
Features of a successful therapeutic fast of 382 days' duration (1973) [pdf] - joak
https://pmj.bmj.com/content/postgradmedj/49/569/203.full.pdf
======
PretzelFisch
I guess that's why the body stores fat in the first place. Having done some
intermittent fasting and a little 2-3 day fasts, I have seen the longer the
fast the less urgent my hunger pains felt. This story is probably great
motivation for some redit subs.
[https://www.reddit.com/r/fasting/](https://www.reddit.com/r/fasting/) and
[https://www.reddit.com/r/intermittentfasting/](https://www.reddit.com/r/intermittentfasting/)

~~~
hyperdunc
I did a nine day fast and the first three days were difficult. From day four I
was not hungry at all but also felt noticeably weaker and couldn't do anything
strenuous. After nine days I lost 10kg and six months later had only gained
back 3kg. But the best thing about the whole experience was redefining my
relationship with food. I appreciate and enjoy it a lot more now.

~~~
arkitaip
Are you saying you didn't eat or drink anything during 9 days? What was your
initial and final weight?

~~~
Someone1234
They said nothing about drinking. It is pretty common parlance to use "fast"
to mean "without food/calories" (i.e. water is completely kosher, and some
argue "black" tea/coffee/diet soda is too as it is 0 calories/negative
calories).

~~~
copperx
One warning - tea isn't necessarily kosher, because some artificial flavors
are made from non-kosher ingredients.

~~~
selectodude
I don't think he's referring to kosher as confirming to kashrut. I think he's
using it more literally as hebrew for "fit".

------
xanth
Having switched to eating once a day four days of the week with great results
and no adverse effects I cant help but feel like there was a concerted
misinformation campaign, to have us eat three times a day every day.

~~~
ajmurmann
I did intermittent fasting for a while and want to go back to it. I in essence
just skipped breakfast and ate a little later. It was astonishing how easy it
was and how well it worked. But also how many comments and even pushback I got
about skipping breakfast. I constantly would hear from someone how breakfast
is the most important meal. Anytime I didn't feel well, regardless of
symptoms, friends and family brought up how this is likely because breakfast
is so important and I keep skipping it. Skipping breakfast seemed upsetting to
people. I also didn't take the comments well, because to me it sounded like
unfounded folklore nutrition advise from my grandma en par with "an apple a
day keeps the doctor away"

~~~
GordonS
I've fasted for up to 5 days before, and for the past 6 weeks or so I haven't
eaten breakfast or lunch during Mon-Fri - it's surprisingly easy to do.

I also very much dispute the oft-cited claim that "breakfast is the most
important meal of the day" \- my theory is that it came about as a marketing
push for breakfast cereal companies looking to push their cheap carbs. It's
become an ingrained, indisputable "truth" \- hence some of the comments you
got.

I remember being told as a kid that breakfast was really important, so I had
"energy" and would be able to concentrate better.

I realise now that it's nonsense, at least if you eat a carb-laden breakfast.
Eating carbs seems to start a cycle where you are going to feel hungry ~2h
after eating (signalled by a blood sugar drop back to normal levels),
regardless of how much you ate. I remember this from my school days too, _not_
being able to focus because all I could think about was my next snack/meal!

------
not_a_moth
Even if you're not obese, fasting appears to be one of the most healthy things
you can do for your body. Low insulin variability, autophagy, clear out
visceral fat on organs, yields extended longevity in lab mice, etc.

~~~
rpmisms
Unless you have low body fat, which is less common than it used to be. I
maintain body fat under 7%, and I have to eat regularly or I will become very
ill very quickly. If I'm to fast, I have to cut something from my diet, not
cut my diet.

~~~
jniedrauer
A lot of "conventional wisdom" about health seems to be targeted at people who
are sedentary, which is kind of counterproductive, since being active is the
most effective way to improve your health. When you're highly active, things
like intermittent fasting start to make a lot less sense.

~~~
elif
I disagree completely. Regular caloric restriction has its place, exercise has
its place, and intermittent fasting has its place.

My wife and I are long distance hikers. That means carrying 10-15kg up and
down mountains for 10-14 hours per day every day for 3-6 months.

It also means literally counting every calorie--because you have to plan it in
week-long intervals and also optimize it for minimal weight and sufficient
nutrients.

Sounds like a perfect recipe for weight loss right? Enter 'hiker hunger.'

Appetite is completely elastic. Your ability to perform depends on your
brain's ability to produce happy endorphins and satisfaction signals etc.

