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Features of a successful therapeutic fast of 382 days' duration (1973) [pdf] (bmj.com)
147 points by joak 7 days ago | hide | past | web | favorite | 154 comments

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/ and https://www.reddit.com/r/intermittentfasting/

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.

Your last comment really resonated with me. This year I started thinking about how we relate ourselves to food, and I've come to think that we live in a very food-centric society. We have TV shows, instagram accounts, magazines and influencers all dedicated to sharing the best meals, recipes and restaurants. It is also very hedonistic. If you eat, it must be something delicious and picture-perfect, otherwise it's a missed opportunity. Don't bother cooking if you're not a MasterChef-level cook, it's better to just Deliveroo.

It's okay to sometimes cook bland food, or food that doesn't look that great. It's just food after all. And honestly we cook and eat so much. We don't need to consume as much as we do.

After gaining a few kilos last year I decided to stop following so many cooks and recipe channels. Suddenly my obsession with food was gone. Before, if I wasn't cooking, or eating a meal or a snack, or thinking about going to a restaurant, I was watching cooking videos or reactions to meals. After cutting it off, I only thought about food when I was hungry, and I could spend the rest of the day with more important things. After that I started counting calories and I was surprised how little food we actually need to survive, especially with a sedentary lifestyle.

There's a part of a Louie CK special in which he talks about what would happen if God came back to Earth and talked to Man about what he'd done to his creation. "Why do you need money for?" "I need money to buy food" "What do you mean buy food? Just eat the shit on the floor!" "Yeah, but it doesn't have bacon in it". And honestly we place so much importance on what the food is. It's just sustenance, eat some leaves and you'll be OK.

When I got sick, I became mentally allergic to fat and sugar. I thus spent monthes eating only raw vegetables. There are so many subtleties in taste and texture you can finally 'see' when they're not coated (or drowned even) in sauces.

The pleasure you get is also different in that it doesn't create much of a crave feeling. And you rarely binge on salad or carrots.. your brain will naturally give up and say enough. When anything is sweetened you see yourself in a never ending loop.

Plus vegetables help digestion.

Anyways, raw is actually finer than it appears.

Agree. Your stomach will tell you that you’re full when it’s volume is expanded to where it thinks it’s full. Could be all water, carrots, or fried chicken for all it cares. The effects on your health though depend on what it actually was.

More than volume there id also a taste factor. Non sweetened produce have nice flavours and less nice ones, after a while something between your tongue and brain says 'no more'

Also don’t typically need salt for them to be palatable.

Oh man, I couldn’t disagree more about not needing to cook or make sure things taste good. That’s just knowing how to properly use spices, textures/temperature contrasts, and healthy ingredients. But I do agree that probably not many people know the sort of cooking I’m referring to here. Healthy food for me is nutritious, low to moderate in salt, and Whole Foods plant based. Portions matter too of course.

I think our relationship with food is profoundly linked to the culture we come from.

For me, food is first and foremost a social experience and something you share : everyday lunch with coworkers, dinners with my family, having two hours lunch with my extended family on the weekends. It would be kind of sad to eat bland food together while we could be enjoying something pleasant.

You cant lose 10kg in 9 days.. a normal person barely consume 300g fat a day.

Insulin causes our body to retain water. In the first 3 days or so of a long fast like that you pee water like a firehose as your insulin levels plummet to nearly zero. Also fat burning becomes less efficient in the absence of glycogen stores due to ketone creation. In addition human growth hormone levels will increase.

10kg in 9 days is likely about 3-4kg fat/protein and 6-7kg water roughly speaking.


Moste likely water lost? As is common afaik when going low-carb, at least to start with.


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

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).

Most medical fasts recommend avoiding artificial sweeteners during extended fasts as they cause the release of insulin through the incretin effect.

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

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".

I can’t speak for OP, but most fasts of this kinds allow drinking water at the very least, and sometimes even light broths like chicken broth. Religious fasts, on the other hand, often don’t even allow drinking water.

However it turns out some religious fasts allow you to eat whatever you want after dark, or something like that. The discovery of which tempered my awe somewhat.

Yeah, a lot of Muslims gain weight during Ramadan.[1] And I think they'd point out that the intent is spiritual.

