Tag: fasting | Living with Spondyloarthritis

“You’ve got to be kidding!” said my friend Jeannie about my plan to climb the Eiger over the Mittellegi ridge. Or maybe she thought that I was mad. After all, I have suffered from severe Spondyloarthritis and moderately severe Inflammatory Bowel Disease for decades.

However, the medication I take has a huge positive effect on my quality of life and makes such a mad plan thinkable. But there is a big difference between feeling ok, with bearable pain and being able to manage to get through the day, and feeling really, really fit and strong and confident. And that is the change in the last two years since I became aware of the power of “lifestyle medicine”.

Changes in my lifestyle have transformed my life and made it possible for me – a 60 year old woman with chronic illness – to climb the Eiger. I want to share my experience. Maybe my learnings will be useful for others. But please remember, I’m not a doctor and this is not medical advice. Everybody is different. Try things out, get professional support if you can, and observe carefully what works for you!

If you get to the end of this blog there is a slide show of the Eiger tour!

What is lifestyle medicine?

According the American College of Lifestyle Medicine, it uses evidence-based practice to help people adopt and sustain healthy behaviour that affects health and quality of life. Some Lifestyle health factors are now well-established: don’t smoke; keep your weight under control; exercise regularly. But the benefits of taking these lifestyle changes even further don’t seem to be recommended by most doctors. Perhaps they aren’t proven enough, or not well-known, or not believed in. For whatever reasons, these are all things that I have found out more or less for myself.

Lifestyle medicine focuses on sleep, nutrition, exercise, and stress reduction.

Sleep

Worries, overwork or medication have all affected my ability to get a good nights’ sleep in recent years. Many people know what a problem insomnia can be, and how lack of regular sleep can affect well-being, and how great it is to get a good night’s sleep. One source of support has been from Dr. Guy Meadows and his approach called ACT (Acceptance and Commitment Therapy). At the Sleep School he teaches how to overcome insomnia by observation and acceptance. It often works for me. Trying to control my fears and anxieties in this way matches my approach to Stress Reduction through meditation and mindfulness (see below).

However, the most important factor affecting my sleep is nutrition, which I will explain in more detail.

Nutrition

I’ve been watching carefully what I eat for some time, and have reported my experience in a previous blog called Am I really what I eat? I am still following the recommendations that I received from dieticians, and eat a Mediterranean diet with lots of fruit and vegetables. Now I can’t imagine eating any other way. It’s delicious!

But what about eating less or less often? My first thoughts and impressions about Fasting were A new F-word: FASTING – Love or Hate? Since starting interval fasting in August 2019, I believe that it has had a huge effect on my well-being!

There has been a lot written about diet as a factor in controlling inflammatory diseases, but what I have discovered in the last 6 months or so, is that it is just as important when I eat, as what I eat. Interval fasting has made a real difference to my sensitive gut, and I believe that reducing intestinal irritation, or even inflammation in my gut affects my whole well-being and may even have contributed to reducing inflammation in my back and joints. For over 6 months now, I generally eat my last meal by 6pm in the evening, and fast for 16 hours, meaning that I have a herb tea in the morning and then a delicious breakfast with coffee, fruit, whole grain muesli and yogurt sometime after 10am.

Dr Satchidananda Panda of the Salk Institute of Biological Sciences in California explores the circadian rhythm, and how this cycle of functions, which repeat themselves over 24 hours, affects our performance, mood and overall health. The best-known example is the sleep cycle. Dr. Panda believes that the benefit of sleep for the brain in the circadian rhythm is just the tip of the iceberg. Other organs have a circadian rhythm and also need time to rest and recuperate, such as the digestive system. The circadian clock may even mediate the immune system. He has tested the benefits of fasting extensively over the last 20 years and believes that every cell in our body has its own circadian clock. Every hormone, neurotransmitter, gene in our body has times when it functions best, and times when it needs to rest, repair, and reset. The circadian clock is not just linked to sleeping, but also to eating and exercising. So, it’s important not just to sleep at the right time, but also to eat at the right time.

