How Much Weight Can You Lose on a 40 Day Water Fast

Clin Med Insights Case Rep. 2016; 9: 67–70.

Complete and Voluntary Starvation of 50 days

Bradley Elliott

¹Department of Biomedical Sciences, Faculty of Science and Technology, University of Westminster, London, UK.

Michelle Mina

^twoSection of Life Sciences, Faculty of Science and Technology, University of Westminster, London, UK.

Chrystalla Ferrier

ⁱⁱDepartment of Life Sciences, Faculty of Science and Technology, Academy of Westminster, London, UK.

Received 2022 Mar 24; Revised 2022 May 15; Accepted 2022 May 23.

Abstruse

A 34-year-old obese male person (96.8 kg; BMI, 30.2 kg m⁻¹) volitionally undertook a 50-solar day fast with the stated goal of losing body mass. During this fourth dimension, only tea, coffee, water, and a daily multivitamin were consumed. Severe and linear loss of torso mass is recorded during these l days (terminal 75.iv kg; BMI, 23.5 kg m⁻ⁱ). A surprising resilience to effects of fasting on activeness levels and physical function is noted. Plasma samples are suggestive of early harm of liver role, and perturbations to cardiovascular dynamics are too noted. One month post-obit resumption of feeding beliefs, body weight was maintained (75.0 kg; BMI, 23.iv kg one thousand^−ane). Evidence-based controlling with the fasting or hunger striking patient is express past a lack of testify. This instance written report suggests that total body mass, not mass lost, may be a key observation in clinical decision-making during fasting and starvation.

Keywords: astringent fasting, hunger strike, caloric restriction

Introduction

A 34–yr-old male presented for general examination on twenty-four hours 49 of a 50-mean solar day self-imposed fast, seeking approval to proceed his fasting beliefs. During this flow, the patient reported merely consuming water, tea, coffee (with no milk or sugar), and a daily multivitamin tablet (Centrum Operation; Pfizer).

Patient history prior to fasting beliefs revealed a family history of obesity and the presence of pathologies related to body mass. Personal history involved an oscillating mass between 85 and 134 kg over a 10-year menstruation. At the start of fasting, the patient reported torso mass every bit 96.8 kg, and 29.ii% body fat, as recorded by a personal bioelectrical impedance device. History post-obit the onset of fasting behavior was unremarkable, but included severe abdominal cramps between days vii and 21 of fasting, development and frequent occurrence of vasovagal syncope on transition from sitting to standing, and the well-nigh-abeyance of fecal motion. Eructation frequency was significantly increased. Self-reported physical activity and mobility was reduced, simply not prevented; this participant was not bedridden. Substantial water and java intake was noted (8–12 cups of coffee daily and 2–3 bottles of water daily). As expected, torso mass loss during fasting was severe and noticeable (Fig. 1).

One-year history of body mass.

Notes: Solar day 0 indicates start of fast. Open circles bespeak cocky-reported values, closed circles indicate laboratory recorded. Mass is given in kilogram.

Initial examination showed maintenance of motor and cranial nerve function. Resting metabolic rate (30 minutes past indirect calorimetry) was 1626 kcal twenty-four hour period^−ane. During the 30-minute rest period, ECG and blood pressure were monitored. Resting ECG appeared morphologically normal, patient was bradycardic (52 bpm) and notably hypertensive (150/78 mmHg). Body composition was measured by whole-body air deportation plethysmography (Bod Pod) as 19.8% body fat, while top was 180.9 cm and mass was 75.4 kg, with a BMI of 23.5 kg thousand^−ane, all recorded on calibrated laboratory devices. Sum of four skinfolds¹ was 30.0 mm, approximately half of that of a reference population of similarly aged males (62 ± 25 mm, aged 30–39). Information technology was visually noted that subcutaneous fat in the abdominal region was notwithstanding present, despite severe losses in the peripheral limbs, protruding ribs, and lack of prominent chest and shoulder musculature. A course 1/2 panniculus resulting from rapid intestinal adipose loss was present (Fig. 2). During a half-dozen-infinitesimal walk examination, this individual covered 342 thousand, which was below expected operation for a healthy male adult.ⁱⁱ A mild scoliosis was observed while walking; however, it is unclear if this is related to fasting.

Anterior and lateral view whilst standing. Twenty-four hour period 49 of fast.

