Why should fasts lasting longer than 24 hours and particularly for three or more days only be done under the supervision of a health professional and preferably in a live-in clinic? 
 
Fasting for a week or two can actually interfere with the loss of body fat, as shown at the start of my video Is Fasting for Weight Loss Safe?. But, eventually, after the third week of fasting, fat loss starts to overtake the loss of lean body mass in obese individuals, as seen in the graph below and at 0:14 in my video. Is it safe to go that long without food? 

Proponents speak of fasting as a cleansing process, but some of what is being purged from our bodies are essential vitamins and minerals. People who are heavy enough can fast up to 382 days without calories, but no one can go even a fraction of that long without vitamins. Scurvy, for example, can be diagnosed within as few as four weeks without any vitamin C. Beriberi, deficiency of thiamine (vitamin B1), may start even earlier in fasting patients. And, once it manifests, it can result in brain damage within days, which can eventually become irreversible.  
 
Even though fasting patients report problems such as nausea and indigestion after taking supplements, all of the months-long fasting cases I’ve discussed previously were given daily multivitamins and mineral supplementation as necessary. Without supplementation, hunger strikers and those undergoing prolonged fasts for therapeutic or religious purposes (like the Baptist pastor hoping “to enhance his spiritual powers for exorcism”) have ended up paralyzed, become comatose, or worse. 
 
Nutrient deficiencies aren’t the only risk. After reading about all of the successful reports of massive weight loss from prolonged fasting in the medical literature, one doctor decided to give it a try with his patients. Of the first dozen he tried it on, two died. In retrospect, the two patients who died had started out with heart failure and had been on diuretics. Fasting itself produces pronounced diuresis, meaning loss of water and electrolytes through the urine, so it was the combination of fasting on top of the water pills that likely depleted their potassium and triggered their fatal heart rhythms. The doctor went out of his way to point out that both of the people who died started out “in severe heart failure, complicated by gross obesity; but both had improved greatly whilst undergoing starvation therapy.” That seems like a small consolation since they were both dead within a matter of weeks. 
 
Not all therapeutic fasting fatalities were complicated by concurrent medication use, though. One researcher writes: “At first he did very well and experienced the usual euphoria…His pulse, blood pressure, and electrolytes remained satisfactory, but in the middle of the third week of treatment, he suddenly collapsed and died. This line of treatment is certainly tempting because it does produce weight loss and the patient feels so much better, but the report of case-fatalities”—the whole part about killing people—“must make it a very suspect line of management.” 
 
Contrary to the popular notion that the heart muscle is specially spared during fasting, the heart appears to experience similar muscle wasting. This was “described in the victims of the Warsaw ghetto” during World War II in a remarkable series of detailed studies carried out by the ghetto physicians before they themselves succumbed. In a case entitled “Gross Fragmentation of Cardiac Fiber After Therapeutic Starvation for Obesity,” a 20-year-old woman successfully “achieved her ideal weight” after losing 128 pounds by fasting for 30 weeks. “After a breakfast of one egg,” she had a heart attack and died. On autopsy, as you can see below and at 3:44 in my video, the muscle fibers in her heart showed evidence of widespread disintegration. The pathologists suggested that fasting regimens “should no longer be recommended as a safe means of weight reduction.” 
Breaking the fast appears to be the most dangerous part. After World War II, as many as one out of five starved Japanese prisoners of war tragically died following liberation. Now known as “refeeding syndrome,” multiorgan system failure can result from resuming a regular diet too quickly. This is because there are critical nutrients such as thiamine and phosphorus that are used to metabolize food. Therefore, in the critical refeeding window, if too much food is taken before these nutrients can be replenished, demand may exceed supply. Whatever residual stores you still carry can be driven down even further, with potentially fatal consequences. This is why rescue workers are taught to always give thiamine before food to victims who have been trapped or otherwise unable to eat. Thiamine is responsible for the yellow color of “banana bags,” a term you might have heard used in medical dramas to describe an IV fluid concoction often given to malnourished alcoholics to prevent a similar reaction. (You can see a photo of them below and at 4:53 in my video.) Anyone “with negligible food intake for more than five days” may be at risk of developing refeeding problems. 
Medically-supervised fasting has gotten much safer now that there are proper refeeding protocols. We now know what warning signs to look for and who shouldn’t be fasting in the first place, such as those who have advanced liver or kidney failure, porphyria, uncontrolled hyperthyroidism, and pregnant and breastfeeding women. The most comprehensive safety analysis of medically supervised, water-only fasting was recently published by the TrueNorth Health Center in California. Out of 768 visits to its facility for fasts up to 41 days, were there any adverse events? There were 5,961 of them! Most of these were mild, known reactions to fasting, such as fatigue, nausea, insomnia, headache, dizziness, upset stomach, and back pain. Only two serious events were reported, and no fatalities. You can see the chart below and at 5:58 in my video. 
“Fasting periods lasting longer than 24 hr, and particularly those lasting 3 or more days, should be done under the supervision of a physician and preferably in a [live-in] clinic.” In other words, don’t try this at home! This is not just legalistic mumbo-jumbo. For example, normally, your kidneys dive into sodium conservation mode during fasting, but should that response break down, you could rapidly develop an electrolyte abnormality that may only manifest with non-specific symptoms, like fatigue or dizziness, which could easily be dismissed until it’s too late. 
 
