Features of a successful therapeutic fast of 382 days' duration

Stewart, W. K.; Fleming, Leanne

doi:10.1136/pgmj.49.569.203

Cited by 83 publications

(49 citation statements)

References 19 publications

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“…16 The history of the study of therapeutic starvation starts with the classical experimental starvation studies of Benedict (1915). 17 Further work has been done by Bloom (1959), Duncan et al (1962), Drenick et al 135 (1964) and Cahill (1970) who treated lean and obese subjects by total withdrawal of food for periods ranging from 10 to 117 days.…”

Section: Treatment For 'Gross Refractory Obesity'mentioning

confidence: 99%

Fasting for weight loss: an effective strategy or latest dieting trend?

Johnstone

2014

Int J Obes

142

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With the increasing obesity epidemic comes the search for effective dietary approaches for calorie restriction and weight loss. Here I examine whether fasting is the latest 'fad diet' as portrayed in popular media and discuss whether it is a safe and effective approach or whether it is an idiosyncratic diet trend that promotes short-term weight loss, with no concern for long-term weight maintenance. Fasting has long been used under historical and experimental conditions and has recently been popularised by 'intermittent fasting' or 'modified fasting' regimes, in which a very low-calorie allowance is allowed, on alternate days (ADF) or 2 days a week (5:2 diet), where 'normal' eating is resumed on non-diet days. It is a simple concept, which makes it easy to follow with no difficult calorie counting every other day. This approach does seem to promote weight loss, but is linked to hunger, which can be a limiting factor for maintaining food restriction. The potential health benefits of fasting can be related to both the acute food restriction and chronic influence of weight loss; the long-term effect of chronic food restriction in humans is not yet clear, but may be a potentially interesting future dietary strategy for longevity, particularly given the overweight epidemic. One approach does not fit all in the quest to achieve body weight control, but this could be a dietary strategy for consideration. With the obesity epidemic comes the search for dietary strategies to (i) prevent weight gain, (ii) promote weight loss and (iii) prevent weight regain. With over half of the population of the United Kingdom and other developed countries being collectively overweight or obese, there is considerable pressure to achieve these goals, from both a public health and a clinical perspective. Certainly not one dietary approach will solve these complex problems. Although there is some long-term success with gastric surgical options for morbid obesity, there is still a requirement for dietary approaches for weight management for the overweight and obese population, particularly as invasive interventions carry post-operative risk of death due to complications. Effective dietary interventions are required that promote long-term adherence and sustained beneficial effects on metabolic and disease markers. In general, such interventions need to be palatable and satiating, meet minimal nutritional requirements, promote loss of fat and preserve lean body mass, ensure long-term safety, be simple to administer and monitor and have widespread public health utility. Intermittent fasting or alternate day fasting may be an option for achieving weight loss and maintenance.

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Section: Treatment For 'Gross Refractory Obesity'mentioning

confidence: 99%

Fasting for weight loss: an effective strategy or latest dieting trend?

Johnstone

2014

Int J Obes

142

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“…Indeed, not only hepatocytes, but virtually all cells have the capacity to store lipid. But this capacity reaches its zenith in adipocytes: adipose tissue in a lean human provides sufficient energy for weeks and even months, and in the obese, this time-frame is significantly extended; one case report documents a monitored fast in excess of one year in an obese patient, 12 although such efforts are not without risk. 13 …”

Section: The Advantages Of Adipose Tissuementioning

confidence: 99%

Metabolic Thrift and the Genetic Basis of Human Obesity

O’Rourke¹

2014

Annals of Surgery

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Evolution has molded metabolic thrift within humans, a genetic heritage that, when thrust into our modern “obesogenic” environment, creates the current obesity crisis. Modern genetic analysis has identified genetic and epigenetic contributors to obesity, an understanding of which will guide the development of environmental, pharmacologic, and genetic therapeutic interventions. “The voyage was so long, food and water ran out. One hundred of the paddlers died; forty men remained. The voyagers finally reached Fitinui, then Aotona.”-From “The Story of Aka”, in The Native Culture in the Marquesas by E. S. Craighill Handy

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“…Drenick et al, 1964; Benoit et al, 1965; Harrison and Harden, 1966; Ball et al, 1967; Gilliland, 1967). Gradually, the durations of these fasts increased until fasts exceeding 100 days were relatively common (Thomson et al, 1966) culminating in a fast of 382 days by a grossly obese male patient from Dundee in Scotland (Stewart and Fleming, 1973). Therapeutic fasting, however, fell out of favour when it became apparent that it had a high incidental mortality rate mostly due to renal dysfunction and cardiac damage (Cubberley et al, 1965; Spencer, 1968; Runcie and Thomson, 1970).…”

Section: Methods and Resultsmentioning

confidence: 99%

A mathematical model of weight loss under total starvation: evidence against the thrifty-gene hypothesis

Speakman

2012

Disease Models &Amp; Mechanisms

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SUMMARYThe thrifty-gene hypothesis (TGH) posits that the modern genetic predisposition to obesity stems from a historical past where famine selected for genes that promote efficient fat deposition. It has been previously argued that such a scenario is unfeasible because under such strong selection any gene favouring fat deposition would rapidly move to fixation. Hence, we should all be predisposed to obesity: which we are not. The genetic architecture of obesity that has been revealed by genome-wide association studies (GWAS), however, calls into question such an argument. Obesity is caused by mutations in many hundreds (maybe thousands) of genes, each with a very minor, independent and additive impact. Selection on such genes would probably be very weak because the individual advantages they would confer would be very small. Hence, the genetic architecture of the epidemic may indeed be compatible with, and hence support, the TGH. To evaluate whether this is correct, it is necessary to know the likely effects of the identified GWAS alleles on survival during starvation. This would allow definition of their advantage in famine conditions, and hence the likely selection pressure for such alleles to have spread over the time course of human evolution. We constructed a mathematical model of weight loss under total starvation using the established principles of energy balance. Using the model, we found that fatter individuals would indeed survive longer and, at a given body weight, females would survive longer than males, when totally starved. An allele causing deposition of an extra 80 g of fat would result in an extension of life under total starvation by about 1.1–1.6% in an individual with 10 kg of fat and by 0.25–0.27% in an individual carrying 32 kg of fat. A mutation causing a per allele effect of 0.25% would become completely fixed in a population with an effective size of 5 million individuals in 6000 selection events. Because there have probably been about 24,000 famine events since the evolution of hominins 4 million years ago, there has been ample time even for genes with only very minor impacts on adiposity to move to fixation. The observed polymorphic variation in the genes causing the predisposition to obesity is incompatible with the TGH, unless all these single nucleotide polymorphisms (SNPs) arose in the last 900,000 years, a requirement we know is incorrect. The TGH is further weakened by the observation of no link between the effect size of these SNPs and their prevalence, which would be anticipated under the TGH model of selection if all the SNPs had arisen in the last 900,000 years.

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Features of a successful therapeutic fast of 382 days' duration

Cited by 83 publications

References 19 publications

Fasting for weight loss: an effective strategy or latest dieting trend?

Fasting for weight loss: an effective strategy or latest dieting trend?

Metabolic Thrift and the Genetic Basis of Human Obesity

A mathematical model of weight loss under total starvation: evidence against the thrifty-gene hypothesis

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