Venous blood was taken for serum markers of metabolism, liver, and renal function. Results are given in Table i. Noteworthy findings include plasma glucose of three.1 mmol L⁻ⁱ and alkaline phosphatase of 36 U L⁻¹. Total bilirubin was xix µmol L⁻¹, direct bilirubin was vii µmol L^−one. Uric acrid was 620 µmol 50^−ane.

Table 1

Serum biochemical values at twenty-four hours 49 of fast and 28 days post cessation of fasting.

	DAY 49 OF FAST	28 DAYS POST RESUMPTION	UNITS
Albumin	49	44	m·L−1
Alkaline phosphatase	36*	42	U·50−ane
Alanine aminotransferase	34	19	U·Fifty−one
Aspartate aminotransferase	33	23	U·L−i
Calcium	ii·twoscore	2·xxx	mmol·50−1
Adapted calcium	2·22	2·22	mmol·L−i
Cholesterol	3·4*	3·7	mmol·L−ane
Creatinine	90	lxxx	µmol·L−i
Gamma-glutamyl transferase	24	27	U·L−1
Glucose	iii·1*	iv·0	mmol·L−1
HDL-cholesterol	1·fifty	ane·37	mmol·L−1
LDL-cholesterol	2·0	2·1	mmol·L−ane
Phosphate	ane·3	1·one	mmol·L−ane
Potassium	4·6	4·six	mmol·50−ane
Sodium	142	148	mmol·L−1
Full bilirubin	19	eighteen	µmol·L−one
Straight bilirubin	7·0*	iv⋅6*	µmol·50−1
Total protein	73	71	thousand·Fifty−1
Triglycerides	0·eight	0·5	mmol·L−1
Urea	2·3	3·4	mmol·L−1
Uric acid	620*	355	µmol·L−one

Urine was straw colored, lacked sediment, and was noticeably sugariness in aroma. Rapid dipstick analysis (Multistix 2161; Siemens) was negative for blood glucose, contained trace proteins, and indicated urine pH of below 5. Urine was highly ketonuric (>16 mmol 50⁻¹).

1 Month By Breaking of Fast

One month following initial presentation, the patient returned for follow-upwardly examination during which body composition, resting metabolic charge per unit, urine, and venous claret were recorded. Resumption of feeding initially involved liquids such as vege table soups, with the resumption of solid foods iii days following breaking of fast. Days three–5 involved one solid meal per twenty-four hours, with 2–3 solid meals during days five–7, and the resumption of three solid nutrient meals per day for 7 days following breaking of fast. In the following 23 days, diet was reported to be of caffeine and alcohol free, low carbohydrate (a piece of bread every 1–3 days), and high servings of fruit and vegetables. Self-estimation of diet by volume was twenty% animal poly peptide (chicken and fish) and eighty% fruit or vegetables; validated, quantifiable measures of intake and caloric content are not available. Heart rate remained bradycardic at rest (48 bpm), and blood pressure was notably reduced (132/78). Metabolic charge per unit was reduced (1413 kcal mean solar day^−ane), and body composition was unchanged (75.0 kg; BMI, 23.4 kg m⁻¹; 16.one% fat mass). Urinary ketones were reduced, merely not removed. Normal fecal movements were reported to begin seven days following resumption of feeding. Blood biochemistry returned to within normal range, with the exception of straight bilirubin (Table 1). The vi-minute walk test was repeated, and the patient covered 401 m.

Discussion

Clinical examinations and inquiry models reporting such severe starvation are absent in modern literature. Clear upstanding barriers preclude structured inquiry into the physiology of such stimuli. It is noteworthy, therefore, in this instance study that moderate concrete function appears maintained at solar day 49, every bit assessed past general observation and results of the six-minute walk test. Frommel et al.³ suggested that fasting in healthy lean individuals was well tolerated until 18% of body mass was lost; the patient reported here lost 20.7% of torso mass without substantial loss of part. Ane prior written report of long-term fasting in obese individuals for 30–xl days demonstrated body mass losses between ten.6% and 20.five%, just does non study on role of individuals.^iv It seems self-apparent and supported by this express evidence, such that the starting mass is a key variable in survival of extreme fasting, and not the amount of loss. This patient started fasting while obese and ended his fast when anthropometric variables were inside the targeted ranges for the general population. Indeed, amongst the few (nonpublished) examples of complete fasting and mortality,⁵ patients were frail between xxx and 50 days, and decease was noted to occur between days 43 and 70, which this example report has reached without obvious or pregnant frailty occurring. These findings were reported in nonoverweight individuals.