The risks of any therapy must be premised on the severity of the disease. The consequences of obesity are considered so serious that effective therapies could have “considerable acceptable toxicity.” For example, many consider major surgery for obesity to be a justifiable risk, but the keyword is effective. 
 
Therapeutic fasting for obesity has largely been abandoned by the medical community not only because of its uncertain safety profile but its questionable short- and long-term efficacy. Remember, for a fast that only lasts a week or two, you might be able to lose as much body fat or even more on a low-calorie diet than a no-calorie diet. 
 
Fasting for a week or two can actually interfere with the loss of body fat. For more background on this, see Is Fasting Beneficial for Weight Loss? and Benefits of Fasting for Weight Loss Put to the Test.
 
If you’re wondering what the best way to lose weight is, I wrote a whole book about it! Check out How Not to Diet. 
 
Interested in learning more about fasting? See related videos below. 

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Like the keto diet, fasting for one or two weeks can actually slow the loss of body fat rather than accelerate it. 

Fasting obviously causes consistent, dramatic weight loss, as shown in the graph below and at 0:09 in my video Is Fasting Beneficial for Weight Loss?, but how do fasted individuals do long-term? Some research groups reported “extremely disappointing long-term effects,” as you can see in the graph below and at 0:19 in my video. 

Average subjects started at about 270 pounds and, in the six months before the fast, continued to gain weight as obese persons tend to do. After 24 days of “inpatient starvation,” they experienced a dramatic 27-pound weight loss. Then, what do you think happened?

They gained it all back and more, though one could argue if they had not fasted, they might have weighed even more at that point, as seen in the graph below and at 0:45 in my video. 
In another study with follow-ups ranging up to 50 months, only 4 out of 25 “superobese” patients achieved even partial sustained success. Based on these kinds of data, some investigators “concluded that complete starvation is of no value in the long-term treatment of obese patients.” 
 
Other research teams reported better outcomes. One series with about 100 individuals found that 60 percent retained at least some weight loss at follow-up or even continued losing. The follow-up periods varied from 1 to 32 months with no breakdown as to who fasted and for how long, though, making the data hard to interpret. In another study, 62 patients were down an average of 16 pounds after fasting for 10 days. After one year, 40 percent of the group had retained at least 7 pounds of that weight loss. 
 
As you can see below and at 1:37 in my video, when you put together six such studies, hundreds of obese subjects fasted for an average of 44 days and lost an average of 52 pounds. And, around one or two years later, 40 percent retained at least some of that weight loss. So, most gained back all of the weight they had lost, but 40 percent is extraordinary for a weight-loss study. 

Following a hundred obese individuals getting treated at a weight-loss clinic with a standard low-calorie diet, researchers found that only one out of a hundred lost more than 40 pounds and only about one in ten lost even 20 pounds, with overall successful weight maintenance at only two patients over two years, as seen below and at 2:08 in my video. That’s why having a control group is so important. What may look like a general failure may actually be a relative success compared to more traditional weight-loss techniques. 

Researchers new to the field may find it “clearly disappointing” that the “overall results of follow-up for 12 months or more” found that “two-thirds of the patients were ‘failures’ and more than one-third actually regained all the weight lost.” But, 12 percent were labeled successes, maintaining 59 pounds of weight loss two years later. As you can see in the graph below and at 2:42 in my video, the subjects lost massive amounts of excess weight and kept it off. 

In a direct comparison of different weight-loss approaches at the same clinic, five years after initiating a conventional low-calorie approach, only about one in five was down 20 pounds compared to nearly half in the group who instead had undergone a few weeks of fasting years previously. By year seven, as you can see in the graph below and at 3:03 in my video, most of those instructed on daily caloric restriction were back up to their original weight or had even exceeded it, but that was only true for about one in ten in the fasted group. In an influential paper in the New England Journal of Medicine on seven myths about obesity, fallacy number three was identified as: “Large, rapid weight loss is associated with poorer long-term weight-loss outcomes, as compared with slow, gradual weight loss.” In reality, the opposite is true. The hare may end up skinnier than the turtle.  

