PROLONGED FASTING – MY 5 DAY JOURNEY OF DEPRIVATION AND DISCOVERY

By Dr. Tony Cassis (chiropractor)

 

Recently, there has been a growing interest in and experimentation with various forms of dietary fasting. From the most well-known ‘intermittent fasting’, to the more radical ‘prolonged fasting’, more and more of our patients are beginning to dabble in fasting for weight loss. Intermittent fasting typically comes in two flavours – a “5:2” diet; and a “16:8” diet. The 5:2 involves significant caloric restriction (consuming less than 600 calories per day) for 2 days of the week, followed by 5 days of regular caloric intake, whereas the 16:8 involves taking in zero calories for 16 hours of each day, and consuming all your calories in an 8-hour window each day. Both Dr. Noone and myself have had significant personal experience with both types of intermittent fasting. However, the new player in the fasting field is the more radical and formidable prolonged fasting which involves zero caloric intake for between 2 and 5 days! What’s that, you say? How can one survive that long without eating? Well, the answer is simple: KETONES!

 

There has been a lot of talk lately about the wonders of Ketones, and ketosis, but what actually are ketones? Ketones are a natural by-product of your body breaking down fat to use as an alternative fuel source in the absence of glucose. When the body is not able to access its primary fuel source, glucose (either due to fasting, low-carb diet or prolonged exercise), it is forced to come up with an alternative fuel source – fats. In a process known as beta-oxidation, your body breaks down fats to produce ketones which are then used as the alternate energy source. The emerging research on ketosis (the physical state wherein your body is fuelled by ketones rather than glucose) suggests that it may have myriad health benefits beyond simply weight loss, including improved recovery after stroke [1], increased lifespan [2], Alzheimer’s [3] and Parkinson’s [4] prevention, cardiovascular disease prevention [5], diabetes prevention [6], lowered blood pressure [7], cancer prevention [8], reduced oxidative stress [9], increase in brain-derived neurotrophic factor (BDNF) [10], more efficient oxygen utilisation [11], decreases in LDL cholesterol [12] and many others [7].

 

On the back of this mounting and already imposing evidence, along with the increased curiosity from our patients, I decided to take it upon myself to undergo a case study on the effect of a 5-day zero-calorie fast. As any good scientist should I read whole lot of research, both scientific articles as well as other people’s accounts of their own fasting. I also listened to a couple of podcasts interviews with leading ketosis researcher Dominic D’Agostino (you can find them here , here and here). There seemed to be a point sometime between day 1 and 3 where people would begin to feel any of a constellation of physical symptoms (nausea, weakness, shaking, dizziness, pain etc), which seemed to correlate with the period where they had depleted their readily available glucose but had not begun producing enough ketone bodies to meet their metabolic demand. I discovered a few tips and secrets that others had gleaned to help ease their transition from glucose metabolism to ketosis to avoid the nasty ‘in-between’ phase. My main weapon in that fight was “exogenous ketones” (I used a product called KetoCana). Exogenous ketones, as the name suggests and ketones that are artificially produced and available in powder form to help supplement your available blood ketones to use as fuel until you can produce enough of your own. This product, more than ANYTHING else was my saviour. I don’t want to give away too many spoilers, but these exogenous ketones were most likely the main reason why I never experienced any uncomfortable physical symptoms throughout my 5-day fast.

 

The other main concern of mine was that I had been training really hard both at the gym and in at my chosen sport – volleyball and I wanted to minimise the amount of muscle lost during my fast. For those unaware, a good portion of the glucose that you take in nutritionally that is unused gets stored as muscle glycogen, and hence, when you don’t have any glucose coming in, your body breaks down muscle to increase and maintain circulating blood-glucose levels. I used branch chain amino acids (BCAAs) to attempt to minimise the muscle loss. The product I used was called Scivation Xtend and I chose this because it has ZERO CALORIES (much like the KetoCana) as well as being highly recommended by Dom D’agostino in the podcasts I linked to above.

 

I fasted from Sunday night until Friday night for a total of 120 hours straight without calories. I occasionally had a black coffee or black tea, which reliable has at most 3-5 calories (and in some cases none). I cut out all exercise except a 5km walk each morning and my one two-hour volleyball training. I also spent about 10-20 minutes each morning practicing mindful meditation (I used the app Meditate.io) which really assisted in the early days when I struggled. Twice every day (first thing in the morning and before bed in the evening) I would measure my vitals – heart rate, blood ketone and blood glucose levels (I used the Abbott Freestyle Optimum monitor and test strips as they seem to be very accurate), oxygen saturation, hunger levels and a couple of others. I documented and tabulated these results along with a journal of how I was feeling in an excel spreadsheet (see link below). Without being too clichéd, the results blew me away.