That's where intermittent fasting is crucial. You exercise your body's
regulatory functions. It's not just some belief or willpower or placebo I
mean: at a chemical level you transform the function of your neurochemistry to
improve your metabolic process.

~~~
jniedrauer
> That's where intermittent fasting is crucial

Would you be able to use IF _during_ a thru hike? I suspect that the answer is
no. The weight gain problem for distance hikers is _after_ the hike is
finished and we reduce activity significantly. I've solved that by training
for distance races when I'm not hiking.

Zach Bitter, the current 100 mile record holder, put it in a way that makes a
lot of sense to me[0]. For a mere mortal, fasting for 6 hours puts you in the
hole for about 700 kcal. A world class athlete like him is at more like a
2000+ kcal deficit. It's impossible to catch up once you get that far behind,
and you end up losing weight and injuring yourself. I only burn about 800 kcal
during training on an easy day, but I still find it nearly impossible to catch
up if I miss a meal. I'm already eating 5x a day. It's hard to cram 5 full
meals into a few hours.

[0]:
[https://zachbitter.com/blog/2014/04/06/intermittent_fasting_...](https://zachbitter.com/blog/2014/04/06/intermittent_fasting_feast_or_famine_for_endurance_athletes)

~~~
elif
Of course not.

And weight gain is not contained to "after the trail"

And weight loss is not guaranteed.

It's great that you've found something that works for you. Like I said, it
works for me too.

Bodies are different though.

"I've hacked around this problem" != "This problem is illusory"

------
dreamer_soul
A guy did this 6 years ago [1]. He doesn't recommend it since he got into
heart issues later on. [1]
[https://www.reddit.com/r/IAmA/comments/1o5ndh/iama_guy_who_w...](https://www.reddit.com/r/IAmA/comments/1o5ndh/iama_guy_who_went_from_430_pounds_to_170_pounds/ccozvkv?utm_medium=android_app&utm_source=share)

------
dang
A user emailed to ask that we change the article from
[https://www.diabetes.co.uk/blog/2018/02/story-angus-
barbieri...](https://www.diabetes.co.uk/blog/2018/02/story-angus-barbieri-
went-382-days-without-eating/) to the paper, which is famous enough on its
own. We've done so.

A thread about this from 2018:
[https://news.ycombinator.com/item?id=16941097](https://news.ycombinator.com/item?id=16941097)

------
siliconc0w
I used to be a much larger mammal and lost a lot of weight (100+) through
fasting and diet change. Longest I did was a 14 day fast with zero-calorie
electrolytes, black coffee, and sparkling water. You get pretty low energy but
the hunger just kinda subsides into background noise. I still try to do a 5
day 'reset' fast every quarter or if I hit 200. Diet change is really the most
important factor but fasting is a nice tool to have because at least for me
it's relatively easy and provides quick results compared to trying to maintain
a sustained calorie deficit for multiple weeks. IF is, of course, likely safer
so definitely start there if you're new to the game.

~~~
lostmsu
During these 5 day resets, are you as productive (important: not 'focused') as
usual?

------
crazygringo
I mean, sure. I've done keto, I've fasted for several days, it's fine. I
personally would have eaten some cruciferous vegetables since I don't trust
multivitamins to provide everything, but sounds like he did fine.

My only curiosity as a strategy for months or over a year is if the lack of
any protein whatsoever has harmful effects.

I was under the impression that some level of protein intake was necessary to
maintain muscles -- something that burning fat doesn't provide.

I'm wondering if he had any muscle loss problems? Or if his leg and back
muscles were already so extremely overdeveloped to support his original weight
(as is normal), that as they naturally decreased, their protein was made
available for normal baseline muscular maintenance?

~~~
heymijo
We are firmly in conjecture-only territory here, especially discussing a 382
day fast.

Having said that, Dr. Peter Attia has some reasonable
hypotheses/extrapolations on how one may maintain muscle on a prolonged fast.