As shown in the graph below and at 3:39 in my video, researchers set up a study comparing the sustainability of weight loss at three different speeds: six days of fasting, three weeks on a very-low-calorie diet of 600 calories a day, or six weeks on a low-calorie diet of 1,200 calories a day. 

The question is: What happened a year later? At one year, the fasting group was the only one that sustained a significant loss of weight, as you can see below and at 3:55 in my video. 

What happened nine years later? “Therapeutic Fasting in Morbid Obesity” is the largest, longest follow-up study I could find. At least some of the fast-induced weight losses were maintained a year later by the great majority. After one year, 90 percent remained lighter than they had started, but after two years, three years, four years, and seven years, fewer and fewer patients maintained their weight loss. By nine years later, that number dropped to fewer than one in ten. By then, almost everyone had regained the weight they had initially fasted away, as you can see in the graph below and at 4:17 in my video. “Many patients thought that the temporary loss was worth the effort,” though. As a group, they had lost an average of about 60 pounds. They described improved health and quality of life and claimed that “reemployment was facilitated and earnings increased” during that period of time. But the fasting didn’t appear to result in any permanent change in eating habits for the vast majority. 
The small minority for whom fasting led to sustainable weight loss “all admit to a radical change in previous eating habits”; indeed, fasting only works long-term if it can act as a jumpstart to a healthier diet. In a retrospective long-term comparison of weight reduction after an inpatient stay at a naturopathic center, those who fasted lost more weight at the time, but they were back to the same weight at around seven years, as you can see in the graph below and at 5:14 in my video. 

It’s no surprise since most reported returning to the same diet they had been on before. However, those who were placed instead on a healthier, more whole food, plant-based diet were more likely to make persistent changes in their eating and, seven years later, were lighter than when they started, as you can see in the graph below and at 5:36 in my video. 

Why can’t you have it both ways, though? Use fasting to kickstart a big drop, then start a healthier diet. The problem is that the big drop is largely illusory, as you can see in the graph below and at 5:48 in my video. 

Fasting for a week or two can cause more weight loss than caloric restriction, but, paradoxically, it may actually lead to less loss of body fat. How can eating fewer calories lead to less fat loss? Because during fasting, your body starts cannibalizing itself and burning more of your own protein for fuel. Emperor penguins, elephant seals, and hibernating bears can survive by just burning fat without dipping into their muscles, but our voracious big brains appear to need at least a trickle of blood sugar. If we aren’t eating any carbohydrates, our body is forced to start turning our protein into sugar to burn. Even getting just a few grams of carbs—from adding honey to water when fasting, for instance—can cut protein loss up to 50 percent.  

What about adding exercise to prevent the loss of lean tissues during a fast? That may make it worse! At rest, most of your heart and muscle energy needs can be met with fat, but if you start exercising, some of the blood sugar meant for your brain starts getting snatched up and your body may have to break down even more protein. 
 
As you can see in the graph below and at 7:00 in my video, less than half of the weight loss during the first few weeks of fasting ends up coming from your fat stores. So, even if you double your daily weight loss on a fast, you may be actually losing less body fat. 

In an NIH-funded study, obese individuals were placed on an 800-calorie-a-day diet for two weeks and steadily lost about a pound of body fat a day. They were then switched to about two weeks of zero calories and started losing more protein and water. On average, though, they only lost a few ounces of fat daily. When they were subsequently switched back to the initial 800-calories-a-day diet for a week, they rapidly replaced the protein and water, so the scale registered their weight as going up, but their body fat loss accelerated back to the approximate pound a day. The scale made it look as though they were doing better when they were completely fasting, but the reality is they were doing worse. So, during the five-week experiment, they would have lost even more body fat had they stuck with their calorie-restricted diet rather than completely stopping eating in the middle. They would have lost more body fat by eating more calories. Fasting for a week or two can interfere with the loss of body fat, rather than accelerate it. You can see a series of graphs depicting this from 7:13 in my video, including the one below. 

This is the follow-up to Benefits of Fasting for Weight Loss Put to the Test. It seems fasting may only work long-term if it can act as a jumpstart to a healthier diet, and just fasting for a week or two can be counterproductive, like the keto diet. Is it even safe to fast longer than that? Find out in Is Fasting for Weight Loss Safe?. 
 
For more on the keto story and more on fasting for weight loss, see related videos below. 
 
I’ve done my third live webinar on fasting, Fasting and Cancer. Those videos are also on NutritionFacts.org. 

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For more than a century, fasting has been used as a weight-loss treatment. 

