Therapeutic Fast Study

DanaDark

This thread is to discuss the study posted here:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2495396/pdf/postmedj00315-0056.pdf

I think it should be discussed as it has been going around as "proof" for stating you never enter "starvation mode". Disregarding the "starvation mode" argument, it is beneficial to analyze this study on its own merits as to prevent people from simply seeing it cited and assuming they can stop eating till they are their ideal weight.

Things I noticed in it that I found interesting were as follows

Patient: 456 pound male, 27 years of age, Height unspecified

1. The patient fasted for 382 days. No food.
---- This seems nearly impossible until I read up more.

2. The patient was given ample supplements
---- This offsets the onset of malnutrition. Malnutrition typically is the actual effect people have in VLCDs, not Starvation. This is specifically why the patient survived that many days without food. He got ALL of his nutritional needs through supplements. His caloric needs were obtained through fat stores.

3. Average weight loss was 0.72 pounds a day
---- This means he was spending roughly 2500 calories. This is significantly less than the estimated TDEE of 4100 (at 5 feet tall) to 4800 (6 feet tall). This means his daily energy use went down 52.1% to 60.9%. (This is assuming he led a sedentary lifestyle). I have argued before that protein is needed to repair damaged cells in the body and that it takes energy to do the repairs, in the form of calories. Given the patient no longer had protein intake, using only supplements for vitamins and minerals, it would make sense his energy expenditure would go down significantly due to the lack of protein.

4. Study indicates 5 examples of previous patients dying
---- 2 of the five died of ventricular failure while 1 died due to blockage in intestines, 1 died of acidosis during re-feed, and another died by unspecified causes related specifically to the fasting. This shows that this is an incredibly dangerous weight loss program.

The study concludes that while prolonged fasting under strict medical guidance can work, it is dangerous and should only be used as a last effort by the morbidly obese.



For those that are more scientifically inclined, I'd love to hear what you found interesting and/or took issue with in this study. It is definitely well worth the read.

CorvusCorax77

whoa. Well, I'll be honest that I didn't read it in depth. I just skimmed it becuase I'm on the job and I haven't much time right now... but my thoughts are this:

I wish there had been some tracking of his muscle mass. As you noted, his caloric expenditure went down, this probably also had to do with muscle mass being consumed by his body to function. Your body can't function on nothing. And i don't think it can function just on lipids.

They said five years after the study that he had the same low weight. That's great but he had to learn to live different. I think when it comes to risky stuff like starving yourself, i don't see why take that route when there is a non-risky solution. Like you said, a bunch of people died doing this.

This is kinda unrelated, but I think this guy is awesome sauce, and I can pretty much guarantee he ate well and exercised on his journey:
http://www.youtube.com/watch?v=qX9FSZJu448

Chief_Rocka

The "starvation mode" argument says that eating a low calorie diet will cause your metabolism to slow down to the point where weight loss becomes next to impossible. While it's true that metabolic rate does decrease in response to decreased calories, this study clearly demonstrates that there's no such thing as your metabolism slowing down to the point where a deficit cannot be reestablished by lowering caloric intake. Whether a particular low calorie amount is advisable on other grounds is a separate issue.

drmerc

again?

CorvusCorax77

well, here's my two cents:

When I didn't eat at all for 6 months (this really happened) while working out 2 hours a day, I weighed in at 125 and wore a size 11, and felt bad about myself.

Later I went up to 174.

Then i did 1200 + cals for 1.5 years and was about 135.

Then I started lifting heavy and watching my macros and eating 1300-1400 cals or so. I got down to 123 and a size 5 pants/dress, size 4 skirts, and could do chin ups for the first time in my life and felt amazing.

I think starvation isn't the way to go if you want to look good and feel good.