APPENDIX B
FASTING: A PRACTICAL GUIDE
FASTING IS DEFINED as the voluntary act of withholding food for a specific period of time. Non-caloric drinks such as water and tea are permitted. An absolute fast refers to the withholding of both food and drink. This may be done for religious purposes, such as during Ramadan in the Muslim tradition, but is not generally recommended for health purposes because of the accompanying dehydration.
Fasting has no standard duration. Fasts can range from twelve hours to three months or more. You can fast once a week or once a month or once a year. Intermittent fasting involves fasting for shorter periods of time on a regular basis. Shorter fasts are generally done more frequently. Some people prefer a daily sixteen-hour fast, which means that they eat all their meals within an eight-hour window. Longer fasts are typically twenty-four to thirty- six hours, done two to three times per week. Prolonged fasting may range from one week to one month.
During a twenty-four-hour fast, you fast from dinner (or lunch or breakfast) the first day until dinner (or lunch or breakfast) the next day. Practically, this means missing breakfast, lunch and snacks on the fasting day and only eating a single meal (dinner). Essentially, you skip two meals as you fast from 7:00 p.m. to 7:00 p.m. the next day.
During a thirty-six-hour fast, you fast from dinner on the first day until breakfast two days later. This means missing breakfast, lunch, dinner and snacks for one entire day. You would be skipping three meals as you fast from 7:00 p.m. the first day to 7:00 a.m. two days later. (See appendix A for sample meal plans and fasting protocols.)
Longer fasting periods produce lower insulin levels, greater weight loss and greater blood sugar reduction in diabetics. In the Intensive Dietary Management Clinic, we will typically use a twenty-four-hour or thirty-six- hour fast two to three times per week. For severe diabetes, patients may fast for one to two weeks, but only under close medical supervision. You may take a general multivitamin if you’re concerned about micronutrient deficiency.
What can I take on fasting days?
ALL CALORIE-CONTAINING FOODS and beverages are withheld during fasting. However, you must stay well hydrated throughout your fast. Water, both still and sparkling, is always a good choice. Aim to drink two liters of water daily. As a good practice, start every day with eight ounces of cool water to ensure adequate hydration as the day begins. Adding a squeeze of lemon or lime flavors the water. Alternatively, you can add some slices of orange or cucumber to a pitcher of water for an infusion of flavor, and then enjoy the water throughout the day. You can dilute apple-cider vinegar in water and then drink it, which may help with your blood sugars. However, artificial flavors or sweeteners are prohibited. Kool-Aid, Crystal Light or Tang should not be added to the water.
All types of tea are excellent, including green, black, oolong and herbal. Teas can often be blended together for variety, and can be enjoyed hot or cold. You can use spices such as cinnamon or nutmeg to add flavor to your tea. Adding a small amount of cream or milk is also acceptable. Sugar, artificial sweeteners or flavors are not allowed. Green tea is an especially good choice here. The catechins in green tea are believed to help suppress appetite.
Coffee, caffeinated or decaffeinated, is also permitted. A small amount of cream or milk is acceptable, although these do contain some calories. Spices such as cinnamon may be added, but not sweeteners, sugar or artificial flavors. On hot days, iced coffee is a great choice. Coffee has many health benefits, as previously detailed.
Homemade bone broth, made from beef, pork, chicken or fish bones, is a good choice for fasting days. Vegetable broth is a suitable alternative, although bone broth contains more nutrients. Adding a good pinch of sea salt to the broth will help you stay hydrated. The other fluids—coffee, tea and water—do not contain sodium, so during longer fasting periods, it is possible to become salt-depleted. Although many fear the added sodium, there is far greater danger in becoming salt depleted. For shorter fasts such as the twenty-four- and thirty-six-hour variety, it probably makes little difference. All vegetables, herbs or spices are great additions to broth, but do not add bouillon cubes, which are full of artificial flavors and monosodium glutamate. Beware of canned broths: they are poor imitations of the homemade kinds. (See here for a bone broth recipe.)
Be careful to break your fast gently. Overeating right after fasting may lead to stomach discomfort. While not serious, it can be quite uncomfortable. Instead, try breaking your fast with a handful of nuts or a small salad to start. This problem tends to be self-correcting.
I get hungry when I fast. What can I do?
THIS IS PROBABLY the number one concern of fasters everywhere. People assume they’ll be overwhelmed with hunger and unable to control themselves. The truth is that hunger does not persist, but instead comes in waves. If you’re experiencing hunger, it will pass. Staying busy during a fast day is often helpful. Fasting during a busy day at work keeps your mind off eating.