[1]: https://latimesblogs.latimes.com/world_now/2012/07/cairo-the...

FWIW this depends on the religion, traditional Christian fasts usually did allow water even in their strictest forms https://en.wikipedia.org/wiki/Black_Fast

Although as others pointed out, Ramadan in Islam does not.

The fasting discussion in this thread seems to be about caloric fasting, rather than religious fasting. The latter tending to prohibit drinking, while the former doesn’t.

The terms set tasting and dry fasting are sometimes used to distinguish between fasting from food and fasting from eating and drinking. For weight loss fasting, it's usually wet fasting if not specified.

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.

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"

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!

I skip breakfast almost everyday. I get my morning brain startup sugar from cream in my coffee. I too get pushback from people when they find out I skip breakfast. They say it's the most important meal of the day. I tell them that's propoganda. Thank Kelloggs for that. People always ask how I'm so "skinny" (I'm not, I'm just not overweight like most Americans...) I believe it's because first off, I eat meals when I'm hungry, not when I'm 'supposed' to eat. I will sometimes miss or 'forget' lunch. If I'm not hungry enough to remember, then I'm not hungry yet. Second, I believe my longer fasts between meals, skipping breakfast, I believe I go into ketosis sometime in the early AM. By not breaking my fast my body continues to burn fat. One other thing to note: if I eat a breakfast, I'm bound to get hunger pangs around breakfast time the following day or two. If one succumbs to the hunger pangs, they will soon be eating breakfast daily. Get through the pangs for a day or two (drink coffee, water, or tea) until they are gone then you can get off the need for breakfast. Also, I avoid alcohol in the evening. Especially anything more than one drink. Getting drunk will lead to hunger pangs the next day well into the afternoon.

Eating breakfast was historically seen as a sign of weakness; a meal for children and the elderly. This changed in the 1700s and the modern concept of three meals appears.

Fascinating! Do you have a source for that?

I don't get y'all. I have to remind myself to eat and stuff myself at least 3 times a day just to maintain weight. If I want to gain, I have to set an alarm to eat a meal every 3 hours (minus when I'm sleeping, that's sacred time)

That sounds like hyperthyroidism - You should get your blood checked.

No it doesn't.

First off, people with hyperthyroidism generally have increased appetite because of an accelerated metabolism, not reduced appetite. So half his symptoms already don't match.

Secondly, don't try to diagnose people over the internet based on half a symptom and today's weather. Suggest them to see a doctor and leave it at that.

Just because you happened recently read of one random disease out of millions doesn't mean everyone has that now. You'll cause more harm than anything.

He only suggested him to have is blood checked. In what way is this ever harmful? From my point of view you are doing far more damage implying that he is fine and he doesn’t need a blood test.

> you are doing far more damage implying that he is fine

I did not imply that.

> He only suggested him to have is blood checked.

He did not only do that.

I've been on about one meal per day for several years now. If I do a full brunch/lunch and late dinner, I feel so heavy.

I typically do a scoop of chunky peanut butter or some yogurt in the morning with coffee, then nothing until dinner. If I'm cooking, then I'll also snack a little while I prep. Usually at some point after dinner, I'm having another scoop of peanut butter.

I don't think this is for everyone, but for me it's perfect.

Years ago I would fast on a regular basis. Typically 1 - 3 days. It's something everybody should do once, even if they don't hit their target.

Like jahewson said, breakfast wasn't always a thing for adults. I'm not a nutritionist, but unless I'm training for something (which I am not), I don't see how my body could put three meals to work.

This really depends on what you are doing with your day.

If you're getting up before the sun comes up to plow the fields all day, you'll probably eat more food to account for the amount of calories you burn.

If you're waking up around 8 or 9 to start your remote desk job from home, you can probably get by on a couple small snacks per day, or one meal.

The concept of a desk job is relatively newish, historically speaking. We've been eating a lot longer than desk jobs have been around.

Calories in vs. calories out

Totally sounds like a 1950s post war thing. The stereotype Americana decade.

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.

Been fasting on and off for a while now, maybe 1-2 days every week. The effects are immediately noticeable, on about day 3 i feel better. A week later i see the weight loss, better skin, etc. It's a good feeling that everyone should try at least once.

