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Is fasting safe? A review of adverse events during water-only fasting (2018)
- lm28469 8y agoCompared to what ? Is it safe to eat 3 times a day + snacks, mostly over processed, calorie dense, low micro nutrients food ? Food is like most things, moderation/balance is key. I have no doubt fasting can be beneficial in some cases just as I have no doubt that the typical western diet is universally bad. This new fasting trend is just the blowback of the over abundance / over consumption of low quality food we experience pretty much everywhere in US / Europe.
- rfreytag 8y agoIt is an NIH study which to me implies rigor; including controls.
- glastra 8y agoYou cannot assume this is an NIH study just because the website hosting the PDF is from the NIH. The NCBI is somewhat of an online repository of papers and citations, nothing more. The study was published in the journal BMC Complementary and Alternative Medicine, and none of its authors are affiliated with the NIH, judging from their affiliation statement in the paper itself: Author details 1 AOMA Graduate School of Integrative Medicine, Austin, TX 78745, USA. 2 NoviSci, Durham, NC, USA. 3 TrueNorth Health Center, Santa Rosa, CA 95404, USA. 4 TrueNorth Health Foundation, 1501 Pacific Avenue, Santa Rosa, CA 95404, USA.
- leemailll 8y agoBmc on the nih website nowadays basically hosting nih-founded research papers. Not just papers published from nih
- pbhjpbhj 8y agoThe report appears rigorous, but it notes in several places that the data is not acquired in a rigorous way as it was not intended to be used to make such assessments. As to controls: >"the relative safety of water-only fasting is necessarily descriptive in nature as we did not identify a comparison group(s)" It's a good paper. I was left wondering why people attended the facility. A 9 day water only fast, with limited activity, sounds pretty extreme for a 70+ yo.
- shiven 8y agohttps://en.m.wikipedia.org/wiki/Sallekhana https://en.m.wikipedia.org/wiki/Sallekhana
- Legogris 8y agoIf you read the article you will see that the results and conclusion might be in line with what you expect. Academic papers don't necessarily follow Poe's Law in their titles ;)
- arkades 8y agoIt is bad form to criticize posters on HN for not reading the article they’re criticizing. Oddly, it seems to be less accepted than not reading the article one’s criticizing.
- vanderZwan 8y agoI don't know what gave you that impression, but it doesn't match my experience on HN at all. Discussions based on headlines alone tend to be accepted (especially if the poster mentions they haven't read the article), but "the article addresses your questions <here> and <here>" is usually the top reply.
- arkades 8y agoIn fairness, I tend to see two types of responses: One of the kind you mention - “the article actually says ...”, in which the respondent goes to the effort of basically summarizing the article OP didn’t bother to read. Those generally catch moderate upvotes. Then there’s the more blunt variety, along the lines of RTFM. Those catch solid downvotes. Frankly, I’d rather neither existed, and posts that clearly didn’t bother looking at anything but the headline were just flagged and deleted.
- andreareina 8y agoThere's a line between criticizing someone for not reading the article (or insinuating that they didn't read it, per the guidelines[1]) and stating that such-and-such claim is found in the article. Please don't insinuate that someone hasn't read an article. "Did you even read the article? It mentions that" can be shortened to "The article mentions that." [1] https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
- DeusExMachina 8y ago> the typical western diet is universally bad As if there is a "western" diet. Even just remaining in Europe, the typical diet in Italy has nothing to do with the typical diet in Germany. And while southern countries and northern countries tend to have more similar diets, even between them they have big differences. Same goes for "eastern diets". China and India, to pick just two, have completely different diets. Criticize overcompsuntion of low quality food all you want when it occurs, but I think that broad-stroke generalizations like "western diet bad" are not useful.
- dagw 8y agotypical diet in Italy has nothing to do with the typical diet in Germany. That's not really true. Both build a lot of their meals around a boiled starch, a grilled or fried protein and a vegetable dish, often prepared separately. It is not uncommon that this dish is primarily made up of raw vegetables. The starch and protein component almost always makes up the bulk of the meal. Both use a lot of dairy based sauces and/or a sauce made by thickening a meat stock (either pre-made or by de-glazing the pan they fired their protein in). Bread and other baked goods are a common component in many meals in both counties, often served with vegetable or dairy fat.
- geowwy 8y agoConclusion: >> To our knowledge, this is the most comprehensive analysis of adverse events experienced during medically supervised, water-only fasting conducted to date. Overall, our data indicate that the majority of adverse events experienced were mild to moderate and known reactions to fasting. This suggests that the protocol used in this study can be safely implemented in a medical setting with minimal risk of a serious adverse event.
