul 8y ago
Because 1) doctors are typically against this 2) when eating carbohydrates regular this is extremely extremely difficult today. I have discussed it many many times with my doctors and they have all talked about "starvation mode" and all of these things. I currently intermittently fast very frequently and that has helped immensely with my weight. I have never done more than a 5 day fast, but even that much can do great things in combination with almost-0-carb.
- vanderZwan 8y ago
  Hey John! You probably don't remember me, but we met in Malmö a couple of years back when you gave a very nice talk. I remember you being very nervous about Douglas Crockford attending it, haha. I was being grumpy about the death of Google Reader, and you said that that's what you use Twitter for. So you're basically the reason I'm now on Twitter actually. Glad to hear the intermittent fasting is working well for you! Hope you'll have to buy a new wardrobe for yourself soon ;)
  - johnkpaul 8y ago
    Hello! I definitely remember having this conversation with someone lol. Thank you so much! I definitely remember being nervous that he was going to be an attendee in my own talk and if he'd ask questions afterward that showed I was a fool. :-) Glad that didn't happen! I've gratefully already given myself a new wardrobe and another one will be coming in a few years. I'm on a slow descent and have been for over 2 years, since cutting out carbohydrates
jemfinch 8y ago
> I don't know why I haven't seen more studies where extremely obese individuals just stop eating. Primarily because it's not considered medically safe, and a study along those lines would be too dangerous to the patients to be permitted. In this particular case, the 27yo male patient informed the doctors of his plan and said, "This is what I'm doing, you can monitor me or not." They didn't propose the study themselves.
- bko 8y ago
  It may be dangerous. But I imagine being 400+ pounds is even more dangerous, especially at an advanced age. Experimental treatments that may be more risky should be encouraged. Otherwise being that size is a death sentence.
  - _jal 8y ago
    One can imagine what one likes, of course. I personally prefer to base medical decisions on, well, medical advice than on mental meanderings. And the medical advice leans the other direction[1]. > Otherwise being that size is a death sentence. Being any size is a death sentence. Balancing tradeoffs more or less well determines the appeals process length. [1] People quibble with for all sorts of reasons, some of them even somewhat reasonable. But > Experimental treatments that may be more risky should be encouraged. Eh? Do whatever you like with your body, and more power to you. But this is the same flavor of ignorant social pressure game the anti-vaxxers get up to, and is deeply irresponsible.
    - aldoushuxley001 8y ago
      It's quite ironic that your citation for medical advice is just a mental meandering that you were so dismissive of... maybe don't be so arrogant if you're also unwilling to cite the literature.
    - bko 8y ago
      Body mass index (BMI) is associated with a reduce lifespan. Compared to a normal-weight BMI, a BMI of: 40-44.9 leads to a loss of life of 6.5 years 45-49.9 leads to a loss of life of 8.9 years 50-54.9 leads to a loss of life of 9.8 years 55-59.9 leads to a loss of life of 13.7 years Assuming a 445 pounds at 6 feet tall is a BMI of about 60, at about the top of the highest range. I think extreme obesity is a big enough health risk that it should be studied with more experimental treatments [0] https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001673 https://journals.plos.org/plosmedicine/article?id=10.1371/jo...
vanderZwan 8y ago
While not this obese, I have gone through a similar experience in the last couple of years where medication almost completely suppressed my hunger trigger. As a result I kind of "accidentally" did intermittent fasting for over a year. My BMI went from 31 to 24 in the span of half a year, at which point my colleagues were getting worried because of the rapid weight loss and I started to rationally force myself to eat during lunchtime. Since a couple of months the hunger suppression is no longer an issue, but it has been surprisingly easy to maintain a healthy weight and healthy eating habits since. I suspect one part of the problem is that the body takes a long time to adjust to what it considers a new "normal" weight, which is why diets often don't work. Maybe if they were specifically oriented towards staying at a certain weight for an extended period of time?
- tomcam 8y ago
  Obviously I have to know what the medication was!
aantix 8y ago
I remember Joe Rogan and Peter Attia talking about this on Joe's podcast. The patient did supplement with yeast, for the branched-chain amino acids. And strangely, at the end of the fast, he didn't have all of that loose skin that you typically see in those with rapid weight loss. They were speculating if the BCAAs helped with that or not.