Disclaimer: I eat like garbage so it's more likely that not eating garbage is having these positive effects, not just fasting.

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.

I found something similar too -- and I'm nowhere even near that thin.

I successfully lost 50 lbs a few years ago doing keto and brought myself to exactly the middle of normal BMI.

While I was losing the weight, keto was easy -- I always had energy (more than ever before), felt great, wasn't getting sick.

But once I hit my target weight... all of a sudden keto became miserable. I had brain fog all the time, except for about the window of 2-4 hrs after each meal when my digestion seemed to peak. I started getting colds all the time.

Once I switched back to eating carbs, I felt great.

My theory is that your body burns fat proportionally to the amount of fat you have... and that it's fine to fuel yourself until you just don't have enough fat anymore to keep it going to even things out between meals.

I was pretty bummed actually to discover that keto doesn't work for me anymore, when I'm already at a healthy weight. I just loved the constant energy. But for however my body's built, it's just not an option for me anymore.

Oh that sounds difficult. Were you eating enough fat & protein each meal, that you needed to burn off? Since your body didn’t have the fat stored...

You are an extreme outlier. Even for men, bf% under 7 is in or getting into the unhealthily low range. Fasting is not for you.

Intermittent Fasting, as described on the internet, doesn't involve eating less food but rather eating within a narrower time window. You can get 16-23 hours of fasting in a 24 hour day, and suggestions are that useful changes happen around 12 hours after eating, and (e.g. work of Prof. Sachin Panda) that fasts of this kind of length can do significant good for animal health.

Are you talking of this kind of thing, low body fat makes even this difficult, or are you talking of multi-day fasting?

I don't understand Intermittent Fasting from a digestion point of view. The fast usually starts when you end your last meal, however you'll be busy digesting your food for hours, can those hours really be counted as "fasting".

Fasting, to me, begins when all previous meals are digested

FWIW, the time window of Intermittent Fasting usually leads to eating less food.

Although there are other benefits to IF, the weight loss is principally from calories in, calories out, because it’s much harder to cram an excess of calories into a small time window unless you purposefully eat beyond satiation.

> the weight loss is principally from calories in, calories out

Is it? Study [1] claims "Mice fed an FS [fat and sugar] diet ad libitum (FSA) consumed the same amount of calories as mice fed within a 9 hr window of the dark phase (FST) [fat and sugar, time restricted] (Figure S2A, i), yet the FST [time restricted] mice gained less body weight"

and then "to investigate the therapeutic potential of TRF [Time Restricted Feeding], we tested whether TRF could reverse or arrest body weight gain [..] Within a few days the mice were habituated to the new feeding paradigm and continued to consume equivalent calories (Figure S2A, iv). The 13:12 FAT mice showed a modest drop in body weight"

[1] https://www.cell.com/cell-metabolism/fulltext/S1550-4131(14)...

From related work of https://www.salk.edu/scientist/satchidananda-panda/

I think "it has to be calories in/calories out because it's just common sense" is not nuanced enough for biological systems.

I do intermittent fasting frequently. I can't fast from food for long periods, or go below a certain calorie count in a day. As long as I get the nutrition I need, I'm ok, I just run on thin margins.

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.

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.

> 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_...

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"

Being active is one factor, but doesn't fix obesity. It's also difficult or even potentially harmful to start doing some kinds of activity when you're extremely obese.

Highly active is something you can be when you're at or approaching a healthy weight; the causality is IMO almost backwards from what you've described.

You can't outrun a bad diet. It's way too easy to overeat in our modern world, even if you're active.

> You can't outrun a bad diet

In spite of jamming as much junk food down my throat as I possibly could, I struggled to maintain weight on the Appalachian trail. You can definitely outrun a bad diet. (Not that it's a healthy way to live either.)

Not everyone can. Genetic factors and how your body handles insulin determine almost everything about how your body will gain or lose weight and in what conditions.

Gary Taubes book “Why we get fat,” is a great read on this subject.

I agree that outrunning a diet is something that outliers do, but has Gary Taubes found a way for his foundation to confirm his claims after it refuted them? There's little doubt that genetics and how your body handles insulin have influence, but the variations still don't compare with how many calories you consume versus how much you move, given a healthy diet.

