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

1. Fredericks R. Fasting: an exceptional human experience. San Jose: All Things Published Well; 2013.

2. Goldhamer AC, Helms S, Salloum TK. Fasting. 4. St. Louis: Elsevier Churchill Livingstone; 2013.

3. Furhman J. Fasting and eating for health: a medical doctor's program for conquering disease. New York: St. Martin's Griffin; 1995.

4. Longo VD, Mattson MP. Fasting: molecular mechanisms and clinical applications. Cell Metab. 2014;19(2):181–192. doi: 10.1016/j.cmet.2013.12.008. [PMC free article] [PubMed] [CrossRef]

5. 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):335–339. doi: 10.1067/mmt.2001.115263. [PubMed] [CrossRef]

6. 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):643–650. doi: 10.1089/107555302320825165. [PubMed] [CrossRef]

7. 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. doi: 10.1016/0140-6736(91)91770-U. [PubMed] [CrossRef]

8. 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):814–819. doi: 10.1016/j.amjcard.2008.05.021. [PMC free article] [PubMed] [CrossRef]

9. 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):1050–1057. doi: 10.1016/j.numecd.2012.09.007. [PubMed] [CrossRef]

10. 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):413–420. doi: 10.1159/000353672. [PubMed] [CrossRef]

11. 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):383–390. doi: 10.1159/000258142. [PubMed] [CrossRef]

12. 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. doi: 10.1159/000285479. [PubMed] [CrossRef]

13. 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. [PMC free article] [PubMed]

14. 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. doi: 10.1080/10284150600929656. [PubMed] [CrossRef]

15. 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):601–607. doi: 10.1089/acm.2005.11.601. [PubMed] [CrossRef]

16. Wilhelmi de Toledo F BA, Burggrabe H, et al. Leitlinien zur Fastentherapie. Forsch Komplementärmed Klass Naturkeilkd. 2002;9:189–98.

17. 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):434–443. doi: 10.1159/000357602. [PubMed] [CrossRef]

18. Goldhamer AC. Therapeutic fasting: an introduction to the benefits of a professionally supervised fast in a natural hygiene facility. Health Science. 1987;10-11:16–17.

19. Burfield-Hazzard L. The pioneers of therapeutic fasting in America. Whitefish: Kessinger Publishing; 2005.

20. Shelton HM. The hygienic system. San Antonio: Dr. Shelton's Health School; 1950.

21. Bloom WL. Fasting as an introduction to the treatment of obesity. Metabolism. 1959;8(3):214–220. [PubMed]

22. Drenick EJ, Swendseid ME, Blahd WH, Tuttle SG. Prolonged starvation as treatment for severe obesity. JAMA. 1964;187:100–105. doi: 10.1001/jama.1964.03060150024006. [PubMed] [CrossRef]

23. Duncan GG, Jenson WK, Fraser RI, Cristofori FC. Correction and control of intractable obesity. Practicable application of intermittent periods of total fasting. JAMA. 1962;181:309–312. doi: 10.1001/jama.1962.03050300029006. [PubMed] [CrossRef]

24. Cahill GF, Jr, Marliss EB, Aoki TT. Fat and nitrogen metabolism in fasting man. Horm Metab Res. 1970;2(Suppl 2):181–185. [PubMed]

25. Cubberley PT, Polster SA, Schulman CL. Lactic acidosis and death after the treatment of obesity by fasting. N Engl J Med. 1965;272:628–630. doi: 10.1056/NEJM196503252721208. [PubMed] [CrossRef]

26. Spencer IO. Death during therapeutic starvation. Lancet. 1968;2(7569):679–680. doi: 10.1016/S0140-6736(68)92530-0. [PubMed] [CrossRef]

27. Spencer IO. Death during therapeutic starvation for obesity. Lancet. 1968;1(7555):1288–1290. doi: 10.1016/S0140-6736(68)92299-X. [PubMed] [CrossRef]

28. Garnett ES, Barnard DL, Ford J, Goodbody RA, Woodehouse MA. Gross fragmentation of cardiac myofibrils after therapeutic starvation for obesity. Lancet. 1969;1(7601):914–916. doi: 10.1016/S0140-6736(69)92546-X. [PubMed] [CrossRef]

