Sustain BP Health With Supervised Fasting

Alan Goldhamer, DC

Doing great.

Laurie Marbas, MD, MBA

Wonderful. Well, I’m excited to dive into the world of fasting because it’s been a huge topic, becoming more popular in recent years. Maybe we can get into the nuances of it, specifically, of course, around high blood pressure, but other health conditions as well. What are the physiological mechanisms by which fasting might influence blood pressure levels or any health condition in general?

Alan Goldhamer, DC

Well, yes, fasting has become more popular, particularly intermittent fasting, where people do it with limited feeding windows. What we’re doing is a little bit different because it’s prolonged, medically supervised water-only fasts where people are on water only for 5 to 40 days. During this period of prolonged water, only fasting, there is a big physiological adaptation that takes place, and there are a lot of changes that are occurring physiologically. One of the most obvious changes is that the primary source of your glucose changes to being fat, the set of specifically beta-hydroxybutyrate gases in the brain. Your brain’s your biggest burner of glucose, and it changes to the point where, by the end of the second week of fasting, the majority of calories are being burned as fat. That is a huge adaptation. This ketonic environment changes the body’s immune response. That affects the gut microbiome. It has effects on all kinds of downstream physiological adaptations, not the least of which is a natriuretic effect where the body selectively mobilizes excessive amounts of sodium and gets rid of them very much as a diuretic does only more powerfully. As the blood sodium levels drop and the excess sodium levels drop, the blood volume drops. As the blood volume drops, blood pressure normalizes, and congestive heart failure starts to ease. The non-healing wounds start to heal, as you see in diabetics; it’s just a profound change. 

Of course, the hypoglycemic response often associated with diabetes is also ameliorated because you’re going to a ketonic environment. The insulin resistance that’s associated with type 2 diabetes is profoundly affected. Insulin resistance is reduced. That’s why, as much as 80% of our type 2 diabetics, who butchered without medication after fasting. Now, of course, they still have to keep eating well to maintain the results or their problems will just recur. But fasting is a great filter. It’s like taking a corrupted hard drive on a computer, and you shut the computer off. When you turn it back on, you may not know exactly why, but things are starting to work again. That’s what happens to the body physiologically in fasting, whether it’s the sodium natriuretic effect or the alteration in the gut microbiome. 

You think about the five pounds of creatures living in your intestinal tract: the bacteria, the protozoa, the trillion-plus creatures—these living organisms that are swimming around inside you and eating, drinking, and defecating in you as we speak. Those organisms are profoundly reduced during fasting, and then when you feed after fasting, you can regrow the normal 10,000 strains of bacteria that are populating a healthy person’s gut rather than the altered microbiome that is dominating in people that are living on meat, fish, fowl, eggs, and dairy products, also on sugar. A big part of the reason why people are probably having difficulties with the standard American diet is because of its impact, not just on general toxicity that is endogenous, exogenous just poisons, but also on the organisms that play such a profound part in our immune system.

Laurie Marbas, MD, MBA

This is speaking to the prolonged fast. What is the difference between someone who can maybe be engaged in intermittent fasting and someone who can engage in prolonged fasting? There are things that we can see in either one.

Alan Goldhamer, DC

We also recommend intermittent fasting for everyone. We think everybody should fast every day for between 12 and 16 hours, depending on what their goals are. That means you’re limiting your feeding window to 8 hours a day, which means you don’t eat for 3 to 4 hours before you go to sleep. If you do that, you can burn the calories you eat. You don’t end up having to disrupt sleep quality by having to deal with digestion, urination, defecation, etc. during the evenings. That intermittent fasting is thought cumulatively, day after day after day, to have some of the same effects that long-term fasting has; it’s just something you can do on your own. You can do it safely; it doesn’t require modification of your existing medical management procedures, and it is a much gentler, safer, and milder intervention. But it doesn’t have the same profound effect that we see over a shorter period in long-term fasting. If you’re trying to break a tumor down, you’re trying to normalize insulin resistance, which can take weeks or months of careful feeding and intermittent fasting and can sometimes happen much more rapidly with water-only fasting. It’s a little bit more dramatic. I consider it much more entertaining.

Laurie Marbas, MD, MBA

What would you consider a prolonged fast?