You can eat a lot of calories and lose weight.

I have lost weight like that before, but can't maintain a 2 hour a day exercise routine.

I imagine you can't stay on the Appalachian trail forever.

So eventually a bad diet will lap us.

I had the same problem on the AT.

But, yknow, HYOH

My mom used to regularly fast for "religious" purposes. One day during a week long fast she passed out in the shower. According to the doctor it's because we're not supposed to keep a full schedule while fasting.

Was it a wet fast or a dry fast?

> According to the doctor it's because we're not supposed to keep a full schedule while fasting.

That's a standard answer that likely does not draw on his medical knowledge. People pass out even when not fasting (women more so than man, something to do with vagus nerve IIRC), and thousands of people do long wet fasts while keeping a full schedule with no ill effects.

The feeling ill part is a n=1.

As mentioned from fasting you still get major benefits from autophay, sirtuin activation, longevity, low insulin variability.

Some of the top fitness and health practitioners who are big on fasting are very low body fat, incredible shape.

If you are highly active and have a low bodyfat percent, then you are just catabolizing your own muscle by fasting, and you become very injury prone. There's no upside.

You seem out of touch with the scientific literature, and have hand-waved all the real health benefits I've listed.

Leading figures like Peter Attia, Tim Ferriss, Ben Greenfield, David Sinclair, Kevin Rose to name a few, all pro fasting, all in top shape/low body fat.

> and you become very injury prone

No, you become temporarily weaker, and that's only if you're fasting multiple days. It's recommended you work out during fasts... your body remains anabolic to muscle (barring other variables like elevated stress).

With the exception of Ben Greenfield, none of these people seem to have a sports science background. In the realm of athletics, things like intermittent fasting and keto diets are something of a meme. Some people do advocate for training with depleted muscle glycogen first thing in the morning, but there's no consensus that this does anything.

Autophagy for me is my muscles eating themselves for energy. Not healthy, and it feels like being beaten.

I just learned about autophagy (literally self-eating) this week reading about fasting and the Prolon Fast Mimicking Diet. This is why fasting is popular with cancer patients, your body maybe will start eating the cancer cells.



In no way is fasting healthy for you if you rely on having energy, focus, or any ability to function as an independent adult while fasting for more than a day or so at most.

That's not my experience. I've done a few 72hr fasts, and many 48hrs fasts. In general I find I have more focus, more even mood and more enthusiasm (though less energy for physical activity) while fasting.

If you don't mind sharing, what kind of starting body fat % (or as a poor proxy, BMI), did you have at the beginning of your multiday fasts? I don't care about the literal numbers, but: bottom of healthy range? Mid-healthy range? Above healthy range? Do you exercise regularly (and did you keep it up during the fasts)?

I guess this is always my question of anyone who has a positive experience with fasts. Personally, I have been at the mid-upper range of healthy bf%/weight for years and exercise frequently (running 30+ minutes 7 days a week for a few years, cycling 60+ minutes 2-3 a week this year) and find much shorter fasts (say, 20h) excruciating and completely draining mentally and physically. And I'm not at 7% body fat like that other guy. Lowest I got was maybe 14% while I was running daily; while I'm up to 18%ish now, fasting hasn't gotten any easier.

(Even if I skipped exercising, just the mental effects made my mood significantly worse by the end of the day, which makes it harder to work effectively in a collaborative environment.)

I'd say that I'm in a similar position to you, though not as fit. I do a short HIIT session every day and am marginally chubby.

What's your non-fasting diet like? Fasting is the quickest way to get into ketosis. If you're used to eating a carb-heavy diet, the switch into ketosis can be brutal. So if you either ease off carbs leading up to the fast, or just all the time, it'll be easier.

The other thing is electrolytes. Your body doesn't store them, so you (IMO) have to supplement. If you start to feel like crap, have 1tsp of salt in about 1L of water and see if it fixes it. I also supplement with magnesium and occasionally potassium.

I was going to say something similar.

I've fasted for up to 5 days before, and I felt just fine - especially on days 4 and 5, I actually feel like I have more mental clarity and drive than usual.

You're arguing against evolution. Not only are we deeply wired to function for long periods of time without food, but when you haven't eaten in a while your mind becomes focused and alert since your body thinks it needs to find or hunt food.

