by Arnold De Vries V E G E T A R I A N N E W S D I G E S T 2146 BRANDEN STREET LOS ANGELES 26, CALIFORNIA COPYRIGHT 1 9 5 I ARNOLD DE VRIES All rights reserved. This book, or parts thereof, must not be reproduced in any form without permission. SECOND EDITION P R O D U C E D B Y H I G G I N S I N C O R P O R A T E D , C H I C A G O , A N D P R I N T E D I N T H E U N I T E D S T A T E S O F A M E R I C A Table of Contents 1. Forms of Fasting 1 2. A Short History of Fasting 3 3. Physiological Reactions to Fasting 6 4. Efficiency of Fasting I* 5. The Complete Fast 27 6. Safety of the Fast 3 3 7. Symptoms of the Fast 3 9 8. Supervising the Fast 47 9. Breaking the Fast 53 10. Living after the Fast 57 Bibliography Index 6 9 F O R M S O F F A S T I N G T H E T E R M , FASTING, IMPLIES total or partial abstinence from food or water for any of a number of reasons. Thus one may refer to fruit fasts, vegetable fasts, milk fasts, water fasts and many other types. As the different reasons for fasting are considered, other divisions may be given—viz, religious fasting, pro- fessional fasting, physiological fasting, pathological fast- ing and accidental or experimental fasting. A fruit fast is abstinence from fruit; a vegetable fast is abstinence from vegetables; a milk fast is abstinence from milk; a water fast is abstinence from water, and similar fasts may be defined accordingly. Religious fast- ing is abstinence to develop spiritual thought or fulfill a religious rite. Professional fasting is abstinence for pur- poses of notoriety and publicity. Physiological fasting is normal inanition in nature, such as the hibernation and seasonal abstinence of certain animals. Pathological fast- ing is associated with organic derangements which make one unable to take or retain food. Accidental or experi- mental fasting is forced inanition among man or animals for purposes of scientific investigation. These are the recognized forms of fasting. Yet, there is another, and perhaps much more important, classifica- tion which is seldom given mention or even known about. This is therapeutic fasting—total abstinence from all i food, but not water. The purpose of therapeutic fasting is the promotion and restoration of health. It is associated with experimental and physiological fasting in the sense that studies of the latter provide the knowledge and information which make therapeutic fasting possible. Therapeutic fasting is not the result of any particular new scientific discovery, but rather has proceeded to its present development as the result of centuries of experi- mentation, observation and study. It is today the culmina- tion of a large number of scientific investigations and discoveries which have reached their climax during the past century. Fasting for therapeutic purposes is thus an important, though in popular conception, almost un- known, phase of the modern science of medicine, and as such it is the subject of our present inquiry and analysis. IO T H E R A P E U T I C F A S T I N G 2 A S H O R T H I S T O R Y O F F A S T I N G T H E ORIGIN OF FASTING FOR illness perhaps dates back to the development of the present forms of animal life. Among undomesticated ani- mals it is a common practice to fast when ill, though this is of course an instinctive procedure rather than a plan- ned therapeutic measure. The first records -of human fasting for the remedy of disease go back to the ancient civilizations of Greece and the Near East. Both Plato and Socrates are said to have fasted for 10 days at a time to "attain mental and physical efficiency." Pythagoras fasted for 40 days before taking his examination at the University of Alexandria, and then he also required his pupils to fast before they could enter his class. The an- cient Egyptians were said to treat syphilis with their fast- ing cures, and the great Greek physician, Hippocrates, prescribed fasting during the critical periods of disease. Asclepiades and Thessalus employed fasting; Celsus is said to have used it in the treatment of jaundice and epilepsy, and the Arab physician, Avicenna, prescribed fasting for three to five weeks at a time. Later Tertullian wrote of fasting, and Plutarch said: "Instead of using medicine better fast a day." During the sixteenth century, the renowned Swiss physician, Paracelsus, claimed that, "Fasting is the great- est remedy." In the seventeenth century, Dr. Hoffman 3 wrote a book entitled, Description of the Magnificent Re- sults Obtained Through Fasting in All Diseases. Dr. Anton Nikolai followed in the next century with recommenda- tions of fasting instead of food for those who