Alan Goldhamer, DC

I think in 5 to 40 days, we don’t typically go longer than 40 days in our facility. We arbitrarily stop it there. The gentleman I trained with, Alec Burton, didn’t fast people over 40 days when I was there. He used to track people for 100 days or longer, and I asked him why he was no longer doing that. He said it was because of the sleep deprivation. I said I didn’t realize patients had more trouble sleeping on very long fasts. It was not that patient, it’s me! What happens is that after 40 days, you get into more and more physiological concerns, and whatever happens, you have to monitor it much more carefully. More things can go awry if you keep the fat short. What we consider short is up to 40 days. It’s a very safe process. We’ve had over 25,000 people now undergo fasting at TrueNorth Health. Of the 25,000 people that walked in, 25,000 people have walked out. We’ve published a fasting safety study that shows that fasting is, in fact, a safe process when using this protocol. But that means we don’t fast for over 40 days. Everybody has a proper history exam lab, and monitoring is examined twice a day by our staff doctors during their stay. It’s in a closed environment. They’re able to control their environment as well as the input and stresses on their system during the fasting process. When that’s done properly, it is a safe process, but that does not mean that only fast people are appropriate candidates for fasting. Not everybody is a candidate for fasting and the only way you can determine that is through history, an exam, and laboratory testing.

Laurie Marbas, MD, MBA

What would be an ideal candidate for someone to come to TrueNorth, for example?

Alan Goldhamer, DC

The people that we do the most work with are those who have high blood pressure, cardiovascular disease, type 2 diabetes, autoimmune disorders, and rheumatoid arthritis. I was inspired to add some asthma and eczema to these kinds of conditions and some types of cancer, including lymphoma. Those are what we’ve published outcome data on. In terms of conditions, conditions associated with dietary excess tend to respond well to fasting. Because fasting, exercise, and careful eating get rid of the consequences of dietary excess, and dietary excess is why these conditions develop. What happens is that people get fat, and they get a certain type of fat called visceral fat that produces inflammatory markers, like IL-1, 6, 8, 10, TNF-Alpha etc. That’s what causes cardiovascular disease, diabetes, autoimmune disease, and these forms of cancer. It’s not shocking that when you fast and get rid of the dietary excess and the visceral fat, these conditions reverse. We’ve published a study that shows that not only is visceral fat mobilized during fasting, but it’s preferentially mobilized during water-only fasting. The ratio of visceral fat to adipose tissue is 3 to 1. A person who goes on a 15-day fast loses 20% of their total body fat but 50% or more of their visceral fat. This particularly nasty type of material, visceral fat, is preferentially eliminated during water fasting. Again, you can get a lot of change in a short time. Then the downstream consequence in terms of disease modification is also apparent.

Laurie Marbas, MD, MBA

Is there any part of the fasting protocol that you’ve seen work better with hypertension that they all have to do for 10 or 12 days? Is there a particular number of days or anything? I’m curious about those.

Alan Goldhamer, DC

It’s an individual process, and it’s from 5 to 40 days, and you don’t know exactly how long is ideal until you see how the person responds to fasting. A very thin person whose BMI is, say, 17, wouldn’t be fasting as long as a person whose BMI is 35 or 50, depending on the resource. But it also depends on their micronutrient capacity, how well they maintain electrolytes, what their kidney function looks like, what other concomitant diseases are associated with it, and how well they do both physically and psychologically. Because people are addicts. They’re addicted to the artificial stimulation of doping in the brain, whether it’s heroin, cocaine, alcohol, or the chemicals added to food that make us fat, sick, and miserable. Those chemicals are salt, oil, and sugar. Salt, oil, and sugar are not foods. They’re chemicals added to food or hyper-concentrated food byproducts that are put back into food to stimulate dopamine production in the brain and make us feel good. But so you have to keep in mind that if you’re trying to change that, whether it’s quitting smoking, quitting drinking, or stopping eating salt with sugar, it’s going to be very difficult because at first you’re eating those substances; you’re taking those drugs to feel good, but eventually you have to keep taking them to avoid feeling very bad, which is the hallmark of addiction and withdrawal. When you stop eating only salt, sure, you’ll know it, and your brain will know it. it’s hard. It’s a tough business, and fasting makes that much easier for people who quit smoking. For example, during fasting, oftentimes within 48 hours, has no cravings. Alcohol withdrawal, heroin withdrawal, and cocaine withdrawal are greatly facilitated. Some people say, Well, that’s because you’re so miserable in fasting, and you don’t even think about the drugs and alcohol. That might be partially true, but mostly it’s because these metabolic products are processed much more rapidly during fasting. There’s a rapid detoxification of both endogenous and exogenous toxins from fasting.