I’ve talked about the benefits of caloric restriction. Well, the greatest caloric restriction is getting no calories at all. Fasting has been branded “the next big weight loss fad,” but it has a long history throughout various spiritual traditions, practiced by Moses, Jesus, Muhammed, and Buddha. In 1732, a noted physician wrote, “He that eats till he is sick must fast till he is well.” About one in seven American adults today report taking that advice, “using fasting as a means to control body weight,” as I discuss in my video Benefits of Fasting for Weight Loss Put to the Test. 
 
Case reports of the treatment of obesity through fasting date back more than a century in the medical literature. In 1915, two Harvard doctors indelicately described “two extraordinarily fat women,” one of whom “was a veritable pork barrel.” Their success led them to conclude that “successive moderate periods of starvation constitute a perfectly safe, harmless, and effective method for reducing the weight of those suffering from obesity.” 
 
The longest-recorded fast, published in 1973, made it into the Guinness Book of World Records. To reach his ideal body weight, a 27-year-old man fasted for 382 days straight, losing 276 pounds, and managed to keep nearly all of it off. He was given vitamin and mineral supplements so he wouldn’t die, but no calories for more than a year. In the researchers’ acknowledgments, they thanked him “for his cheerful co-operation and steadfast application to the task of achieving a normal physique.” 
 
In a U.S. Air Force study, more than 20 individuals at least 100 pounds overweight and most “unable to lose weight on previous diets” were fasted for as long as 84 days. Nine dropped out of the study, but the 16 who remained “were unequivocally successful” at losing 40 to 100 pounds. In the first four days, the subjects were noted as losing as much as four pounds a day, which “probably represents mostly fluid,” mostly water weight as the body starts to adapt. But, after a few weeks, they were steadily losing about a pound a day of mostly straight fat. The investigator described the starvation program as “a dramatic and exciting treatment for obesity.” 
 
Of course, the single most successful diet for weight loss—namely no diet at all—is also the single least sustainable. What other diet can cure morbid obesity in a matter of months but practically be guaranteed to kill you within a year if you stick with it? The reason diets don’t work, almost by definition, is that people go on them, then they go off of them. Permanent weight loss is only achieved through permanent lifestyle change. So, what’s the point of fasting if you’re just going to go back to your regular diet and gain right back all of that lost weight? 
 
Fasting proponents cite the psychological benefit of realigning people’s perceptions and motivation. Some individuals have resigned themselves to the belief that weight loss for them is somehow impossible. They may think “that they are ‘made differently’ from those of normal weight” in some way, and no matter what they do, the pounds don’t come off. But the rapid, unequivocal weight loss during fasting demonstrates to them that with a large enough change in eating habits, it’s not just possible, but inevitable. This morale boost may then embolden them to make better food choices once they resume eating. 
 
The break from food may allow some an opportunity “to pause and reflect” on the role food is playing in their lives—not only the power it has over them but the power they have over it. In a fasting study entitled “Correction and Control of Intractable Obesity,” a patient’s personality was described as changing “from one of desperation, with abandonment of hope, to that of an eager extravert full of plans for a promising future.” She realized that her weight was within her own power to control. The researchers concluded: “This highly intellectual social worker has been returned to a full degree of exceptional usefulness.” 
 
After a fast, newfound commitment to more healthful eating may be facilitated by a reduction in overall appetite reported post-fast, compared to pre-fast, at least temporarily. Even during a fast, hunger may start to dissipate within the first 36 hours. So, challenging people’s delusions about their exceptionality to the laws of physics—thinking they are “made differently”—with “short periods of total fasting may seem barbaric. In reality, this method of weight reduction is remarkably well tolerated by obese patients.” That seems to be a recurring theme in these published series of cases. In the influential paper “Treatment of Obesity by Total Fasting for up to 249 Days,” the researchers remarked that the “most surprising aspect of this study was the ease with which the prolonged fast was tolerated.” All of their patients “spontaneously commented on their increased sense of well-being, and in some, this amounted to frank euphoria.” They continued that, although “treatment by total fasting must only be prescribed under close medical supervision,” they “are convinced that it is the treatment of choice, certainly in cases of gross obesity.” 
 
Fasting for a day can make people irritable and feel moody and distracted, but after a few days of fasting, many report feeling clear, elated, and alert—even euphoric. This may be in part due to the significant rise in endorphins that accompanies fasting, as you can see in the graph below and at 5:48 in my video. Mood enhancement during fasting is thought to perhaps represent an adaptive survival mechanism to motivate the food search. This positive outlook towards the future may then facilitate the behavioral change necessary to lock in some of the weight-loss benefits. 

Is that what happens, though? Is fasting actually effective over the long term? There are articles with titles like “Death During Therapeutic Starvation for Obesity.” Is fasting even safe? We’ll find out next. 
 
This is the sixth in a 14-part series on fasting for weight loss. In case you missed any of the others, see the related videos below. 

My book How Not to Diet is all about weight loss. You can learn more about it and order it here. 

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