I'm sure Dorsey isn't the only high profile/ functioning CEO who does multi day fasts each week.

Who's arguing against evolution? Humans evolved to use our brains to help us develop ways to prevent having to go without food for extended periods of time.

"Not only are we deeply wired to function for long periods of time without food"

So the body doesn't collapse after x number of hours without fuel. Your body also has the ability to generate its own heat when it's cold. Does that mean that it's desirable or ideal that we deliberately use these abilities? Does it mean that there is no harm or risk in doing so? I'm not saying that there is or isn't; I don't know.

"but when you haven't eaten in a while your mind becomes focused and alert"

This is sort of like the focus that you get when you're being chased by a wild animal or falling out of a tree. I don't know that seeking focus from sources like this is a great idea, but YMMV.

"since your body thinks it needs to find or hunt food."

So maybe your body is telling you that fasting isn't such a good idea?

"I'm sure Dorsey isn't the only high profile/ functioning CEO who does multi day fasts each week."

I don't do multi-day fasts and I've lived for years longer than Dorsey.

I hear your perspective.

The evolutionary angle isn't the reason why I believe fasting is a good idea - it's just a rebuttle to "there's no way you function well while fasting"... of course you can, it was likely the MO for millions of years of modern human evolution (or 100+ M years for mammals). It's as natural to fast as it is to fornicate.

Rather, my reasons for fasting come from the scientific literature, centered around autophagy, insulin control, sirtuin activation, visceral (organ) fat depletion, and troves of clear lab test results of benefits (albeit most on non human mammals).

Based on many comments here I think folks just haven't caught up with the longevity research of the last 3-4 years.

From what I've read, this "evolution" argument doesn't seem to hold much weight. If you take other apes as examples, they tend to eat much more, and more regularly than modern humans. Modern hunter-gatherer tribes do as well. So, I don't think there is reasonable evidence that our ancestors normally followed a feast-and-starve diet.

What you've written here sounds a lot like the utter pablum that comes from the marketing literature of every fad diet on this planet. Besides, how CEOs behave and what is sane are not overlapping circles if you're trying to draw a Venn diagram relating the two...

Not my experience, having fasted periodically (2-5 day fasts) for years. It's absurd to think everybody reacts the same to fasting given the range of bodyweights/types out there. This article is evidence this is not the case.


Your earlier comment came across as a pretty literal blanket statement for me, FWIW.

> In no way is fasting healthy … while fasting for more than a day or so at most.

The italicized portions are both qualifiers that suggest / reinforce something like "literally no one in human history has successfully fasted."

If you meant "On average, low blood sugar will cause lower metal and physical performance," just say it. Sarcasm and hyperbole don't come across clearly on the internet. It's much easier and more considerate to write what you mean the first time, rather than writing a hyperbolic and simplistic statement and then retroactively rationalizing it.

diminoten 6 days ago [flagged]

I did write what I meant; there's simply no way, on average, fasting has zero negative side effects. That's what I wrote. The fact that you or others couldn't navigate your way to that conclusion is on you, not me.

And I did want to come across as sarcastic and condescending because it's frankly insulting to others when you claim such outrageous and wrong nonsense on the internet. You deserve sarcasm and negativity if you bring idiocy to a reasonable conversation.

We've banned this account for repeatedly breaking the site guidelines and ignoring countless requests to stop. We've cut you an incredible amount of slack, but at some point enough is enough, and this is it.

If you don't want to be banned, you're welcome to email hn@ycombinator.com and give us reason to believe that you'll really follow the rules in the future.


> it's frankly insulting to others when you claim such outrageous and wrong nonsense on the internet. You deserve sarcasm and negativity if you bring idiocy to a reasonable conversation.

I think you're replying to a different person than you think you are. I'm not nverno nor not_a_moth; I've made no radical claims about fasting. It's insulting to me to … claim such outrageous and wrong nonsense, to put it in your words.

Finally, one suggestion. If you find yourself writing, "You deserve sarcasm and negativity," click the X, take a break, and go for a walk to clear your head. That's just not really appropriate or useful anywhere.

diminoten 6 days ago [flagged]

I'm not you; I don't need the kind of help navigating the Internet that you do, and it's condescending as hell, writing what you're writing. You have zero clue what my mental state is, please don't presume to know how I'm feeling.