were ill. Later Dr. Von Seeland, of Russia, wrote: "As a result of experiments I have come to the conclusion that fasting is not only a therapeutic of the highest degree possible but also deserves consideration educationally." In Ger- many, Dr. Adolph Mayer asserted that "fasting is the most efficient means of correcting any disease," and Dr. Moeller wrote that "fasting is the only natural evolu- tionary method whereby through a systemic cleansing you can restore yourself by degrees to physiologic nor- mality." It has been during the past century that the greater portion of scientific data has been gathered. Both Europe (in particular, Germany) and America have contributed heavily to the research on experimental and physiological fasting. Hundreds of publications have been the result of this work and they provide thorough and exact knowledge regarding many phases of fasting. Among the best known research scientists who studied fasting were: Sergius Morgulis, Professor of Biochemistry at the University of Nebraska College of Medicine; Professor Child, of the University of Chicago; Herbert Sidney Langfield, of Harvard University; Dr. Frederick M. Allen, of the Rockefeller Institute; Francis Gano Benedict and Ernest G. Ritzman, of the Carnegie Institute; Luigi Luciani, Professor of Physiology at the University of Rome, and Victor Pashutin, Director of the Imperial Military Medi- cal Academy of pre-revolutionary Russia. Other scientific studies of fasting have been made by N. Pyaskovski, W. Skorczewski, N. J. Sands, A. Cleghorn, N. Morozov, P. B. Hawk, P. E. Howe, O. S. Soltz, C. A. Stewart, S. R. Wreath, C. M. Jackson, L. H. Hyman, N. Zuntz, Roger et Josue, Miescher, Mansfield, Rosenfeld and many others. All told, during the past century, hundreds of IO T H E R A P E U T I C F A S T I N G scientific workers in many countries have added to our knowledge of the biological importance of fasting. In contrast to these scientists, who were concerned primarily with developing laboratory data from studies of experimental and physiological fasting, chiefly among animals and to a lesser extent among humans, we have the other men of science who were concerned with the clinical and therapeutic phases of fasting. They super- vised tens of thousands of fasts, and as a result discovered the exact effectiveness of fasting as a remedy for specific diseases. Among these physicians were many of the nine- teenth century, in addition to those now practicing. They include, among others: Dr. Isaac Jennings, Dr. Joel Shew, Dr. Russell Thacker Trail, Dr. Robert Walter, Dr. Henry S. Tanner, and Dr. Edward Hooker Dewey. The experi- ence of these men was followed in the twentieth century by that of Dr. Linda Burfield Hazzard; Dr. Hereward Carrington; Dr. Eugene A. Bergholtz, of Milwaukee, Wisconsin; Dr. John M. Tilden, of Denver, Colorado; Dr. William Howard Hay, of Mount Pocana, Pennsyl- vania, and Dr. George S. Weger, of Redlands, California. Today Dr. Herbert M. Shelton, of San Antonio, Texas, carries on the important work, and Doctors Esser, Benesh and Gian-Cursio are also making important contribu- tions. History thus affords evidence of the considerable amount of scientific and clinical work done to determine the effects of fasting. The therapeutic measure is not a new and untried method, but on the contrary has been recognized for centuries and has been studied by some of the most brilliant minds in the science of medicine and related fields. The importance of these studies may be readily seen upon examination of the unique record of fasting, as regards its curative influence in the case of many specific diseases. A careful scientific appraisal of therapeutic fasting may then be of significance to both physician and layman. History of Fasting 5 P H Y S I O L O G I C A L R E A C T I O N S T O F A S T I N G T H E DEVELOPMENT A N D EVOLU- tion of the forms of human pathology are governed by the physiological and chemical reactions that are taking place. Anything that induces such reactions plays a role in determining the state of human health. Whenever food is witheld from consumption beyond the usual period in the case of man or other animals there are certain changes in the function, chemical reactions and life pro- cesses of the cells and tissues. It is these changes which give fasting its therapeutic properties. By considering the physiological reactions to fasting we can thus gain an understanding of the reasons which determine its thera- peutic value. Of great importance among the physiological effects of fasting is rejuvenescence—the acquiring of fresh vitality and