> _" I don’t think it’s out of the realm of possibility that you can “eat” a
> meal of protein that contains all of the essential amino acids during a
> fast. This may be one of the benefits of autophagy, which literally
> translates to “self-eating.” Your muscle cells may be dining off your skin
> cells, so to speak._

> _" Obviously, the longer you fast, the more you drain your internal sources
> of food, and the more likely MPB will exceed MPS over time. (This may also
> suggest that the fatter you are to begin with, the longer you can eat
> yourself, and presumably maintain muscle mass for longer.)"_

[https://peterattiamd.com/can-you-maintain-muscle-during-
fast...](https://peterattiamd.com/can-you-maintain-muscle-during-fasting/)

~~~
crazygringo
Fascinating article, addresses my question exactly. Thanks.

------
tomhoward
"without eating" != "without sustenance"...

> To compensate for his lack of nutrients, he was prescribed multivitamins to
> take regularly, including potassium and sodium, as well as yeast.

------
floatingatoll
Readers, please be very cautious when trying these things. There is research
into "never hungry" eating disorders hinting that you can trigger a permanent
(erroneous) negative feedback loop with fasting. If it works for you, hooray,
but if you or your blood relatives have a history with anorexia etc., be _very
careful_ experimenting with fasting diets.

EDIT: The final page of the (1973) medical study about this patient has some
rather specific warnings about testing certain blood and urine metrics to
minimize risk of e.g. death.
[https://pmj.bmj.com/content/postgradmedj/49/569/203.full.pdf](https://pmj.bmj.com/content/postgradmedj/49/569/203.full.pdf)

~~~
milesvp
This. The dieter was on a multi vitamin. I saw reference some years ago to an
eating disorder (anorexia I believe) being directly linked to low levels of
some common trace mineral. Some proper dosing brought back an appropriate
appetite. Which made it easier to deal with the remaining psychological
aspect.

~~~
ianai
You can count me in the camp of believing in the power of vitamins, minerals,
and getting the right requirements met. And matcha tea (just a little). The
positive effects on my energy levels since just picking out a good B complex
impress me every day. Plus other stuff, too. It’s enough that I think it
should be a common basic societal good like indoor plumbing and AC/power.

~~~
floatingatoll
That approach did not work out perfectly for fluoridated water and mandatory
vaccinations.

------
paulcole
This guy’s blood glucose being at 36mg/dL (2mmol/L) for months at a time is
insane to me. I’ve had an ambulance called when mine was around 45 and I was
so loopy I couldn’t form a sentence or stand up without falling right back
down.

I’ve heard that long term low BG can lead to heart muscle damage which may
have been what eventually did this guy in?

~~~
virtuallynathan
Ketones! When you are metabolizing fat, your need for glucose drops
substantially. Only a few cell types require glucose. Ketones also spare
muscle.

------
fortran77
This man was under medical supervision.

Many obese people believe the body will enter a "starvation mode" and make it
impossible to lose weight under a certain amount of calories. This is simply
untrue. Cutting calories to less than your body burns each day always leads to
weight loss.

He needed vitamin and mineral supplements (potassium, etc) because not
everything is produced when your body burns fat. But if an obese person eats,
say, 1,000 calories a day of a balanced diet, he can probably continue this
indefinitely until all the extra weight is off without any ill effects. (Of
course, don't go below, say, 1800 kcal/day without talking to a doctor if
you're obese or overweight.)

------
tus88
> His body began to adapt to the lack of food by burning its own fat stores
> for energy.

Yeah that's called metabolism and happens whenever anyone loses weight.

~~~
samatman
This process, while a part of metabolism, is specifically catabolism.

------
Cougher
It's funny that everywhere we see the discussion of weight loss, there's so
much insistence that this "one way is the only valid way" because of "this
irrefutable process that science proves is real". Yet millions of people have
used any number of ways to lose weight. I've used three ways successfully and
they all have one thing in common: I consumed fewer calories than I burn. And
the one weight-loss method that actually prepared me for the long-term weight
maintenance that must come after we reach our goal is the method that wasn't
some form of dietary ostracization: eating fewer calories than the number that
made me fat.

------
romaaeterna
[https://www.findagrave.com/memorial/117717047/angus-
barbieri](https://www.findagrave.com/memorial/117717047/angus-barbieri)

Died age 51.

~~~
point78
25 years later, trying to find cause of death...

~~~
quaquaqua1
We have a discord server where we studied Angus' life.

A very good friend of mine in the UK officially requested his death
certificate.

The causes of death, if I remember correctly, were:

Stomach bleeding, something else (sorry), and obesity.