And no, I didn't misdirect my comment; you said my comment came across one way, and I replied to that. You are, again, not an objective arbiter of intent, and again, please stop trying to be.

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...

A user emailed to ask that we change the article from https://www.diabetes.co.uk/blog/2018/02/story-angus-barbieri... 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

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.

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

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?

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.)"


Fascinating article, addresses my question exactly. Thanks.

The article mentions him being given vitamins and yeast, and "nutritional yeast" is a protein source.

He was eating yeast which is a solid protein source...

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

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.

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.

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

The article does dedicate about 25% of its content to the "don't try this at home" section, but I understand not everyone will read it all the way before going to HN comments.

"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.

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?

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

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.)

> 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.

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

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.

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

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

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:


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.


Dude weighed 450+ pounds at the start. Gonna say the weight loss isn’t what killed him 25 years after the fact

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

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.

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.

Spoiler alert:

He's dead.

How did he avoid stomach ulcers?

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


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/

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

4 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3763921/

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

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

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.

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.

My god, I'm so sorry.

I know you say she's tried every treatment (un)known. I'm just curious, since you shared this with us... why hasn't feeding through an IV worked? [1] It obviously hasn't, I just didn't know there were situations where that wasn't an option of last resort.

Again, so sorry.

[1] https://en.wikipedia.org/wiki/Parenteral_nutrition

That failed, sadly.

I'm so sorry for your wife. Please focus on the time you have with her.

You did genetic testing? That’s what found my similar case.

My friend I am so sorry to hear of your spouse's medical condition.

I fasted for 3 days and it wasn’t that horrible. Once you are passed a day mark it gets easier. I was doing all my normal activities and working.

I believe you. I also believe OP and the horrendous experience his wife is going through. I don't think your and his wife's experiences are analogous.

1. by eating less you are going to lose weight

2. It's no going to be easy

Not eating less, eating BETTER. It's a lifestyle change that requires a lot of exercise and eating right. As somebody who lost 114kg in 2 years due to gastric sleeve, it's a complete lifestyle change (proper diet, exercise) that leads to better health.

Yes, literally by eating less. You can lose weight on a diet of pure granulated sugar.

For the purposes of weight loss, exercise is absolutely overrated, especially the low intensity cardiovascular type that most individuals trying to lose weight engage in. The actual number of calories burned for the mental effort/discipline is garbage and that effort would be better spent on better dietary discipline.

High intensity training and weightlifting have better results due to increasing metabolic rate for a long period after the activity, but the key to weight loss is diet.

A proper diet helps with satiety, gut flora and the like which will have an impact on success, but ultimately losing weight is calories-in, calories-out. It's restriction. There's no way around it. You can lose weight without exercise as well. However, it's an essential part of a healthy lifestyle, just like proper nutrition, and can facilitate weight-loss.

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.

> 1. by eating less you are going to lose weight

> 2. It's no(t) going to be easy

> Not at all

Self righteous nonsense.

It does matter. I would suggest, that it would be compelling to stop with the deterministic statements that are equivocations to fit your own narrative. What "less" means or what "starvation" means, is information that would be helpful. Given the multiple vectors that compose the general term "nutrition", we can be sure that less intake is more effective for losing weight. Then going on to say "pretty damn easy" is insulting. Most people aren't informed enough to make measured political decisions (many state initiative cycles in the US have shocking consequences), choosing what to eat and how much is an impracticable behavior.

> What "less" means or what "starvation" means, is information that would be helpful.

Good points. When you're on a high carb diet you can feel like you're starving when you're not, because of the speed at which the energy is dumped after eating. Actual starvation is when you don't get enough calories over long enough time so that your body starts to feed on its own fat, and then muscle, and then you die. But that takes a while to kick in.

> Given the multiple vectors that compose the general term "nutrition", we can be sure that less intake is more effective for losing weight.

Firstly, nutrition: Like the article says, the guy kept up his nutrition by taking vitamins, yeast, and electrolytes. A food can be highly energy dense and have little nutritional value. Nutrition is important. One can have good nutrition and be overweight, and one can be overweight and have bad nutrition. Nutrition is a very broad subject that has little to do with straight up calories, energy, and fat burning/storage.