Laurie Marbas, MD, MBA

How do you deal with the medication? Someone is coming in to, let’s say, do a fast-in. They’re on three blood pressure medications because that’s what it takes. How do you handle the medications? Like one of the first.

Alan Goldhamer, DC

The step is to get people on a vegan S.O.S.Free diet, and then within days, you have to withdraw medications. Otherwise, they’ll be crashing because people are not being medicated for their blood pressure; they’re being medicated for the diet they’re eating that causes them to sustain their blood pressure. The moment you change that diet, your blood pressure starts coming down. For most patients, we can have them weaned off medications within a few days. Then, once you start fasting, there’s a profound drop. You do not fast on these medications. Fasting on medications can be extremely dangerous because medications can be greatly potentiated during fasting. 

It’s also not necessary because the short-term issues with elevated blood pressure are relatively low-risk issues, and their blood pressure drops so rapidly during fasting that most people are below those hypertensive thresholds within a matter of days. But in our studies, we did a study with the Mayo Clinic looking at subjects for the treatment of hypertension. Although occasionally you’ll see people have a little rebound blip of blood pressure as they come off their medication, none of that in any of those patients didn’t last more than a day. All of those patients, of the 30 people that did the study—29 that completed the fasting—had normal blood pressure without medications. In a six-week follow-up, 28 to 29 had normal blood pressure. One person had to restore 50% of their doses of medication. 

What’s even more impressive is that we followed those people for one year. Where they were back home, free living. Of the people on follow-up, 75% of those people had maintained their weight loss their blood pressure, and their drug-free state. It shows you that not only can people get, well, fasting, but they’re also able to sustain the dietary changes and sustain normal blood pressure a year later. This is a no-brainer. These are highly motivated patients because they’re willing to fast. They’re not the people you drive off the street, but highly motivated people willing to do dangerous and radical things, eat well, exercise, and go to bed on time, they can normalize their blood pressure in almost every case. Those who are willing to maintain their diet and lifestyle can sustain those results indefinitely and without the medications that are causing them; chronic fatigue, impotence, and premature death.

Laurie Marbas, MD, MBA

That is pretty incredible. How many days? How long was it fast for these folks to go to 40 days? Or what was the average fast in your study?

Alan Goldhamer, DC

Ranges from 5 to 40 days, but the majority of people are fasting for 2 to 3 weeks.

Laurie Marbas, MD, MBA

To three weeks.

Alan Goldhamer, DC

Most people do not need to fast for 40 days. Most people wouldn’t be appropriate because they don’t have the reserves and capacity for that. However, a typical blood pressure patient comes in with hypertension and medications within a 2–3-week period of fasting or even has normal blood pressure without medication.

Laurie Marbas, MD, MBA

Got it.

Alan Goldhamer, DC

174 consecutive patients. We did this with T. Colin Campbell from Cornell. Of the 174 people with hypertension, 174 people achieved normal blood pressure without medication.

Laurie Marbas, MD, MBA

Meaning?

Alan Goldhamer, DC

The largest effects that have ever been shown in treating hypertension in humans have an average impact size of over 60 points in stage three hypertension.

Laurie Marbas, MD, MBA

Wow.

Alan Goldhamer, DC

Look, the point is, there is nothing that’s been shown to be more effective at normalizing high blood pressure in humans than water-only fasting, followed by a whole plant food S.O.S. free diet.

Laurie Marbas, MD, MBA

Excellent. What effect does fasting have on other cardiovascular risks,  cholesterol, and inflammation? What are you seeing there?

