Skip to main content
Top
Published in: BMC Complementary Medicine and Therapies 1/2018

Open Access 01-12-2018 | Research article

Is fasting safe? A chart review of adverse events during medically supervised, water-only fasting

Authors: John S. Finnell, Bradley C. Saul, Alan C. Goldhamer, Toshia R. Myers

Published in: BMC Complementary Medicine and Therapies | Issue 1/2018

Login to get access

Abstract

Background

Evidence suggests that fasting, during which only water is consumed, results in potentially health promoting physiological effects. However, peer-reviewed research assessing the safety of water-only fasting is lacking. To address this, we conducted a chart review to describe adverse events (AEs) that occurred during medically supervised, water-only fasting.

Methods

Electronic charts from patient visits to a residential medical facility from 2006 to 2011 were reviewed. Patients who were at least 21 years of age and water-only fasted for ≥2 consecutive days with a refeeding period equal to half of the fast length were included. Out of 2539 charts, 768 visits met our inclusion and exclusion criteria. AEs were abstracted from chart notes and classified according to CTCAE (v4.03) and MedDRA (v12.1) terminology. Descriptive analysis of AEs is reported.

Results

During the protocol period, the highest grade AE (HGAE) in 555 visits was a grade 2 event or lower, in 212 visits it was a grade 3 event, in 1 visit it was a grade 4 event, and there were no grade 5 events. There were 2 (0.002%) visits with a serious adverse event (SAE). The majority of AEs identified were mild (n = 4490, 75%) in nature and known reactions to fasting.