Secondly, let's say you're a regular sedentary American. The amount of calories your body needs will be surprisingly little. It may even feel disturbingly little.

So lets say you eat just enough to meet your body's requirements (which is different for everyone, depending on genes and activity). If you don't exercise and still eat lots of carbs and sugar, this will seem like a shockingly small amount and you will feel like you are periodically starving after your body has burned the carbs into energy, but you won't actually be starving, because it takes a decent amount of time for your body to flick over to fat burning mode. So you go through this bumpy starvation feeling diet, where you only feel satiated a short while after eating.

And still you body won't burn fat, because it's still sporadically getting enough calories from carbs, but your energy levels will be all fucked up because carbs are so easily turned into energy. You will feel high when you eat, and fucking exhausted when all that energy is burned up.

Actual starvation is when you don't get enough calories for long enough that your body is forced burn its own fat.

This feels fucking awful. It's hard. It sucks.

However, by eliminating carbs but keeping fat in your diet you can get your body to switch into fat burning mode without feeling like you're starving. So now, lets say you have a good meal, and you feel full. Maybe you've had too much. Whatever. What happens when you've burned all that energy? Instead of your body panicking and feeling like its starving, it's already in fat burning mode, so it simply goes to its own reserves without panicking. You won't get that 2pm sleepy feeling of lacking energy because your body will be happily start burning its own fat.

Over time your weight will come down. Combined with modest fasting (skipping breakfast for example) you will lose weight even quicker, and you won't feel like you're starving because your body will not have to wait for you to stop feeding in carbs before it switches over to fat.

> Then going on to say "pretty damn easy" is insulting. Most people aren't informed enough to make measured political decisions (many state initiative cycles in the US have shocking consequences), choosing what to eat and how much is an impracticable behavior.

Which is why we are having this dialogue I guess.

Do you believe the human body is picky about where its fat came from? Fat from carbs and fat from fat is still fat.

You do not need to starve yourself for your body to use energy stored in fat cells. You need your body to use up its immediate stores of glycogen, after which it will use fat or protein. With a caloric target set for a lower goal weight, the carbs you eat will be used up quicker, so your body will then go for the fat (and possibly protein). You therefore can eat carbs, burn fat, and lose weight.

It should not be understated that the best way to speed this process is with light cardio and resistance training, as it speeds up glycogen use and builds muscle, which increases rate of energy use. At no time do you need to remove carbs for this to work.

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.

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

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.

> 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.

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.

This is the stereotypical speculation that comes with diet claims.

I lost a lot of pounds one summer when I used to live in a school that served vegetarian food only for religious reasons. The reason I lost almost 30 to 40 pounds is I cooked my own food which was vegetarian, but probably didn't use the high sugar the cafeteria used to compensate for the lack of meat. A lot of it is simple energy in and energy out. People honestly really underestimate their energy in and overestimate their energy out.

Everything's relative, what was your diet before you embarked on your -100# pasta dish diet? Pasta dishes chased by ice cream and snickers bars?

Pasta dishes in larger portions with less exercise and a stressful commute.

I know multiple people with type two diabetes who aren't overweight. They have good genes with regards to weight, yet bad genes with regards to blood sugar. One of these people runs every day.

Carbs are not bad for you in moderation, but if your body is drowned in them you can easily develop blood sugar problems, especially if you're predisposed to it. Otherwise, if you're highly active and aren't constantly eating more calories than you burn then of course you will have a healthy weight.

I'm not being anti carb or anything. It's just waaaaaay easier to cut them out, lose a bunch of weight, then reintroduce them in moderation, than to try and burn off an excess of calories each day via intense exercise.

Stop. There are many valid ways that a person can use to lose weight, but . . .

"Eat as much as fills you up of everything else."

. . . that sentence should never be a part of it.

Perpetual motion is impossible, though.

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.

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

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

That sounds like a great way to develop several kinds of vitamin deficiencies (look up Wernicke’s encephalopathy—vitamin B1 deficiency and vitamin B9 and B12 deficiency). Do you supplement any kinds of vitamins with your detox?

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