29. Runcie J, Thomson TJ. Prolonged starvation--a dangerous procedure. Br Med J. 1970;3(5720):432–435. doi: 10.1136/bmj.3.5720.432. [PMC free article] [PubMed] [CrossRef]

30. Rose M, Greene RM. Cardiovascular complications during prolonged starvation. West J Med. 1979;130(2):170–177. [PMC free article] [PubMed]

31. Stewart WK, Fleming LW. Features of a successful therapeutic fast of 382 days' duration. Postgrad Med J. 1973;49(569):203–209. doi: 10.1136/pgmj.49.569.203. [PMC free article] [PubMed] [CrossRef]

32. Thomson TJ, Runcie J, Miller V. Treatment of obesity by total fasting for up to 249 days. Lancet. 1966;2(7471):992–996. doi: 10.1016/S0140-6736(66)92925-4. [PubMed] [CrossRef]

33. Gilliland IC. Total fasting in the treatment of obesity. Postgrad Med J. 1968;44(507):58–61. doi: 10.1136/pgmj.44.507.58. [PMC free article] [PubMed] [CrossRef]

34. Scobie IN, MacCuish AC, Kesson CM, McNeil IR. Neutropenia during allopurinol treatment in total therapeutic starvation. Br Med J. 1980;280(6224):1163. doi: 10.1136/bmj.280.6224.1163. [PMC free article] [PubMed] [CrossRef]

35. 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):275–277. doi: 10.1089/acm.2010.0253. [PubMed] [CrossRef]

36. 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. [PMC free article] [PubMed]

37. 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. doi: 10.18632/aging.100114. [PMC free article] [PubMed] [CrossRef]

38. 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. CTC CTCAE Mapping Document CTCAE v4.0 to MedDRA 12.1. US National Cancer Institute, Division of Cancer Treatment & Diagnosis, Cancer Therapy Evaluation Program.

40. Standards of Practice of Fasting Supervision.

41. Mattson MP, Longo VD, Harvie M. Impact of intermittent fasting on health and disease processes. Ageing Res Rev. 2017;39:46–58. doi: 10.1016/j.arr.2016.10.005. [PMC free article] [PubMed] [CrossRef]

42. 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):2545–2550. doi: 10.1016/j.pain.2014.09.014. [PubMed] [CrossRef]

43. 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. doi: 10.1186/1471-2474-9-55. [PMC free article] [PubMed] [CrossRef]

44. 45 CFR 46. In: Department of Health and Human Services; 2009.

45. Gamer M, Lemon J, Fellow I, Singh P. Various Coefficients of Interrater Reliability and Agreement. In: 0.84 edn. R Package; 2012.

46. Spearman C. The proof and measurement of association between two things. Am J Psychol. 1904;15(1):72–101. doi: 10.2307/1412159. [CrossRef]

47. Kaplan EL, Meier P. Nonparametric Estimatino from incomplete observations. J Am Stat Assoc. 1958;53(282):457–481. doi: 10.1080/01621459.1958.10501452. [CrossRef]

48. Team RC. R: a language and environment for statistical computing. Vienna: R foundation for statistical Computing; 2016.

49. Therneau T. A package for survival analysis in S. In: 2.38 EDN; 2015.

50. Wickham H. Elegan graphics for data analysis. New York: Springer-Verlag; 2009.

51. Wickham H, Francois R. Dplyr: a grammar of data manipulation. In: 5.0 EDN; 2016.

52. Gordon M. htmlTable: Advanced Tables for Markdown/HTML. In: 1.6 edn. R Package; 2016.

53. Nair PM, Khawale PG. Role of therapeutic fasting in women's health: an overview. J Midlife Health. 2016;7(2):61–64. [PMC free article] [PubMed]

54. 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. [PMC free article] [PubMed]

55. Longo VD, Panda S. Fasting, circadian rhythms, and time-restricted feeding in healthy lifespan. Cell Metab. 2016;23(6):1048–1059. doi: 10.1016/j.cmet.2016.06.001. [PMC free article] [PubMed] [CrossRef]