As the body becomes accustomed to fasting, it starts to burn its stores of fat, and your hunger will be suppressed. Many people note that as they fast, appetite does not increase, but rather starts to decrease. During longer fasts, many people notice that their hunger completely disappears by the second or third day.
There are also natural products that can help suppress hunger. Here are my top five natural appetite suppressants:
1. Water: As mentioned before, start your day with a full glass of cold water. Staying hydrated helps prevent hunger. (Drinking a glass of water prior to a meal may also reduce hunger.) Sparkling mineral water may help for noisy stomachs and cramping.
2. Green tea: Full of antioxidants and polyphenols, green tea is a great aid for dieters. The powerful antioxidants may help stimulate metabolism and weight loss.
3. Cinnamon: Cinnamon has been shown to slow gastric emptying and may help suppress hunger.1 It may also help lower blood sugars and therefore is useful in weight loss. Cinnamon may be added to all teas and coffees for a delicious change.
4. Coffee: While many assume that caffeine suppresses hunger, studies show that this effect is likely related to antioxidants. Both decaffeinated and regular coffee show greater hunger suppression than caffeine in water.2 Given its health benefits (see chapter 19), there is no reason to limit coffee intake. The caffeine in coffee may also raise your metabolism further boosting fat burning.
5. Chia Seeds: Chia seeds are high in soluble fiber and omega 3 fatty acids. These seeds absorb water and form a gel when soaked in liquid for thirty minutes, which may aid in appetite suppression. They can be eaten dry or made into a gel or pudding.
Can I exercise while fasting?
ABSOLUTELY. THERE IS no reason to stop your exercise routine. All types of exercise, including resistance (weights) and cardio, are encouraged. There is a common misperception that eating is necessary to supply “energy” to the working body. That’s not true. The liver supplies energy via gluconeogenesis. During longer fasting periods, the muscles are able to use fatty acids directly for energy.
As your adrenalin levels will be higher, fasting is an ideal time to exercise. The rise in growth hormone that comes with fasting may also promote muscle growth. These advantages have led many, especially those within the bodybuilding community, to take a greater interest in deliberately exercising in the fasted state. Diabetics on medication, however, must take special precautions because they may experience low blood sugars during exercise and fasting. (See “What if I have diabetes?” for recommendations, on page 262.)
Will fasting make me tired?
IN OUR EXPERIENCE at the Intensive Dietary Management Clinic, the opposite is true. Many people find that they have more energy during a fast—probably due to increased adrenalin. Basal metabolism does not fall during fasting, but rises instead. You’ll find you can perform all the normal activities of daily living. Persistent fatigue is not a normal part of fasting. If you experience excessive fatigue, you should stop fasting immediately and seek medical advice.
Will fasting make me confused or forgetful?
NO. YOU SHOULD not experience any decrease in memory or concentration. On the contrary, the ancient Greeks believed that fasting significantly improved cognitive abilities, helping the great thinkers attain more clarity and mental acuity. Over the long term, fasting may actually help improve memory. One theory is that fasting activates a form of cellular cleansing called autophagy that may help prevent age-associated memory loss.
I get dizzy when I fast. What can I do?
MOST LIKELY, YOU’RE becoming dehydrated. Preventing this requires both salt and water. Be sure to drink plenty of fluids. However, the low salt intake on fasting days may cause some dizziness. Extra sea salt in broth or mineral water often helps alleviate the dizziness.
Another possibility is that your blood pressure is too low—particularly if you’re taking medications for hypertension. Speak to your physician about adjusting your medications.
I get muscle cramps. What can I do?
LOW MAGNESIUM LEVELS, particularly common in diabetics, may cause muscle cramps. You may take an over-the-counter magnesium supplement. You may also soak in Epsom salts, which are magnesium salts. Add a cup to a warm bath and soak in it for half an hour. The magnesium will be absorbed through your skin.
I get headaches when I fast. What can I do?
AS ABOVE, TRY increasing your salt intake. Headaches are quite common the first few times you try a fast. It is believed that they’re caused by the transition from a relatively high-salt diet to very low salt intake on fasting days. Headaches are usually temporary, and as you become accustomed to fasting, this problem often resolves itself. In the meantime, take some extra salt in the form of broth or mineral water.
My stomach is always growling. What can I do?
TRY DRINKING SOME mineral water.
Since I’ve started fasting, I experience constipation. What can I do?
INCREASING YOUR INTAKE of fiber, fruits and vegetables during the non-fasting period may help with constipation. Metamucil can also be taken to increase fiber and stool bulk. If this problem continues, ask your doctor to <