- leereeves 8y agoBut is it safe to fast on our own in a non-medical setting? If only "the majority" of adverse events were mild to moderate known reactions, how many were severe? How many were unusual? And what does the medical setting provide (clearance, planning, monitoring, intervention) that people fasting on their own might lack?
- RobertRoberts 8y agoYes. Edit: It seems HN as a culture has a dislike of self confidence when it comes to health. Yes, you can take care of yourself for the most part. Fasting is done by many people in many cultures all over the world. It seems this is a new concept to US citzens and maybe they are afraid of the idea that health is mostly a personal choice.
- sageabilly 8y agoHN has a dislike of one-word answers without any hard data to back them up. If fasting can be undertaken safely by an individual not in a health care setting, how? What is the mechanism for safety? What are some signs that fasting is veering towards unsafe- for that matter, what's unsafe fasting, anyway?
- teknopaul 8y agoPick any one on the ways used by all the religions that have been doing it safely for generations. You should probably be asking is not fasting safe.
- firasd 8y agoThe two patients with most serious side-effects experienced dehydration and hyponatremia. This supports my view that it's important to maintain electrolyte balance during fasting (or other types of dieting like low-carb). When doing these kinds of practices I usually add some salt to water (or other electrolyte solutions if needed although there might be some sugar in them). I think this should help with the common complaints they saw like headache, fatigue, even the cardiovascular related issues. I gotta admit that as far as 'insomnia' goes I don't think electrolytes will help with that... you probably need some combination of fat/protein/carbs to get good sleep.
- nabla9 8y agoWater-only diet is fine, but it's possible to make it unnecessarily uncomfortable (tired and headaches) Idiocracy was right. You need the electrolytes. In other words, you should drink water with enough magnesium, sodium and, potassium. Many mineral waters, zero-calorie sports-drinks and low-sodium salts like Pansalt contain the right mix.
- beoh 8y agoIndeed, it's surprising they went with distilled water exactly for this reason.
- deleted 8y ago[deleted]
- RobertRoberts 8y agoCommon pharmaceuticals (even vaccines) have known (and some extremely debilitating) side effects. While the conclusion seems reasonable (ie, some people have adverse affects to not eating) it's by no means a condemnation of fasting. Fasting is the universal method of allowing the body to heal itself, animals fast to heal naturally. (ie, no medicine actually heals only compliments/supports healing, the body does all the real work)
- fromthestart 8y ago>Fasting is the universal method of allowing the body to heal itself This sounds like folkloric nonsense.
- RobertRoberts 8y agoIt's how wild animals that are wounded or sick heal. How is this "folkloric nonsense"?
- alistairSH 8y agoAnimals fast on purpose to facilitate healing? Do you have a source for this? I suspect some are forced to fast because they are too injured/ill to obtain food. A positive impact from entering a massive caloric deficit when the body is actively burning calories is counter-intuitive.
- JulianMorrison 8y agoThe positive impacts of fasting are supposedly due to increased efforts by the body to scrounge and scrape for calories, which up-regulates processes that have the effect of clearing undesirable built-up matter/cells/etc.
- beagle3 8y agoAnecdotal: Not GP. I don't remember where I read it about wild animals, but my dog would have the occasional "low energy, don't want to play" day, followed by a couple of days of not eating, and then being super-energetic when he went back to eating. On one of these occasions, I took him to the vet, who said he had a fever, likely of viral cause, and that him losing appetite was perfectly natural and likely helping him heal. When I'm sick I lose my appetite (and don't eat, sometimes for a few days). Don't you lose your appetite when you are sick?
- aedron 8y agoI would be interested in a comparison to 'total' fasting, i.e. abstaining from both solid food and liquid. This is the most commonly practiced religious practice (and so has a thousand year history). It would be interesting to know what the differences were, if any. In my own experience, somewhat unintuitively, total fasting is a lot easier than water-only fasting. I ascribe this to the digsetive system kind of shutting down after several hours of complete fasting. It feels like the stomach shrivels up, and hunger pangs become fewer and further between as time passes. Whereas going without proper food, but consuming water or small snacks, I feel very uncomfortable and usually get a headache.
- nurettin 8y agoGoing for a long period of time without water is intuitively a bad idea for your health. I think this is the reason for this study being water-only. It also makes sense from religious perspective, since a religion will prepare you for another life which is only attainable by dying, with no apparent intention to give you a good and healthy life on Earth.
- darkerside 8y agoCultural evolution suggests that, regardless of intention, these practices which have become mainstays of popular religions around the world, cover some type of benefit to survival, reproduction, or intellectual spread.
- JulianMorrison 8y agoOr to spiritual practise. The idea that they have to have a mundane use strikes me as wilfully blind to their intended purpose.