- WalterSear 8y ago
  This is a phenomenon that's been noted by others regarding weightloss during fasting, so it's probably the fasting itself, rather than the BCAAs.
bloak 8y ago
That patient did (of course) receive vitamins during the fast. I read somewhere that people who go on hunger strike, consuming nothing but water, die without becoming completely emaciated: they don't look like chronically underfed people at the end. There are plenty of well-known examples of prisoners dying while on hunger strike: they seem to last about 60 days. If you lost weight for 60 days at a constant rate taken from the 1973 case then you would lose about (456-180)/382*60 =~ 43 pounds. I would guess that most people could survive losing that much weight. But unless your aim is to kill yourself then I would advise not doing it with a hunger strike.
bonestamp2 8y ago
> I don't know why I haven't seen more studies where extremely obese individuals just stop eating. It's probably not common because you'd be trying to study the one thing they have the most trouble doing. To understand what I mean, you have to understand that asking an extremely obese person to stop eating is like asking an Alcoholic to stop drinking. All of them know that's what they have to do but that's literally their problem, they can't stop drinking and extremely obese people can't stop eating. More importantly, the drinking and eating in these diseases is not the problem per se, they're typically symptoms of less obvious root problems. In the case of food, these people get a dopamine rush each time they eat. It makes them feel good. But then they feel bad because they're getting fatter (for various physiological, social and psychological reasons), which then makes them want to eat more because that at least makes them feel good (temporarily). It's pretty easy to spot the mental illness and similarity to drug addiction in this feedback loop. I know this is hard to swallow for people who find it easy not to be alcoholics or overeaters but here's a journal article that studied the connection: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4166230/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4166230/ They say there is strong evidence that food addiction is similar to opiate and other psychoactive drug addictions. It also calls out alcohol and carbohydrate binges as stimulants for the brain's production and utilization of dopamine. The carbohydrates part is interesting since of course, that's literally what pig farmers use to fatten up pigs. So of course, if eating those makes you feel good and eating too many of them makes you fat then problem really starts to make sense. I used to be obese. When I moved to a new city and found a new doctor, I asked him if there was anyone I could talk to so I could get more help. He told me it's simple, I just need to eat less and exercise more. I've been called a lot of lousy names in my life, but what he said was the most insulting thing I had ever heard... that it was simple. You don't tell an alcoholic it's simple not to be an alcoholic, "Just stop drinking!" or to a drug addict, "Just stop taking drugs!". It's simple for you, but it's not simple for them. That's what makes them an alcoholic and not you. I had lost 50lbs about 10 years earlier, so I knew the technical requirements to lose weight. My problem was not with dietary knowledge or exercise. But, as many doctors do, they give you advice/pills/creams/etc to improve the symptoms rather than trying to understand the root problem. I don't blame the doctor though, he didn't understand my problem. In these cases, it has to be treated as an addiction and that's how I approached it. Once I realized my problem was one of addiction, I started to make some progress. I started to realize I would zombie walk to the kitchen like an addict in a daze, looking for a fix. I was thinking about something else completely but my body was on autopilot looking for food. I had a problem with food itself. Definitely carbs (especially sugar). I read a lot about eating disorders to better understand the problem and hoped to find a solution to the problem and not just the symptom. I wish I found out about the link between carbs/dopamine a lot sooner. I discovered it accidentally when I found out about the Keto diet around 2013. When I cut out almost all carbs, I quickly discovered my brain fog went away, I felt happy most of the time, I wanted to exercise, I had more energy, and finally... I didn't want to eat all the time. So, that was the basic solution for me, but even then it wasn't easy or simple. I did a lot of research and it took many false starts to finally make good progress. I'm sorry for the wall of text, and for hijacking your comment, but I hope this helps some people understand why it's not simple to do (or study) and I hope it helps some people who have an eating disorder find their path or get professional help (if they'll listen).