Alan Goldhamer, DC

During fasting, of course, the body generates an acute healing response. Inflammatory markers, as you would expect, go up. then when you follow it at six weeks post-fasting, not only do they normalize, but they reduce down to more normal levels. That’s where you also see tremendous benefits in autoimmune diseases and inflammatory conditions such as rheumatoid arthritis, ulcerative colitis, asthma, and eczema. These conditions respond profoundly to fasting. To the degree that people are willing to go on a whole plant-based diet, they’re often able to sustain those results after fasting. During fasting, it can be a very intense process because the body will experience chronic problems that will become acute as the body resolves them. In your acute phase, regular proteins will go up. Cholesterol, for example, will often go up in people as they mobilize cholesterol plaques in their vessels that go into the bloodstream temporarily. But then, if you look at the six weeks post-fasting, not only is it normalized, it’s often reduced dramatically, sometimes as much as 100 milligrams per day.

Laurie Marbas, MD, MBA

Wow. Is there any concern about muscle loss during prolonged fasting?

Alan Goldhamer, DC

Yes, we were so concerned about that because there were common concerns that people would atrophy. We did a study, and we brought in a DEXA scanner for two years. We monitored several patients before fasting, after fasting, and on follow-up. What we found was that when you go on a fast, you lose a bunch of weight, a pound in a day. On average, some of that is fat and visceral fat. Some of it’s water; some of it’s fiber, glycogen, and protein. Then, when you come off that fast, you gain a bunch of weight, but you do not gain fat. What you gain is lean tissue or water, glycogen, and fiber in your gut. 

When we looked at the patients’ weight loss and body composition changes six weeks after fasting, they lost substantial amounts of weight; they lost 20% of their fat, 55% of their visceral fat, and only 4% of their lean tissue. But that lean tissue was not only recovered by six weeks, but it was a higher proportion of their body to lean tissue was higher at six weeks. That professor, then was at baseline. The bone density had not changed, and the only thing that had been lost was fat and visceral fat. Water, fiber, and glycogen are the weights that come back after fasting, not fat, assuming you’re eating healthy. Now, if you went back on some greasy, slimy, dead, decaying flesh that Dr. Atkins diet type thing, you certainly could gain fat back. But if you’re eating a whole plant-based diet that’s free of salt and sugar, you will continue to lose weight until you reach your optimum weight.

Laurie Marbas, MD, MBA

Got it. Also, you said they’re being monitored medically. What are you looking for? Are there signs that someone should come off that fast or that they’re okay to continue? What exactly does that look like?

Alan Goldhamer, DC

First of all, we have a detailed medical history exam based on laboratory studies, and we’ve got electrolytes, liver function, kidney function, urinalysis, etc. Then we’re monitoring the patients twice a day. The doctors examine the patient, interview them, and take their vitals. We do appropriate lab and urine monitoring as well as other diagnostic testing as indicated. There are several things that we have to watch out for when fasting. Typically, the rate-limiting factors are electrolytes. We’re monitoring your electrolytes, including sodium and chloride, potassium, calcium, magnesium, etc. Then we’re also looking at liver and kidney function in general. You’re looking at our filtration rates and creatinine levels, making sure that the body is adapting to the fasting state appropriately. If things get outside our protocols, then we would either move on to broth and juices or terminate the fast-moving to refeeding. 

As I said, we’ve done this 25,000 times, including with very seriously ill patients. To date anyway, everybody that walks in walks out. We know we can do it safely. We’ve got a fasting safety study that looks at all the adverse events, what happens in fasting, and what’s anticipated. But it is important, for example, that people restrict fasting because if you’re too active, you will dramatically increase gluconeogenesis, which is the breakdown of protein. One of the reasons we avoid excess lean tissue loss is because we have people in a controlled setting and they’re resting. They’re not driving and running around, getting into trouble. You’re not taking medications while fasting. You have to have patients that you can stabilize off medications, and you’re monitoring patients appropriately so they don’t get dehydrated. Hydration is one of the critical issues in fasting. If a person becomes dehydrated and you’re more vulnerable to dehydration, fasting is better than feeding because you’re only consuming water. You’re not taking in outside electrolytes, etc. You have to count on recycling. If you were to be too energetic during fasting, you could become dehydrated. Dehydration, of course, is a really serious problem. We’re monitoring a person’s pulse—not only their pulse rate but also their pulse volume. We’re looking at their urine and their specific gravity. There are a lot of indications of physical hydration, not the least of which is the person’s ability to function and carry on in a controlled setting.