- darkerside 8y agoConsidering the infinite variety of ways to exercise a spiritual practice, and that many (perhaps most?) of them have died out in favor of the dominant religions and spiritual practices that survive today, I'd actually say it's willfully blind to ignore the likely impact of religion on survival and reproduction. It's simple game theory. The religions that survive today outcompeted the others.
- Timucin 8y agoNot only electrolytes but the lack of fibre is also a big problem when you fast more than a few days. Body needs fibre to maintain a healthy gut flora. So when the body lose the flora, it will struggle to digest the food, take the vitamins and nutritions from it etc. at the end of the fasting period. This is not only something I read from articles but also something I have experienced for a long time by the way. So please bear that in mind, keep your gut flora healthy and your life will be easier.
- Torwald 8y ago> Body needs fibre to maintain a healthy gut flora. Do you have a good link that explains that further?
- Timucin 8y agoI am on mobile, couldn’t find the original article but this one seems good enough. Please take a look. https://www.scientificamerican.com/article/fiber-famished-gut-microbes-linked-to-poor-health1/ https://www.scientificamerican.com/article/fiber-famished-gu...
- amanaplanacanal 8y agoI don't think this has been well established. We have several examples of people who have eaten nothing but animals products for long periods, without adverse health effects.
- mirceal 8y agoFor people that come into this and think: “wtf is wrong with someone that they want to starve themselves” there is more to this than meets the eye. There is more than one type of fasting (more than one protocol - thowing this here: IF with 16:8/18:6/omad, ADF, 5/2, Extended) and there is some science backing this up. some of the benefits of fasting are mind blowing but it’s hard to “swim upstream” when some of our beliefs are so entrenched (examples: not eating is going to slow your metabolism down, not eating is going to make you lose muscle mass, it’s a sing of mental health issues, it’s a eating disorder, breakfast is the most important meal of the day, you need to eat X time per day to keep your metabolism working) go to reddit and read the side bar for r/fasting and r/intermittentfasting and do a little bit of research/keep an open mind.
- draxofavalon 8y agoAgree, keep an open mind and don't be affraid to try. I don't know how to categorize my IF, I've been doing it for 4 years. Tuesday and Thursday a snack at 14 and dinner around 21. Friday night, saturday and sunday I eat whatever I want. All other days just tea or cofee. I'm 42 and I feel better than ever.
- iambateman 8y agoJust to make sure I understand... Sunday: coffee Monday: coffee Tuesday: snack and dinner Wednesday: coffee Thursday: snack and dinner Friday: three full meals Saturday: three full meals Are you able to focus by Tuesday? I feel like I would struggle to be productive.
- carlmr 8y agoYou get used to it after a while. The hardest part I found was social pressure to eat. So much of our culture revolves around eating that it's hard to do IF with any schedule where you leave out dinner time. So skipping breakfast is super easy (IMHO) and skipping dinner is nigh impossible. Skipping lunch highly depends on how pressured you feel to eat with your colleagues. I think one meal a day (usually named OMAD) is also not hard if you don't have lunch at work.
- buckthundaz 8y agoYes, it is. The better question: is it safe to eat/snack/graze chronically? Type 2 Diabetes seems to indicate it is not.
- projectramo 8y agotl;dr: yes it mostly is.
- davebryand 8y agoOnly for Americans in labs, though. It's totally fine for the rest of the world and our ancestors. I'm an American not in a lab and I do it all the time with life-changing results.
- projectramo 8y agoI think you think I am saying the opposite of what I think I am saying.
- davebryand 8y agoApologies, my mistake!
- lqet 8y agoI am confused by some of the comments in here who seem to see no food intake for more than 36 hours as dangerous or even pathological or assume that you need to somehow "prepare" for that or take certain precautions. Is this a cultural thing? When I was I student, I ate one meal a day, maybe some snacks in between. Very often, I went without food for a day, simply because I was too lazy / too emerged in some project to leave the house to buy food. Eating the last meal on Sunday evening, not eating on Monday, eating again on Tuesday evening - 48 hours without food. I did this many, many times, and still (in my early 30ies) do it occasionally, again just because I am too lazy to buy food sometimes. It never occurred to me that this could be considered "fasting", because neither did I feel any different after going 48 hours without food, nor did I lose any measurable amount of weight from it. Days, weeks or even months without food was pretty much the norm until ~150 years ago. If a day, or even a week without eating would be seriously dangerous to your body, mankind would've become extinct a long, long time ago.
- fargo 8y agoYou may be underestimating the snacking then. Your body starts missing a lot of nutrients after going without food for so long
- lqet 8y agoYou might have misunderstood me: 48 hours without food were 48 hours without food. I ate the snacks on days when there was food in the house. Or do you already consider 1 meal a day + snacks fasting?