by bko 8y ago

johnkpaul 8y ago

Because 1) doctors are typically against this 2) when eating carbohydrates regular this is extremely extremely difficult today. I have discussed it many many times with my doctors and they have all talked about "starvation mode" and all of these things. I currently intermittently fast very frequently and that has helped immensely with my weight. I have never done more than a 5 day fast, but even that much can do great things in combination with almost-0-carb.

vanderZwan 8y ago
Hey John! You probably don't remember me, but we met in Malmö a couple of years back when you gave a very nice talk. I remember you being very nervous about Douglas Crockford attending it, haha. I was being grumpy about the death of Google Reader, and you said that that's what you use Twitter for. So you're basically the reason I'm now on Twitter actually. Glad to hear the intermittent fasting is working well for you! Hope you'll have to buy a new wardrobe for yourself soon ;)
- johnkpaul 8y ago
  Hello! I definitely remember having this conversation with someone lol. Thank you so much! I definitely remember being nervous that he was going to be an attendee in my own talk and if he'd ask questions afterward that showed I was a fool. :-) Glad that didn't happen! I've gratefully already given myself a new wardrobe and another one will be coming in a few years. I'm on a slow descent and have been for over 2 years, since cutting out carbohydrates

jemfinch 8y ago

> I don't know why I haven't seen more studies where extremely obese individuals just stop eating. Primarily because it's not considered medically safe, and a study along those lines would be too dangerous to the patients to be permitted. In this particular case, the 27yo male patient informed the doctors of his plan and said, "This is what I'm doing, you can monitor me or not." They didn't propose the study themselves.

bko 8y ago
It may be dangerous. But I imagine being 400+ pounds is even more dangerous, especially at an advanced age. Experimental treatments that may be more risky should be encouraged. Otherwise being that size is a death sentence.
- _jal 8y ago
  One can imagine what one likes, of course. I personally prefer to base medical decisions on, well, medical advice than on mental meanderings. And the medical advice leans the other direction[1]. > Otherwise being that size is a death sentence. Being any size is a death sentence. Balancing tradeoffs more or less well determines the appeals process length. [1] People quibble with for all sorts of reasons, some of them even somewhat reasonable. But > Experimental treatments that may be more risky should be encouraged. Eh? Do whatever you like with your body, and more power to you. But this is the same flavor of ignorant social pressure game the anti-vaxxers get up to, and is deeply irresponsible.
  - aldoushuxley001 8y ago
    It's quite ironic that your citation for medical advice is just a mental meandering that you were so dismissive of... maybe don't be so arrogant if you're also unwilling to cite the literature.
  - bko 8y ago
    Body mass index (BMI) is associated with a reduce lifespan. Compared to a normal-weight BMI, a BMI of: 40-44.9 leads to a loss of life of 6.5 years 45-49.9 leads to a loss of life of 8.9 years 50-54.9 leads to a loss of life of 9.8 years 55-59.9 leads to a loss of life of 13.7 years Assuming a 445 pounds at 6 feet tall is a BMI of about 60, at about the top of the highest range. I think extreme obesity is a big enough health risk that it should be studied with more experimental treatments [0] https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001673 https://journals.plos.org/plosmedicine/article?id=10.1371/jo...

vanderZwan 8y ago

While not this obese, I have gone through a similar experience in the last couple of years where medication almost completely suppressed my hunger trigger. As a result I kind of "accidentally" did intermittent fasting for over a year. My BMI went from 31 to 24 in the span of half a year, at which point my colleagues were getting worried because of the rapid weight loss and I started to rationally force myself to eat during lunchtime. Since a couple of months the hunger suppression is no longer an issue, but it has been surprisingly easy to maintain a healthy weight and healthy eating habits since. I suspect one part of the problem is that the body takes a long time to adjust to what it considers a new "normal" weight, which is why diets often don't work. Maybe if they were specifically oriented towards staying at a certain weight for an extended period of time?

tomcam 8y ago
Obviously I have to know what the medication was!

aantix 8y ago

I remember Joe Rogan and Peter Attia talking about this on Joe's podcast. The patient did supplement with yeast, for the branched-chain amino acids. And strangely, at the end of the fast, he didn't have all of that loose skin that you typically see in those with rapid weight loss. They were speculating if the BCAAs helped with that or not.