Conclusions

To our knowledge, this is the most comprehensive analysis of AEs experienced during medically supervised, water-only fasting conducted to date. Overall, our data indicate that the majority of AEs 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 SAE.
Appendix
Available only for authorised users
Literature
1.
go back to reference Fredericks R. Fasting: an exceptional human experience. San Jose: All Things Published Well; 2013. Fredericks R. Fasting: an exceptional human experience. San Jose: All Things Published Well; 2013.
2.
go back to reference Goldhamer AC, Helms S, Salloum TK. Fasting. 4th ed. St. Louis: Elsevier Churchill Livingstone; 2013. Goldhamer AC, Helms S, Salloum TK. Fasting. 4th ed. St. Louis: Elsevier Churchill Livingstone; 2013.
3.
go back to reference Furhman J. Fasting and eating for health: a medical doctor's program for conquering disease. New York: St. Martin's Griffin; 1995. Furhman J. Fasting and eating for health: a medical doctor's program for conquering disease. New York: St. Martin's Griffin; 1995.
5.
go back to reference Goldhamer A, Lisle D, Parpia B, Anderson SV, Campbell TC. Medically supervised water-only fasting in the treatment of hypertension. J Manip Physiol Ther. 2001;24(5):335–9.CrossRef Goldhamer A, Lisle D, Parpia B, Anderson SV, Campbell TC. Medically supervised water-only fasting in the treatment of hypertension. J Manip Physiol Ther. 2001;24(5):335–9.CrossRef
6.
go back to reference Goldhamer AC, Lisle DJ, Sultana P, Anderson SV, Parpia B, Hughes B, Campbell TC. Medically supervised water-only fasting in the treatment of borderline hypertension. J Altern Complement Med. 2002;8(5):643–50.CrossRefPubMed Goldhamer AC, Lisle DJ, Sultana P, Anderson SV, Parpia B, Hughes B, Campbell TC. Medically supervised water-only fasting in the treatment of borderline hypertension. J Altern Complement Med. 2002;8(5):643–50.CrossRefPubMed
7.
go back to reference Kjeldsen-Kragh J, Haugen M, Borchgrevink CF, Laerum E, Eek M, Mowinkel P, Hovi K, Forre O. Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet. 1991;338(8772):899–902.CrossRefPubMed Kjeldsen-Kragh J, Haugen M, Borchgrevink CF, Laerum E, Eek M, Mowinkel P, Hovi K, Forre O. Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet. 1991;338(8772):899–902.CrossRefPubMed
8.
go back to reference Horne BD, May HT, Anderson JL, Kfoury AG, Bailey BM, McClure BS, Renlund DG, Lappe DL, Carlquist JF, Fisher PW, et al. Usefulness of routine periodic fasting to lower risk of coronary artery disease in patients undergoing coronary angiography. Am J Cardiol. 2008;102(7):814–9.CrossRefPubMedPubMedCentral Horne BD, May HT, Anderson JL, Kfoury AG, Bailey BM, McClure BS, Renlund DG, Lappe DL, Carlquist JF, Fisher PW, et al. Usefulness of routine periodic fasting to lower risk of coronary artery disease in patients undergoing coronary angiography. Am J Cardiol. 2008;102(7):814–9.CrossRefPubMedPubMedCentral
9.
go back to reference Horne BD, Muhlestein JB, Lappe DL, May HT, Carlquist JF, Galenko O, Brunisholz KD, Anderson JL. Randomized cross-over trial of short-term water-only fasting: metabolic and cardiovascular consequences. Nutr Metab Cardiovasc Dis. 2013;23(11):1050–7.CrossRefPubMed Horne BD, Muhlestein JB, Lappe DL, May HT, Carlquist JF, Galenko O, Brunisholz KD, Anderson JL. Randomized cross-over trial of short-term water-only fasting: metabolic and cardiovascular consequences. Nutr Metab Cardiovasc Dis. 2013;23(11):1050–7.CrossRefPubMed
10.
go back to reference Li C, Ostermann T, Hardt M, Ludtke R, Broecker-Preuss M, Dobos G, Michalsen A. Metabolic and psychological response to 7-day fasting in obese patients with and without metabolic syndrome. Forsch Komplementmed. 2013;20(6):413–20.CrossRefPubMed Li C, Ostermann T, Hardt M, Ludtke R, Broecker-Preuss M, Dobos G, Michalsen A. Metabolic and psychological response to 7-day fasting in obese patients with and without metabolic syndrome. Forsch Komplementmed. 2013;20(6):413–20.CrossRefPubMed
11.
