A Six-Week Follow-Up Study on the Sustained Effects of Prolonged Water-Only Fasting and Refeeding on Markers of Cardiometabolic Risk

Abstract

(1) Background: Chronic inflammation and insulin resistance are associated with cardiometabolic diseases, such as cardiovascular disease, type 2 diabetes mellitus, and non-alcoholic fatty liver disease. Therapeutic water-only fasting and whole-plant-food refeeding was previously shown to improve markers of cardiometabolic risk and may be an effective preventative treatment but sustained outcomes are unknown. We conducted a single-arm, open-label, observational study with a six-week post-treatment follow-up visit to assess the effects of water-only fasting and refeeding on markers of cardiometabolic risk. (2) Methods: Patients who had voluntarily elected and were approved to complete a water-only fast were recruited from a single-center residential medical facility. The primary endpoint was to describe changes to Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) scores between the end-of-refeed visit and the six-week follow-up visit. Additionally, we report on changes in anthropometric measures, blood lipids, high-sensitivity C-reactive protein (hsCRP), and fatty liver index (FLI). Observations were made at baseline, end-of-fast (EOF), end-of-refeed (EOR), and six-week follow-up (FU). (3) Results: The study enrolled 40 overweight/obese non-diabetic participants, of which 33 completed the full study protocol. Median fasting, refeeding, and follow-up lengths were 14, 6, and 45 days, respectively. At the FU visit, body weight (BW), body mass index (BMI), abdominal circumference (AC), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), low-density lipoprotein (LDL), hsCRP, and FLI were significantly decreased from baseline. Triglycerides (TG) and HOMA-IR scores, which had increased at EOR, returned to baseline values at the FU visit. (4) Conclusion: Water-only fasting and whole-plant-food refeeding demonstrate potential for long-term improvements in markers of cardiovascular risk including BW, BMI, AC, SBP, DBP, blood lipids, FLI, and hsCRP.

Prolonged Water-only Fasting is a Safe and Feasible Treatment Option for Managing Stage 1 and 2 Hypertension

“…This large reduction was observed even though 5/17 participants with stage 2 HTN on enrollment continued to have stage 2 HTN six weeks after the intervention. The reductions in BP correlate with the timing of the intervention and are in agreement with other studies, [12; 13; 15; 36; 37] setting a precedent for future randomized controlled trials. Results from the 12mFU visit are inconclusive due to participant dropout, but the median SBP remained below 130 mmHg and of the 6/17 participants who resumed anti-hypertensive medications, only one had SBP below 120 mmHg.…”

“…These data contribute to a growing body of evidence suggesting that medically supervised prolonged water-only fasting followed by whole-plant-food refeeding may be a safe and feasible treatment option for various health conditions, particularly obesity and hypertension. [12; 13; 15; 36; 37] Importantly, the fasting and refeeding intervention in this study was conducted in a residential setting using a protocol in which participants had access to medical support 24 hours per day and are individually examined twice daily to identify potentially serious complications. Even though the prolonged intervention takes place in a residential setting, participants reported that they found it to be highly acceptable and preferable to conventional treatment with anti-hypertensive medications.…”

“…Study dates overlapped with NCT04514146, conducted at the same fasting center, and 18/29 participants were co-enrolled in that study. [15]…”

“…This calculation was based on data simulated from a model with population effect sizes set as follows: −11.49 mmHg for EOF – BL, −14.58 mmHg for EOR – BL, −7.68 mmHg for 6wFU – BL, and −1.92 mmHg for 12mFU – BL. Since, Gabriel et al[15] did not include a 12mFU visit, the 12mFU effect size of −1.92 mmHg represents a 25% reduction from the 6wFU effect. Additional model parameters included 0.21 mmHg per year for age and 0.73 mmHg for sex.…”

Effects of Prolonged Fasting During Inpatient Multimodal Treatment on Pain and Functional Parameters in Knee and Hip Osteoarthritis: A Prospective Exploratory Observational Study

“…This may lessen mechanical load on the joints of the lower extremities, possibly contributing to pain reduction (59). Furthermore, lipid metabolism is improved by fasting (60). Even in patients with normal BMI, metabolic factors have shown to be associated with disease severity (61).…”