Current World Medical Association guidelines prioritize autonomy, recommending nonintervention in fasting to the point of impairment and/or expiry, if the patient makes a written informed statement of intent.⁵ Lack of research into this field precludes evidence-based conclusion-making or advice. In the limited light of this case written report and celebrated data of fasting in obesity,^four it is tempting to propose that guidelines to physicians for advice to the fasting private reflect body mass, and specifically mass of adiposity at start of fasting behavior. Survival in starvation is ultimately governed past physics, the calories available to maintain metabolic role. Availability of adipose tissue for metabolic usage may thus filibuster the catastrophic degradation of muscular protein, increasing survival time.

That said, small-scale fauna models reveal organ-specific effects of starvation, with loss of liver and gut size and function noted after only iv to 6 days.^vi Functional harm to digestive organs cannot be ruled out, and indeed, the elevated straight bilirubin is suggestive of reduced liver filtration. Of concern, straight bilirubin remained elevated thirty days mail breaking of fast. Elevated uric acid is likely due to reduced kidney filtration, every bit has been reported in caloric brake previously.^seven

Further, hypertension was an unexpected finding. This finding is counter to one of the few published examinations of cardiology in astringent starvation, where bradycardia and hypotension (~xx mmHg below fed country) were noted in juvenile pigs post-obit 29 days of complete starvation.⁸ The porcine heart contains several structural differences relative to the human, most related to bipedal vs. quadrupedal stance.^nine Equally frequent syncope was also noted in that our case study, information technology is plausible that dysregulated autonomic regulation of claret pressure underlies the observed hypertension. Blood pressure was measured in a supine position, increasing venous render in the man relative to standing position. Simple Frank–Starling mechanics combined with a failure of autonomic regulation may thus explain elevated blood pressure. Thus, it is tempting to advise that differences observed may be species dependent; however, this is highly speculative on a single case written report. Further, long-lasting cardiovascular deficits were noted in the in a higher place porcine model on refeeding, as well as chronically following experimental determination.⁸ As decease resulting from starvation often occurs via cardiovascular complications, this elevated claret force per unit area during fast is central to notation; this should be advisedly monitered in fasting individuals.

Caloric restriction and weight loss in overweight or obese individuals is often associated with subsequent regain of weight.^{10 , eleven} Having access to this case report 30 days following resumption of feeding was of interest due to a run a risk to examine any occurrence of such a rebound effect. It is of interest to note that this was not seen here; however, future gains in weight cannot exist ruled out.

Here, we report the maintenance of physical role of an private after 49 days of complete fast. This study does non signal support for such behavioral choices, and the projections of metabolic energy provision by starting adiposity assume no other perturbations to homeostasis, such every bit impaired allowed response, liver and renal function, or cardiovascular events. Such a voluntary behavioral choice is difficult to support.

Acknowledgments

The authors thank Dr. Louise Thomas for discussions regarding modeling of survival during astringent fasting.

Footnotes

ACADEMIC EDITOR: Athavale Nandkishor, Associate Editor

PEER REVIEW: Four peer reviewers contributed to the peer review written report. Reviewers' reports totaled ane,224 words, excluding any confidential comments to the academic editor.

FUNDING: Exist is supported by the Club for Endocrinology (UK). The authors ostend that the funder had no influence over the study design, content of the article, or choice of this journal.

COMPETING INTERESTS: Authors disembalm no potential conflicts of interest.

Paper subject to independent adept bullheaded peer review. All editorial decisions made past contained academic editor. Upon submission manuscript was subject to anti-plagiarism scanning. Prior to publication all authors have given signed confirmation of agreement to article publication and compliance with all applicable ethical and legal requirements, including the accuracy of author and contributor information, disclosure of competing interests and funding sources, compliance with ethical requirements relating to human being and creature study participants, and compliance with any copyright requirements of third parties. This journal is a member of the Committee on Publication Ethics (COPE).

Author Contributions

Conceived and designed the experiments: Be. Analyzed the data: Exist. Wrote the first typhoon of the manuscript: BE. Contributed to the writing of the manuscript: Exist, MM, CF. Agreed with manuscript results and conclusions: Exist, MM, CF. Jointly developed the structure and arguments for the paper: Exist, CF. Fabricated critical revisions and approved the final version: Be. All the authors reviewed and approved the final manuscript.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4982520/