go back to reference Steiniger J, Schneider A, Bergmann S, Boschmann M, Janietz K. Effects of fasting and endurance training on energy metabolism and physical fitness in obese patients. Forsch Komplementmed. 2009;16(6):383–90.CrossRefPubMed Steiniger J, Schneider A, Bergmann S, Boschmann M, Janietz K. Effects of fasting and endurance training on energy metabolism and physical fitness in obese patients. Forsch Komplementmed. 2009;16(6):383–90.CrossRefPubMed
12.
go back to reference Schmidt S, Stange R, Lischka E, Kiehntopf M, Deufel T, Loth D, Uhlemann C. Uncontrolled clinical study of the efficacy of ambulant fasting in patients with osteoarthritis. Forsch Komplementmed. 2010;17(2):87–94.CrossRefPubMed Schmidt S, Stange R, Lischka E, Kiehntopf M, Deufel T, Loth D, Uhlemann C. Uncontrolled clinical study of the efficacy of ambulant fasting in patients with osteoarthritis. Forsch Komplementmed. 2010;17(2):87–94.CrossRefPubMed
13.
go back to reference Michalsen A, Li C, Kaiser K, Ludtke R, Meier L, Stange R, Kessler C. In-patient treatment of fibromyalgia: a controlled nonrandomized comparison of conventional medicine versus integrative medicine including fasting therapy. Evid Based Complement Alternat Med. 2013;2013:908610. Michalsen A, Li C, Kaiser K, Ludtke R, Meier L, Stange R, Kessler C. In-patient treatment of fibromyalgia: a controlled nonrandomized comparison of conventional medicine versus integrative medicine including fasting therapy. Evid Based Complement Alternat Med. 2013;2013:908610.
14.
go back to reference Michalsen A, Kuhlmann MK, Ludtke R, Backer M, Langhorst J, Dobos GJ. Prolonged fasting in patients with chronic pain syndromes leads to late mood-enhancement not related to weight loss and fasting-induced leptin depletion. Nutr Neurosci. 2006;9(5–6):195–200.CrossRefPubMed Michalsen A, Kuhlmann MK, Ludtke R, Backer M, Langhorst J, Dobos GJ. Prolonged fasting in patients with chronic pain syndromes leads to late mood-enhancement not related to weight loss and fasting-induced leptin depletion. Nutr Neurosci. 2006;9(5–6):195–200.CrossRefPubMed
15.
go back to reference Michalsen A, Hoffmann B, Moebus S, Backer M, Langhorst J, Dobos GJ. Incorporation of fasting therapy in an integrative medicine ward: evaluation of outcome, safety, and effects on lifestyle adherence in a large prospective cohort study. J Altern Complement Med. 2005;11(4):601–7.CrossRefPubMed Michalsen A, Hoffmann B, Moebus S, Backer M, Langhorst J, Dobos GJ. Incorporation of fasting therapy in an integrative medicine ward: evaluation of outcome, safety, and effects on lifestyle adherence in a large prospective cohort study. J Altern Complement Med. 2005;11(4):601–7.CrossRefPubMed
16.
go back to reference Wilhelmi de Toledo F BA, Burggrabe H, et al. Leitlinien zur Fastentherapie. Forsch Komplementärmed Klass Naturkeilkd. 2002;9:189–98. Wilhelmi de Toledo F BA, Burggrabe H, et al. Leitlinien zur Fastentherapie. Forsch Komplementärmed Klass Naturkeilkd. 2002;9:189–98.
17.
go back to reference Wilhelmi de Toledo F, Buchinger A, Burggrabe H, Holz G, Kuhn C, Lischka E, Lischka N, Lutzner H, May W, Ritzmann-Widderich M, et al. Fasting therapy - an expert panel update of the 2002 consensus guidelines. Forsch Komplementmed. 2013;20(6):434–43.CrossRefPubMed Wilhelmi de Toledo F, Buchinger A, Burggrabe H, Holz G, Kuhn C, Lischka E, Lischka N, Lutzner H, May W, Ritzmann-Widderich M, et al. Fasting therapy - an expert panel update of the 2002 consensus guidelines. Forsch Komplementmed. 2013;20(6):434–43.CrossRefPubMed
18.
go back to reference Goldhamer AC. Therapeutic fasting: an introduction to the benefits of a professionally supervised fast in a natural hygiene facility. Health Science. 1987;10-11:16–7. Goldhamer AC. Therapeutic fasting: an introduction to the benefits of a professionally supervised fast in a natural hygiene facility. Health Science. 1987;10-11:16–7.
19.
go back to reference Burfield-Hazzard L. The pioneers of therapeutic fasting in America. Whitefish: Kessinger Publishing; 2005. Burfield-Hazzard L. The pioneers of therapeutic fasting in America. Whitefish: Kessinger Publishing; 2005.
20.
go back to reference Shelton HM. The hygienic system, vol. III. San Antonio: Dr. Shelton's Health School; 1950. Shelton HM. The hygienic system, vol. III. San Antonio: Dr. Shelton's Health School; 1950.
21.