Laurie Marbas, MD, MBA

Exactly. Yes. I think the controlled setting pieces are so important.

Alan Goldhamer, DC

Then the most important part of fasting is refeeding. Too rapid a return to feeding after fasting can be very serious or fatal. There’s a process called re-feeding syndrome, in which people found out when they liberated the concentration camps that people had been starved, and then they rapidly fed the reef, relevant to them, and then they would get into serious problems like electrolyte balance, cardiac arrest, etc. The protocol must be followed before taking half the length of the fast with carefully controlled re-feeding to ensure that that doesn’t happen. No. In the 25,000 patients that we’ve fasted for up to 40 days, we’ve never had re-feeding syndrome. We know that using this protocol appears to be a way of avoiding that.

Laurie Marbas, MD, MBA

What does that protocol entail?

Alan Goldhamer, DC

We started with one day of fresh fruit and vegetable juices for every 7 to 10 days of fasting and one day of raw fruit and vegetables for every 7 to 10 days of fasting. Then we introduce steamed vegetables, and we introduce starchy vegetables. Then we introduce more concentrated foods. There’s never any meat, fish, fowl, eggs, dairy products, or all sorts of sugar used with these patients during or hopefully after the fast.

Laurie Marbas, MD, MBA

Got it. Okay.

Alan Goldhamer, DC

If they did a 20-day fast, it would take them about 10 days to get back to where they’d been, exclusively whole plant foods, so they have an S.O.S. free diet, ad libitum.

Laurie Marbas, MD, MBA

Okay, so you just start with the juices and then slowly go in.

Alan Goldhamer, DC

From there, more concentrated foods. Now there are some exceptions. If you have a patient with, say, ulcerative colitis, they may not handle raw fruit and vegetables. We may need to eat more steamed and starchy vegetables. But we still follow the principle, which is to keep look density low, allow people’s systems to gear up, and not let them overconsume so they get into refeeding syndrome or food shock. Post-fasting edema is another problem if people get into salty stuff. If they went out and ate a bunch of, say, V8 juice or a soup at a restaurant, they could get post-fast edema where they would hold fluid retention, their legs would swell, they could put themselves in, and they could just start to have problems. We avoid that by not giving people fluids that they shouldn’t be eating.

Laurie Marbas, MD, MBA

Well. Okay. Are there any populations or individual cases where fasting is an intervention, let’s say, for hypertension or anything else that would be contraindicated? Where do you go? What would you say? Nope, this is not going to work.

Alan Goldhamer, DC

Well, if you’re pregnant and lactating, you have to be very careful with fasting. You lose your milk production. It could be a significant problem. If you have genetic defects, MCAD, meaning medium-chain acyl-coenzyme A dehydrogenase deficiency. You wouldn’t go break down fatty acids, so you couldn’t fast because you have to go to break down fatty acids to get into fasting. If you have depletion or petechiae, where you have a depletion of micronutrients, that would be a problem because you wouldn’t be able to recycle them. If you don’t have enough to begin with, it’s a problem. If you have anorexia nervosa, you might want to fast, but that would not be a condition that’s going to be responsive to fasting if you have problems with cardiac instability. Try anticoagulant therapy. You had DVT, pulmonary embolism, and atrial fibrillation. You can’t just arbitrarily stop any prior therapy without the risk of throwing a clot, having a stroke, or having a heart attack. You can’t fast on those medications because they can become potentiated. 

For those people, you would have to do a different program, reduce fasting, use a modified feeding program, or get them healthy enough that you could stabilize their cardiac instability to the point where they no longer needed to be on any particular therapy. Then you could introduce fasting, but that might take weeks, months, or even years. If people are on heavy steroid therapy, for example, you can’t just stop steroids because you put them into failure. You have to wean them off that. That might again require a modified feeding regime. Some of our people have been here for weeks or months on a healthy eating program, which just gets them off their medications. 

Neuropsychiatric medications are no exception. People who are on certain intake inhibitor medications for long periods. If you just stop it, they’re going to get acute depression and anxiety because these drugs do brain damage and deactivate the D2 receptors in the brain. When you try to stop them, you get the very symptoms you’re trying to treat: acute depression and anxiety. They don’t tell you when they first started on these medications. But interested people, can read the book Anatomy of an Epidemic and learn all about how we’ve created an epidemic of mental illness around the use of Prozac. That’s creating problems far worse than what we’re trying to treat in some cases.