 

I decided to fast for 3 major reasons: (1) to experience it so that I could talk to patients about it from a position of knowledge, (2) for the many health benefits that the research seems to show; and (3) in an attempt to break my addiction to food. Like most people in contemporary society, we tend to over-indulge in food, and especially carbohydrate-rich food. We tend to eat beyond satiety until we’re ‘full’ rather than until we’re no longer hungry. My aim was to break this cycle such that when I finished the 5 days, I could resume a healthy and much-lower carbohydrate-rich diet. I figured that cutting carbs would be a walk in the park compared to cutting all food!

 

Finally, a word of caution: if you’re considering undertaking a prolonged fast. Please consult your health care practitioner about this, and any risk factors or considerations that you need to think about. I strongly recommend monitoring your vitals (at a minimum: blood glucose, blood ketones and heart rate, as well as blood pressure if you know that yours typically has been an issue).

 

If you have completed your own fasts, I would love to hear the results and stories if you would like to share.

 

Best of luck if you attempt it. Please feel free to contact me if you would like to discuss. I can be reached at the clinic 03 9598 7787, or via email: tony.cassis@gmail.com

References

[1]	K. Xu, J. C. LaManna and M. A. Puchowicz, “Neuroprotective Properties of Ketone Bodies,” Advances in Experimental 97 Medicine and Biology, vol. 737, no. 1, pp. 97-102, 2012.
[2]	M. P. Mattson, “Brain evolution and lifespan regulation: conservation of signal transduction pathways that regulate energy metabolism,” Mech. Aging Dev., vol. 123, pp. 947-53, 2002.
[3]	S. Henderson, “Ketone bodies as a therapeutic for Alzheimer’s disease,” Neurotherapeutics, vol. 5, no. 3, pp. 470-480, July 2008.
[4]	W. Duan and M. P. Mattson, “Dietary restriction and 2-deoxyglucose administration improve behavioral outcome,” J. Neurosci. Res., vol. 57, pp. 195-206, 1999.
[5]	L. Fontana, T. E. Meter, S. Klein and J. O. Holloszy, “Long-term calorie restriction is highly effective in reducing the risk for atherosclerosis in humans,” Proc. Natl. Acad. Sci. USA, vol. 101, p. 6659–63, 2004.
[6]	B. E. B. P. M. M. W. R. B. R. Wing RR, “Caloric restriction per se is a significant factor in improvements in glycemic control and insulin sensitivity during weight loss in obese NIDDM patients,” Diabetes Care, vol. 17, pp. 30-36, 1994.
[7]	M. MP, “ENERGY INTAKE, MEAL FREQUENCY, AND HEALTH: A Neurobiological Perspective,” Annu. Rev. Nutr., vol. 25, pp. 237-60, 2005.
[8]	P. S. H. D. H. S. Berrigan D, “Adult-onset calorie restriction and fasting delay spontaneous tumorigenesis in p53-deficient mice,” Carcinogenesis, vol. 23, no. 1, pp. 817-22, 2002.
[9]	M. BJ, “Oxidative stress and mitochondrial function with aging—the effects of calorie restriction,” Aging Cell , vol. 3, pp. 7-12, 2004.
[10]	G. Z. J. H. W. M. L. X. M. M. Duan W, “Dietary restriction normalizes glucose metabolism and BDNF levels, slows disease progression, and increases survival in huntingtin mutant mice.,” Proc. Natl. Acad. Sci., vol. 100, pp. 2911-16, 2003.
[11]	P. S. M. A. e. a. Zajac Adam, “The Effects of a Ketogenic Diet on Exercise Metabolism and Physical Performance in Off-Road Cyclists,” Nutrients, vol. 6, no. 1, pp. 2493-2508, 2014.
[12]	N. G. A. B. J. L. R. S. A Adlouni, “Fasting during Ramadan induces a marked increase in high-density lipoprotein cholesterol and decrease in low-density lipoprotein cholesterol,” Ann. Nutr. Metab., vol. 41, no. 1, pp. 242-49, 1997.