go back to reference Bloom WL. Fasting as an introduction to the treatment of obesity. Metabolism. 1959;8(3):214–20.PubMed Bloom WL. Fasting as an introduction to the treatment of obesity. Metabolism. 1959;8(3):214–20.PubMed
22.
go back to reference Drenick EJ, Swendseid ME, Blahd WH, Tuttle SG. Prolonged starvation as treatment for severe obesity. JAMA. 1964;187:100–5.CrossRefPubMed Drenick EJ, Swendseid ME, Blahd WH, Tuttle SG. Prolonged starvation as treatment for severe obesity. JAMA. 1964;187:100–5.CrossRefPubMed
23.
go back to reference Duncan GG, Jenson WK, Fraser RI, Cristofori FC. Correction and control of intractable obesity. Practicable application of intermittent periods of total fasting. JAMA. 1962;181:309–12.CrossRefPubMed Duncan GG, Jenson WK, Fraser RI, Cristofori FC. Correction and control of intractable obesity. Practicable application of intermittent periods of total fasting. JAMA. 1962;181:309–12.CrossRefPubMed
24.
go back to reference Cahill GF Jr, Marliss EB, Aoki TT. Fat and nitrogen metabolism in fasting man. Horm Metab Res. 1970;2(Suppl 2):181–5. Cahill GF Jr, Marliss EB, Aoki TT. Fat and nitrogen metabolism in fasting man. Horm Metab Res. 1970;2(Suppl 2):181–5.
25.
go back to reference Cubberley PT, Polster SA, Schulman CL. Lactic acidosis and death after the treatment of obesity by fasting. N Engl J Med. 1965;272:628–30.CrossRefPubMed Cubberley PT, Polster SA, Schulman CL. Lactic acidosis and death after the treatment of obesity by fasting. N Engl J Med. 1965;272:628–30.CrossRefPubMed
27.
28.
go back to reference Garnett ES, Barnard DL, Ford J, Goodbody RA, Woodehouse MA. Gross fragmentation of cardiac myofibrils after therapeutic starvation for obesity. Lancet. 1969;1(7601):914–6.CrossRefPubMed Garnett ES, Barnard DL, Ford J, Goodbody RA, Woodehouse MA. Gross fragmentation of cardiac myofibrils after therapeutic starvation for obesity. Lancet. 1969;1(7601):914–6.CrossRefPubMed
30.
32.
go back to reference Thomson TJ, Runcie J, Miller V. Treatment of obesity by total fasting for up to 249 days. Lancet. 1966;2(7471):992–6.CrossRefPubMed Thomson TJ, Runcie J, Miller V. Treatment of obesity by total fasting for up to 249 days. Lancet. 1966;2(7471):992–6.CrossRefPubMed
34.
35.
go back to reference Gershfeld N, Sultana P, Goldhamer A. A case of nonpharmacologic conservative management of suspected uncomplicated subacute appendicitis in an adult male. J Altern Complement Med. 2011;17(3):275–7.CrossRefPubMed Gershfeld N, Sultana P, Goldhamer A. A case of nonpharmacologic conservative management of suspected uncomplicated subacute appendicitis in an adult male. J Altern Complement Med. 2011;17(3):275–7.CrossRefPubMed
36.
go back to reference Goldhamer AC, Klaper M, Foorohar A, Myers TR. Water-only fasting and an exclusively plant foods diet in the management of stage IIIa, low-grade follicular lymphoma. BMJ Case Rep. 2015;2015. Goldhamer AC, Klaper M, Foorohar A, Myers TR. Water-only fasting and an exclusively plant foods diet in the management of stage IIIa, low-grade follicular lymphoma. BMJ Case Rep. 2015;2015.
37.
go back to reference Safdie FM, Dorff T, Quinn D, Fontana L, Wei M, Lee C, Cohen P, Longo VD. Fasting and cancer treatment in humans: a case series report. Aging (Albany NY). 2009;1(12):988–1007.CrossRef Safdie FM, Dorff T, Quinn D, Fontana L, Wei M, Lee C, Cohen P, Longo VD. Fasting and cancer treatment in humans: a case series report. Aging (Albany NY). 2009;1(12):988–1007.CrossRef
38.
go back to reference Common Terminology Criteria for Adverse Events (CTCAE). In: vol. 4.03: US National Cancer Institute, Division of Cancer Treatment & Diagnosis, Cancer Therapy Evaluation Program; 2010. Common Terminology Criteria for Adverse Events (CTCAE). In: vol. 4.03: US National Cancer Institute, Division of Cancer Treatment & Diagnosis, Cancer Therapy Evaluation Program; 2010.
39.
go back to reference CTC CTCAE Mapping Document CTCAE v4.0 to MedDRA 12.1. US National Cancer Institute, Division of Cancer Treatment & Diagnosis, Cancer Therapy Evaluation Program. CTC CTCAE Mapping Document CTCAE v4.0 to MedDRA 12.1. US National Cancer Institute, Division of Cancer Treatment & Diagnosis, Cancer Therapy Evaluation Program.
41.