His first results were with mice who were given a set “Western” diet. One group could only eat within a limited time window of 8 hours. The other could eat exactly the same amount of food, but without any time restrictions. After a few weeks, the mice who fasted 16 hours a day were much slimmer, more energetic and generally healthier than the mice who could eat or snack all day. In the last 5 years he has extended his research to thousands of human volunteers, who monitor their eating habits. The results indicate that similar results can improve the well-being of people. Apart from weight loss, improved mood, better sleeping, trial participants report other benefits such as reduced joint pain and inflammation. Dr. Panda explains his work in the BBC podcast Don’t tell me the score.

This seems entirely plausible to me, because the effect of interval fasting in the last months on my digestion and thus on my general well-being has been nothing less than dramatic. Through fasting I give my digestive system a period of down time when it doesn’t have to digest new food and can rest and repair. I can feel how my gut is more relaxed, how much better I can sleep, and how energised I am. For somebody who has suffered from a leaky gut and chronic inflammation for decades, this is a real gift for me.

If you understand the science (which sadly I am not trained in), then this work is summarized here: Mattson MP, Allison DB, Fontana L, Harvie M, Longo VD, Malaisse WJ, Mosley M, Notterpek L, Ravussin E, Scheer FA, Seyfried TN, Varady KA, Panda S. Meal frequency and timing in health and disease. Proc Natl Acad Sci U S A. 2014 Nov 25;111(47):16647-53. doi: 10.1073/pnas.1413965111. Epub 2014 Nov 17. PMID: 25404320; PMCID: PMC4250148.

Getting fit

To keep my spirits up during Lockdown I made a plan “5 tips to manage your day” which included daily exercise. I used an online fitness programme with a huge of variety of options from stretching and yoga through Pilates to PIIT (professional intensive interval training!). It was amazing how doing this every morning for several months made me fitter than I could ever have imagined, despite never going far from my own house, let alone to the mountains.

Stress Reduction

The key to stress reduction for me is a few minutes of mindfulness or meditation before starting the day. Collecting my thoughts and intentions by keeping a journal also helps. If you are interested in this topic, I reflected on Stress Reduction in a previous blog, the Lockdown.

Putting it all together to climb the Eiger!

These practices all help disease management and improve my well-being. It’s a gradual process. It has taken months for lifestyle changes to translate into improved well-being. Discoveries have been a process of trial and error. No clinician has advised me to adopt these practices. I have had to sort through the available material and decide myself what is quackery and what is responsible advice. If I’m not sure about a theory, I check if the author of recommendations has been willing to expose his or her ideas to scrutiny by publishing them. If there are no recent publications on PubMed, then I’m sceptical about whether the work is serious, and discard it.

There needs to be much more research to provide evidence-based, mainstream recommendations for the benefit of all patients. The Spondylitis Association of America recently published an excellent webinar on lifestyle healthcare, but otherwise it’s hard to find trustworthy information. I believe that if healthcare research were more centred on patients well-being, rather than being driven by commercial considerations or personal aspirations, these areas would be given much higher priority.

Above all, I believe that without all these lifestyle changes…. I never, ever, could have climbed the Eiger at the age of 60!

Here is the Eiger tour in pictures – enjoy!

The whole Eiger tour from the tiny hut on the right to the descent to the left
Ascent to the hut (1)
Ascent to the hut (2)
Arrival at Mittellegi hut
Sundown before the tour
Climbing at daybreak (Photo: J. Zaccaron)
Two more climbers were behind us
Wonderful rock
Warm sunshine at last
Grindelwald below to the right
The glaciers of the Aletsch UNESCO World Heritage Site below to the left
Climbing, climbing (J. Zaccaron)
Much narrower than that: the thinnest snow ridge ever (J. Zaccaron)
Summit after 4 hours!
South: Ewigschneefäld (Eternal snow field)
North: Looking towards Bern
East: Schreck- and Finsteraarhorn
West: Mönch, and Mont Blanc in the distance
Looking down
Walking down (J. Zaccaron)
Abseiling down
Sometimes going up again (J. Zaccaron)
The glacier is getting closer
Last steps to the hut
View of the ridge on the train ride home

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!