WalterSear 8y ago
This is a phenomenon that's been noted by others regarding weightloss during fasting, so it's probably the fasting itself, rather than the BCAAs.

bloak 8y ago

That patient did (of course) receive vitamins during the fast. I read somewhere that people who go on hunger strike, consuming nothing but water, die without becoming completely emaciated: they don't look like chronically underfed people at the end. There are plenty of well-known examples of prisoners dying while on hunger strike: they seem to last about 60 days. If you lost weight for 60 days at a constant rate taken from the 1973 case then you would lose about (456-180)/382*60 =~ 43 pounds. I would guess that most people could survive losing that much weight. But unless your aim is to kill yourself then I would advise not doing it with a hunger strike.

bonestamp2 8y ago

> I don't know why I haven't seen more studies where extremely obese individuals just stop eating. It's probably not common because you'd be trying to study the one thing they have the most trouble doing. To understand what I mean, you have to understand that asking an extremely obese person to stop eating is like asking an Alcoholic to stop drinking. All of them know that's what they have to do but that's literally their problem, they can't stop drinking and extremely obese people can't stop eating. More importantly, the drinking and eating in these diseases is not the problem per se, they're typically symptoms of less obvious root problems. In the case of food, these people get a dopamine rush each time they eat. It makes them feel good. But then they feel bad because they're getting fatter (for various physiological, social and psychological reasons), which then makes them want to eat more because that at least makes them feel good (temporarily). It's pretty easy to spot the mental illness and similarity to drug addiction in this feedback loop. I know this is hard to swallow for people who find it easy not to be alcoholics or overeaters but here's a journal article that studied the connection: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4166230/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4166230/ They say there is strong evidence that food addiction is similar to opiate and other psychoactive drug addictions. It also calls out alcohol and carbohydrate binges as stimulants for the brain's production and utilization of dopamine. The carbohydrates part is interesting since of course, that's literally what pig farmers use to fatten up pigs. So of course, if eating those makes you feel good and eating too many of them makes you fat then problem really starts to make sense. I used to be obese. When I moved to a new city and found a new doctor, I asked him if there was anyone I could talk to so I could get more help. He told me it's simple, I just need to eat less and exercise more. I've been called a lot of lousy names in my life, but what he said was the most insulting thing I had ever heard... that it was simple. You don't tell an alcoholic it's simple not to be an alcoholic, "Just stop drinking!" or to a drug addict, "Just stop taking drugs!". It's simple for you, but it's not simple for them. That's what makes them an alcoholic and not you. I had lost 50lbs about 10 years earlier, so I knew the technical requirements to lose weight. My problem was not with dietary knowledge or exercise. But, as many doctors do, they give you advice/pills/creams/etc to improve the symptoms rather than trying to understand the root problem. I don't blame the doctor though, he didn't understand my problem. In these cases, it has to be treated as an addiction and that's how I approached it. Once I realized my problem was one of addiction, I started to make some progress. I started to realize I would zombie walk to the kitchen like an addict in a daze, looking for a fix. I was thinking about something else completely but my body was on autopilot looking for food. I had a problem with food itself. Definitely carbs (especially sugar). I read a lot about eating disorders to better understand the problem and hoped to find a solution to the problem and not just the symptom. I wish I found out about the link between carbs/dopamine a lot sooner. I discovered it accidentally when I found out about the Keto diet around 2013. When I cut out almost all carbs, I quickly discovered my brain fog went away, I felt happy most of the time, I wanted to exercise, I had more energy, and finally... I didn't want to eat all the time. So, that was the basic solution for me, but even then it wasn't easy or simple. I did a lot of research and it took many false starts to finally make good progress. I'm sorry for the wall of text, and for hijacking your comment, but I hope this helps some people understand why it's not simple to do (or study) and I hope it helps some people who have an eating disorder find their path or get professional help (if they'll listen).