We were trying to understand if they put obesity on there just because he was
obese decades before, or if he was obese again at that time. But we're pretty
sure he put the weight back on. He died in Warwick

~~~
newnewpdro
It's likely he put the weight back on.

Fasting for 382 days as a medical intervention isn't learning how to actually
live with a stable healthy relationship to your food environment. The
behavioral patterns leading to the intervention initially will very likely
resume afterwards.

This reminds of a personal experience, story time:

<anecdata>

An obese friend of mine visited the ER for a persistent respiratory issue.
Through negligence of the hospital staff, he found himself in an emergency
abdominal surgery with a perforated colon.

What started as a relatively casual ER visit turned into an extended many-
month ordeal under hospital care, mostly bedridden. As the months ticked by
his weight dropped to fairly close to normal. He was still a bit overweight,
but easily over a hundred pounds lighter with only hospital food in controlled
portions to live off of.

I clearly recall visiting him in the hospital in the days approaching his
release, and how proud he was for the weight loss. He was so ignorant about
his relationship with food and how significant a factor it was for the
hospital's control being responsible for his weight loss vs. his own chosen
lifestyle. I didn't say anything at the time, but was already a bit nervous
about what would happen when he left the hospital's care, with a severely
compromised abdomen still recovering.

Fast-forward to a year later, and he had become more obese than before
starting this ordeal. No doubt his eating problems were exacerbated by the
depression of his life situation. The last I heard he needed abdominal
reconstructive surgery, and had developed an intestinal hernia from the
substantial size increase while still recovering. Apparently he couldn't have
the procedure done until he lost the weight again.

</anecdata>

------
fyp
I wonder if it's the same process that bears go through when they hibernate?

~~~
rpmisms
IIRC, that's a specific metabolic state that's seasonal. Maybe this guy was
able to replicate it? I'm not seeing any special considerations he took.

------
cable2600
It reminds me of when the Buddha fasted for a long time, sitting in the same
place all day. Everyone worried that he might die.

~~~
Cougher
Spoiler alert:

He's dead.

------
scarejunba
How did he avoid stomach ulcers?

~~~
floatingatoll
Someone above points out that his death certificate included "stomach
bleeding", so the answer may simply be "he didn't":

[https://news.ycombinator.com/item?id=21673521](https://news.ycombinator.com/item?id=21673521)

------
olingern
I find not eating to be a nice way to implement calorie control and also work
on executive control. In my case, I've done it for the greater part of of the
past three years. A typical fasting cycle would be 2 months of 20/4
intermittent fasting and 1 week of "normal" eating. I have an unfounded theory
that re-sensitization helps sustain the benefits.

Initially, I did find great benefit in the cognitive benefits [1] of fasting
but found it came at a price. This price was mostly strength at the gym later
in the day and some added stress during the workday (_not eating is sort of a
stress of its own_). It also led to me yo-yo'ing (5-7 lb fluctuations [2] ) a
bit with weight because I would be so hungry that I would overeat. I should
mention that I paired my fasting with ketosis as type II diabetes runs in my
family. I saw a lot of improvement with how I deal with insulin (shakiness,
irritability, skin issues, bonking[3]).

If anyone is thinking about fasting, here are my beginner recommendations:

\- Contrary to what this link suggests, I think the key is to start slow.
There's no need to even do a 24 hour fast, in the beginning. Your body is not
going to change over night. Build up to daily 10 - 12 hour fasts and build
confidence that you can accomplish the fast. There are a lot of benefits to
prolonged fasts, but I would suggest building up to them and learning how your
body reacts instead of getting to a place where you feel faint-ish and don't
know what that means for your body.

\- Fasting on keto feels like cheating, so I think it's a great tool for
facilitating more frequent, longer fasts. For me, it seems that ghrelin is
highly suppressed by being in a keto induced state. I don't feel well after 72
hours and noticed abnormal heart rhythms, most likely sodium or potassium
imbalance.

\- Practice saying 'no' or at least make note of social obligations where you
have to eat or knock yourself out of your fast / ketosis. 1 day here and there
doesn't make a big difference, but how your overall diet quarter to quarter
and year to year is what really matters.

\- Don't listen to the popular IF / keto sentiments of, "I don't have to track
anything! It's magic," if you're below ~18% body fat. This is what I listened
to and it led to overeating and reaching 10-12% body fat and quickly jumping
back to 15-18%. No matter what your diet is, you should know your caloric
intake and ( in general ) what keeps your body at maintenance.

\- Not sleeping makes fasting so much harder[4]. If I sleep less than six
hours it's definitely an uphill fight.

____

None of this is "fun" per say but it's a process of getting to know yourself
and observing how time, age, and environment affect your body.

1 -
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3670843/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3670843/)

2 - I know salt and water retention play a big role here, but these changes
were more than just looking / feeling bloated.

