A new F-word: FASTING – Love or Hate?

Next week is Ash Wednesday when the Christian fasting period called Lent begins.  I’ve never fasted.  It always seemed rather uncomfortable and difficult.  Until now I couldn‘t see any benefit and feel that managing AS I have enough to do.

The more I read and try things out, the more convinced I am that diet is important to my condition.  We know that AS is about 95% hereditary, so I couldn’t have stopped it breaking out.  But what I eat can maybe influence the progress of the disease, and most importantly how I feel on a day to day basis.  A good diet should also help to keep other health issues at bay, which result from chronic inflammation.

But not eating at all?!   NOT TOO SURE THAT I WANT TO STOP EATING ENTIRELY!

Beautiful organic lettuce
I love my lettuces – this one was grown organically in my garden!

So what is fasting all about?!  HERE IS WHAT I FOUND OUT

The first thing I found out is that I could fast in many different ways.  I could not eat for just 8-12 hours, which is called “interval fasting” and seems the same as eating early in the evening; or fast for perhaps as long as 3 weeks.  I could eat nothing at all, or just limit my diet, for instance to juices or fruits.

The second thing that I realised is that not only Christians of practically all denominations, but also every other leading wisdom tradition, such as Hindus, Muslims, Buddhists, Jews, observe fasting at certain ceremonies or times of the year.  These are traditions which have held for thousands of years, and are based on collective and accumulated knowledge.  Such customs are a spiritual practice but also often developed for practical reasons.  In Western Europe before global trade and industrial greenhouses, food was getting scarse by Spring, so there were good reasons to eat less!  But maybe there were health reasons for these practices too, which could not be scientifically proved, but were observed.  The ancient Greeks believed in fasting.  Indeed Hippocrates is quoted as saying: “Instead of using medicine, rather, fast a day.”

The third thing I found is that Western medicine does not advise fasting, particularly for people who suffer from serious chronic disease.  The fasting article in Wikipedia discusses fasting in religious practice at great length.  Medical applications are referred to only with reference to fasting before surgery or medical tests. 

Alternative medicine gets a one liner in Wikipedia: “Although practitioners of alternative medicine promote “cleansing the body” through fasting, the concept is quackery with no scientific basis for its rationale or efficacy.”

But the fourth thing is that I found an article on the effects of fasting on rheumatoid arthritis in the renowned medical journal “The Lancet” in 1991.  Its conclusion is: “Fasting is an effective treatment for rheumatoid arthritis, but most patients relapse on reintroduction of food.”  But then, after 7-10 days fasting, patients were put on gluten-free vegan and then lactovegetarian diets.  A control group ate an ordinary diet.  The final result: “The benefits in the diet group were still present after one year, and evaluation of the whole course showed significant advantages for the diet group in all measured indices.  This dietary regimen seems to be a useful supplement to conventional medical treatment of rheumatoid arthritis.”

Has this research on rheumatoid arthritis (RA) been followed up?  Yes, a bit!  I found an interesting article from 2014 called “Fasting: Molecular Mechanisms and Clinical Applications“, which states that the positive effects of fasting on RA have been supported by four differently controlled studies.  The authors write: “..for many [RA] patients able and willing to endure long-term fasting and to permanently modify their diet, fasting cycles would have the potential not only to augment but also to replace existing medical treatments.”

Is fasting really “quackery” as Wikipedia claims, or has not enough research been done to establish its value?  And what about the effects on AS?

My fifth thought comes from new knowledge gained in basic medical research.  A process which might have played a key role in the positive effects of fasting for patients with rheumatoid arthritis is Autophagy.  This is a sort of automatic biological cleaning programme.  The removal of waste products and old debris is essential for the cellular and organic fitness of any living organism.  Autophagy describes a fundamental process to degrade and recycle old cells, and then use them for new purposes or as a source of energy.  Yoshinori Ohsumi who discovered the processes and elucidated the basic mechanisms of how autophagy works, was awarded the Nobel Prize for Medicine in 2016 for his work.

Autophagy, as a recycling and cleaning act, is essential in many physiological processes.  It is triggered by the need to adapt to a lack of food caused by starvation or intentional fasting, but it is also a response to infection.  Furthermore, it is now known that mutations in autophagy genes can cause disease, and that the autophagic process is involved in several conditions including arthritis, cancer and neurodegenerative diseases.  But nobody yet understands how.So perhaps the view of fasting will change in the next years.  More research is needed to understand autophagy and how exactly it may be connected to arthritis.  We might  find out that autophagy could contribute to the treatment of diseases, perhaps even by fasting!

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