- draxofavalon 8y agoMost people find that hard to believe. IMHO I think we eat mostly out of habit. I found out what hunger really is after fasting a lot.
- lqet 8y agoIs it really that hard to believe that a CS student in his mid-twenties is too lazy to shower, put on clothes and leave the house? :)
- Novashi 8y agoWho fasts with distilled water? Is this a thing now? It's dangerous because it will dilute electrolyte concentrations in your body. Drink tap/bottled water. Distilled water is completely unnatural to the body and should only be consumed in emergencies when you literally have nothing else. Even then it's still probably not a good idea. There's literally no benefit to choosing distilled water over tap/bottled water.
- davebryand 8y agoAs someone coming off a three-day water fast (five days was my max), all I can recommend is that you try it for yourself. The lightness, clarity, and self-assuredness that it builds is lovely.
- mirceal 8y agohahaha. that’s not healthy for you /s seriously, as someone that has done extended fasting at times (think weeks) my advice is not to jump into the deep end of the pool. Try eating all your food in an 8 hour window for starters and after that do several fasts with increasing duration s 1,2,3,5,8... days of fasting (fibonnaci fasting) the other thing to consider is that if you think or see something is wrong yoh stop. fasting is mostly safe, but there are edge cases were yoh will have a bad time. and last piece of advice is that I have noticed people that eat sugar (lots of sugar) have an exceptional hard time fasting (the hunger is unbearable). So one thing to try is to kick the sugar habit before fasting (at that point even if you decide fasting is bullshit you’ve kicked sugar to the curb and that’s huge in its own way)
- AdmiralAsshat 8y agoThe Chief complaints table had some interesting tidbits: > Cancer: Breast (11), Andrologic (10), Lymphoma (3) > Tumor: Neck (6), Breast (1), Colon (1) So a nontrivial number of people reported cancer as a side effect of water fasting. I suppose you'd probably want to review the standard correlation-does-not-equal-causation fallacy, but still.
- Confiks 8y ago> So a nontrivial number of people reported cancer as a side effect of water fasting. Reporting each and every condition, however unlikely to be caused by the subject of study, is a necessary part of a study into adverse effects. And for good reason, because it allows later research into surprising causal links, by evaluating mere correlations from different studies. It doesn't mean the participant thought the adverse effect had anything to do with fasting.
- deleted 8y ago[deleted]
- beagle3 8y agoThese are the complaints and issues that brought patients to the facility that administered the fast, not "reported as a side effect of water fasting". > Table 1 describes chief complaint categories as total counts and as a percentage of total visits. A patient could have had more than one chief complaint per visit. Quality of life, including prevention and fatigue, was the primary reason patients visited TNHC (n = 384, 50%). Other major chief complaint categories included the cardiovascular (n = 193, 25.1%), musculoskeletal (n = 147, 19.1%), gastrointestinal (n = 122, 15.9%), and endocrine (n = 107, 13.9%) systems. Following prevention (n = 358, 46.7%), hypertension (n = 152, 19.7%) was the largest chief complaint category.
- hourislate 8y agoI did 12 days (300 hours) on water, drinking Snake Juice off and on and seem to be fine. I lost about 15 lbs during that fast and regained about 5-6 lbs afterwards. I did notice my skin was a lot healthier and I felt my mind was much stronger, everyone said I looked younger. I didn't suffer any type of medical problems afterwards and continue to fast at least once a month for 2-4 days on just water and a daily 18/6 IF. I rarely get sick anymore (colds, sore throats, etc). My weight has come down to a healthy level (lost 70+lbs over the last 1.5 years). You just have to get over the fear of not eating and understand that missing a few meals or not eating for a few days can make you feel better. It's sort of the same as quitting smoking, you free yourself from destructive living.
- mirceal 8y agoand learn to keep your mouth shut about what you’re doing
- lymeeducator 8y agoFasting and duration seems to be an individual discovery, until more scientific data measurements about amino acids, genetics, immune state, glycogen levels, etc are established. I've water fasted over 50 times in the 15 months ranging from 16 - 48 hours to help with Lyme and other tick borne pathogens. I've found it to be highly anti-inflammatory and have yet to feel bad (maybe 3 very mild headaches). For example, my vision acuity improves around 15 hours into a fast every time (noticeable when reading). I've even jogged or walked miles 30 hours into a fast, depending on residual glycogen levels in the blood and muscles. The glycogen should be consumed from the liver, blood, and muscles (partial) before entering ketosis. With that said, it's not for everyone and it is probably better to slowly increase the duration of the water fast to evaluate individual response. Also, hundreds of millions in the Muslim culture practice a complete daylight fast every year with minimal side effect. That should be significantly significant ;-).