go back to reference Mattson MP, Longo VD, Harvie M. Impact of intermittent fasting on health and disease processes. Ageing Res Rev. 2017;39:46–58.CrossRefPubMed Mattson MP, Longo VD, Harvie M. Impact of intermittent fasting on health and disease processes. Ageing Res Rev. 2017;39:46–58.CrossRefPubMed
42.
go back to reference Boonstra AM, Schiphorst Preuper HR, Balk GA, Stewart RE. Cut-off points for mild, moderate, and severe pain on the visual analogue scale for pain in patients with chronic musculoskeletal pain. Pain. 2014;155(12):2545–50.CrossRefPubMed Boonstra AM, Schiphorst Preuper HR, Balk GA, Stewart RE. Cut-off points for mild, moderate, and severe pain on the visual analogue scale for pain in patients with chronic musculoskeletal pain. Pain. 2014;155(12):2545–50.CrossRefPubMed
43.
go back to reference Kapstad H, Hanestad BR, Langeland N, Rustoen T, Stavem K. Cutpoints for mild, moderate and severe pain in patients with osteoarthritis of the hip or knee ready for joint replacement surgery. BMC Musculoskelet Disord. 2008;9:55.CrossRefPubMedPubMedCentral Kapstad H, Hanestad BR, Langeland N, Rustoen T, Stavem K. Cutpoints for mild, moderate and severe pain in patients with osteoarthritis of the hip or knee ready for joint replacement surgery. BMC Musculoskelet Disord. 2008;9:55.CrossRefPubMedPubMedCentral
44.
go back to reference 45 CFR 46. In: Department of Health and Human Services; 2009. 45 CFR 46. In: Department of Health and Human Services; 2009.
45.
go back to reference Gamer M, Lemon J, Fellow I, Singh P. Various Coefficients of Interrater Reliability and Agreement. In: 0.84 edn. R Package; 2012. Gamer M, Lemon J, Fellow I, Singh P. Various Coefficients of Interrater Reliability and Agreement. In: 0.84 edn. R Package; 2012.
46.
go back to reference Spearman C. The proof and measurement of association between two things. Am J Psychol. 1904;15(1):72–101.CrossRef Spearman C. The proof and measurement of association between two things. Am J Psychol. 1904;15(1):72–101.CrossRef
47.
go back to reference Kaplan EL, Meier P. Nonparametric Estimatino from incomplete observations. J Am Stat Assoc. 1958;53(282):457–81.CrossRef Kaplan EL, Meier P. Nonparametric Estimatino from incomplete observations. J Am Stat Assoc. 1958;53(282):457–81.CrossRef
48.
go back to reference Team RC. R: a language and environment for statistical computing. Vienna: R foundation for statistical Computing; 2016. Team RC. R: a language and environment for statistical computing. Vienna: R foundation for statistical Computing; 2016.
49.
go back to reference Therneau T. A package for survival analysis in S. In: 2.38 EDN; 2015. Therneau T. A package for survival analysis in S. In: 2.38 EDN; 2015.
50.
go back to reference Wickham H. Elegan graphics for data analysis. New York: Springer-Verlag; 2009. Wickham H. Elegan graphics for data analysis. New York: Springer-Verlag; 2009.
51.
go back to reference Wickham H, Francois R. Dplyr: a grammar of data manipulation. In: 5.0 EDN; 2016. Wickham H, Francois R. Dplyr: a grammar of data manipulation. In: 5.0 EDN; 2016.
52.
go back to reference Gordon M. htmlTable: Advanced Tables for Markdown/HTML. In: 1.6 edn. R Package; 2016. Gordon M. htmlTable: Advanced Tables for Markdown/HTML. In: 1.6 edn. R Package; 2016.
53.
54.
go back to reference Wahl D, Cogger VC, Solon-Biet SM, Waern RV, Gokarn R, Pulpitel T, Cabo R, Mattson MP, Raubenheimer D, Simpson SJ, et al. Nutritional strategies to optimise cognitive function in the aging brain. Ageing Res Rev. 2016. Wahl D, Cogger VC, Solon-Biet SM, Waern RV, Gokarn R, Pulpitel T, Cabo R, Mattson MP, Raubenheimer D, Simpson SJ, et al. Nutritional strategies to optimise cognitive function in the aging brain. Ageing Res Rev. 2016.
Metadata
Title
Is fasting safe? A chart review of adverse events during medically supervised, water-only fasting
Authors
John S. Finnell
Bradley C. Saul
Alan C. Goldhamer
Toshia R. Myers
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Complementary Medicine and Therapies / Issue 1/2018
Electronic ISSN: 2662-7671
DOI
https://doi.org/10.1186/s12906-018-2136-6

Other articles of this Issue 1/2018

BMC Complementary Medicine and Therapies 1/2018 Go to the issue