Laurie Marbas, MD, MBA

Well, thank you so much for joining us today. I hope you found our conversation insightful and engaging. If you’re a summit purchaser, stay right here because we’re about to continue our very captivating discussion, and if you’re not, click on the button below or the site and get access to the rest of the conversation. If you’re watching this, thank you for being a valuable member of our community. Let’s continue this question with Dr. Goldhamer. This has been great. Do you have any advice for someone who maybe can’t come to your center or go to a fasting center that they might want to try for up to five days on their own?

Alan Goldhamer, DC

Well, what we recommend for people is that they fast every day for 16 hours and then eat for 8 hours. If they’re going to extend that, then they still need to get a history exam and labs. They need to work with their doctor to make sure, one; that they’re a good candidate for fasting. Two; if they’re on medications, those medications are addressed appropriately, and number three, they have provisions for money because even shorter-term fasting can run into difficulties, particularly for people with health challenges. We do offer, though, that we have doctors on our staff who will work with the patient’s local doctor to provide remote fasting supervision when it’s appropriate. They can work with one of our doctors, Dr. Justin Wise, who can provide them with coaching. But they still need to have a local doctor who will provide a baseline lab exam and do the things you can’t do remotely. But that does work well for people who are good candidates for passing but don’t want to come to an inpatient facility but still want to benefit from it. They still have to rest. They still have to do everything right. They still have to be careful about refeeding and hydration. They still need to have appropriate support and monitoring. 

But unfortunately, I get a lot of calls from people who are well-intentioned but misguided. So they’re fasting, going into trouble because they fasted on medications, getting into a little healing crisis, and then they end up being hyperhydrated by some well-meaning but misguided physician in some emergency room somewhere, who doesn’t understand what they’re looking at because he’s not used to looking at fasting patients. For those patients, they can go to our website, healthpromoting.com, and complete the registration forms. I talk to them and give them a free phone conversation to discuss whether it’s appropriate. If it is, we can hook them up with either a local something closer to them if we’re too far away, or with one of our remote doctors who can work with them remotely.

Laurie Marbas, MD, MBA

Very good. Finally, I was just meant to ask questions. Given the increasing popularity of fasting for weight loss and metabolic health, how can medical professionals help guide them? What should they say, if doctors want to help or are interested? Where can they go? For more information?

Alan Goldhamer, DC

One thing they can do is go to our website at fasting.org, which is the fasting compendium site. All the research and literature on fasting have been collected. It’s all freely available. They can call me at any time. I’m happy to talk to any clinician who is interested in pursuing this. We have a residency training program for our health workers or doctors at no cost. We have, the foundation, provide them with room, board, and training at no cost to the doctor, where they can undergo training and learn how to fast effectively and use a whole plant food diet. We have a couple hundred doctors that have completed that training. That’s a great way of expanding your experience and getting a chance to do something that many doctors never get to do and that sees people get well. Most doctors will tell you they’ve been treating hypertension and diabetes their whole career, and they may never have seen anybody get well. Because under medical care, you never get well. They guarantee you’ll never get well because they say, Look, take these drugs; you will be on these drugs the rest of your life. I promise you, you do what you’re told. You’ll never recover. That’s true for diabetes, hypertension, and autoimmune diseases. That’s the standard of medical care. It’s giving drugs that don’t resolve the actual cause of the problem but manage some of the secondary symptoms. It’s a very different experience when you get people to make lifestyle changes so the body can heal itself.

Laurie Marbas, MD, MBA

Well, I echo everything you’re saying. It’s part of the joy of practicing using a whole-food, plant-based diet, and lifestyle medicine to see people get well. Thank you so much for your time today, Dr. Goldhamer. We’re excited for people to further look into the resources you have, and could you say that one more time? What were the two domains?

Alan Goldhamer, DC

Our primary website, TrueNorthHealth.com, will get them everything they need. On that website, they can link to fasting.org, which is the fasting compendium website, which contains research articles.

Laurie Marbas, MD, MBA

Awesome. Perfect. Thank you again, everyone, for listening, and looking forward to the next conversation.