3 -
[https://en.wikipedia.org/wiki/Hitting_the_wall](https://en.wikipedia.org/wiki/Hitting_the_wall)

4 -
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3763921/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3763921/)

------
noobermin
"It works" doesn't appear in the article, it might be editorializing.

------
geocrasher
Comment deleted by author. Shouldn't have hit submit.

~~~
tapland
This guy was under (some) medical supervision with some supplements and with
regular testing. Your situation sucks, but this man is not doing what is
happening to your wife and you shouldn't be offended by a story about the
worlds most extreme outlier case of dieting.

~~~
loeg
Not to mention, OP's wife is completely not the norm. There's a growing
majority of overweight, obese and morbidly obese people in the developed world
who do not have any medical problem with absorbing food through their GI and
for whom losing some fat stores would be a health boon.

It is unclear why OP associates this man's anecdote with his wife — the man of
the article was not reported to lose GI function because of his fast. He was
just morbidly obese, and stopped eating until he was at a relatively healthy
weight.

------
joak
1\. by eating less you are going to lose weight

2\. It's no going to be easy

~~~
cairo_x
Not at all. If you've eaten a high sugar/carb diet, it doesn't matter if you
eat less because your body's still not going to burn off the fat unless you
actually starve yourself. Eating less is completely different to starvation,
and starvation is not a good long term strategy.

1\. Cut out sugar and most other carbs (potato,bread,pasta,biscuits,fruit,
etc), not counting fiber as a carb). Have a modest amount of protein and as
much fat as you want. There are multiple diets such as Keto and Paleo that
play with ratio of fats protein and carbs, but they all amount to pretty much
the same thing--cutting out sugars and carbs as much as possible.

2\. Eat as much as fills you up of everything else.

3\. Body learns it needs to use fat for its energy.

4\. Get to target weight, reintroduce yourself to carbs in moderation and
leave sugar for special occasions.

The hardest part is sugar withdrawls for the first couple of weeks. There's
also possible problems with a lazy bile duct due to the body not being used to
a high fat diet, but can be dealt with by taking a modest dose bile
supplements for a period of time.

Other than that, pretty damn easy. Compared to giving up cigarettes or coffee
of which I've done both, it's a walk in the park.

~~~
asveikau
I lost 100 lbs eating mostly pasta dishes. I think the anti-carb thing is
overhyped.

It's funny that you end your comment with "a walk in the park", because my
experience suggests that walk in the park may help more than eliminating
carbs.

~~~
904baf11
I've lost a small amount of weight whilst still entirely eating bread this
year. The only thing food groups have to do with it is how filling everything
is

~~~
TillE
It's incredible how much bizarre pseudoscience exists to dance around this
simple fact.

Even with ketosis (a real thing), 99% of its dietary weight loss effectiveness
is because fat is filling.

~~~
cairo_x
> 99% of its dietary weight loss effectiveness is because fat is filling

This is pretty easy to disprove. It's not at all that fat is more filling.

Once your body starts to burn it's own fat you no longer feel like you're
starving. Anyone whose fasted could tell you that, never mind been on keto.

The starving feeling comes from the period in between where your body is
waiting for more carbs before finally switching to fat burning mode.

So it's not that fat is filling. Carbs are filling, too. It's just that when
carbs are burned, there's nothing to replace them with, but when the fat
you've consumed has gone through your system, and your body is already in
Ketosis, it doesn't feel bad because there's weeks and months worth of food
already on your body to burn.

~~~
GordonS
I like of feel like it's easy to "prove" the opposite.

If I eat a meal comprised of fat and protein (2 fried eggs with some cheese,
for example), I'll feel sated and won't feel hungry again for up to 5 hours.

On the other hand, it I eat a bowl of pasta, I'll feel very full immediately
after eating, but am guaranteed to feel hungry again in ~2h.

I firmly believe that fat and protein are more "filling" than than carbs, and
many people have shared similar anecdotes.

------
smallstepforman
I’ve gone through 2 iterations of nothing but carrot juice for 28 days (detox)
and 2 iterations of 14 days carrot juice only. After the first week which you
go through a healing crisis, where toxins are released and your immune system
goes into overdrive, aftrr that you dont feel hungry or lethargic at all. I
could have easily gone 60 days.

~~~
caymanjim
"Detox" diets are pure nonsense with no basis in medical science.

~~~
noobermin
Perhaps the detox means less than just in-taking calorie low food for a few
days.