renewal of youthful characteristics to the cells and tissues of the body. Evidence of such regeneration comes from many quarters and is particularly impressing with respect to experimental work done with the various forms of lower animal life. Such work may then be given first consideration. The British scientist, Prof. Huxley, has carried out ex- periments with young planaria, more commonly known as earthworms. He fed an entire colony of these worms 6 their usual foods. One of the worms was isolated from the rest and fasted at periodic intervals. In all other respects its diet and mode of life were similar to those of the other worms. The isolated worm lived while 19 generations of * worms in the colony lived and passed away. Prof. Child, of the University of Chicago, likewise has used worms to determine the effects of fasting. He took a group of small flat worms which had grown old and infirm and fasted them for months, until they had been reduced to a minimum size. Then he started feeding them again, and as they grew back to their normal size, they were just as young, from a physiological standpoint, as they ever were. In his Senescence and Rejuvenescence, Prof. Child remarks: "Partial starvation inhibits senes- cence. The starveling is brought back from an advanced age to the beginning of post-embryonic life; it is almost reborn." Other experiments, conducted by E. Schultz, have shown that hydra are rejuvenated by fasting, the animals reverting back to an embryonic state. At the University of Chicago, one insect, the normal life span of which is one day, was fasted and lived for 15 days. There are some species of lower animal life which normally pass through their life span in three or four weeks, but when, because of lack of food, they are forced to fast at intervals, they often remain young and active for three years. Prof. Sergius Morgulis, in his experimental work with animals, has noted the relation between fasting and re- juvenation. He states: "Laboratory as well as clinical ex- periments corroborated the rejuvenating effects of inani- tion. If it is not too prolonged it is distinctly beneficent and may well be used in over-coming somnolence and lassitude as well as in improving the fundamental organic functions (circulation, respiration), muscular strength, or the acuity of the senses . . . Biologically speaking, though the organism acquires no new assets it becomes Physiological Reactions 7 stronger by ridding itself of liabilities. In the foregoing it has been pointed out that the cell-nucleus ratio changes in such a manner as to increase the preponderance of the nucleus. Morphologically, therefore, the cells composing the entire organism assume a more youthful condition. They resemble more the embryonic cells in this respect, and this may account for the expansive growth which they display under the proper nutritive regime." One of the characteristics of old age is a decrease in the metabolic rate. It is interesting to note, in this con- nection, that fasting produces rejuvenation by inducing a permanent increase in the metabolic rate. In experi- ments conducted at the Hull Biological Laboratory of the University of Chicago, both dogs and humans were fasted for extended periods. In fasts of from 30 to 40 days a five to six per cent increase in the metabolic rate was ob- served. Of course rejuvenation does not occur in man to the extent that it does in the lowest forms of animal life. However, the effects of rejuvenescence are nevertheless very noticeable in the case of human fasting. Dr. Carlson and Dr. Kunde, of the Department of Physiology in the University of Chicago, placed a 40 year old man on a 14 days fast. At the end of the fast his tissues were in the same physiological condition as those of a 17 year old youth. In reference to fasting Dr. Kunde remarks: "It is evident that where the initial weight was reduced by 45 per cent, and subsequently restored by normal diet, ap- proximately one-half of the restored body is made up of new protoplasm. In this there is rejuvenescence." It may also be pointed out that quite possibly much of the re- maining part of the body not lost in weight may also undergo significant changes of rejuvenescence as a result of fasting. Mention may also be given to the case of the late Mahatma Gandhi, who was well known for his numerous 8 IO T H E R A P E U T I C F A S T I N G fasts. On May 18, 1933, when Gandhi was in the tenth day of fasting, he was examined by his physicians. One of the physicians stated that "despite his 64 years, from a physiological point of view the Indian leader was as healthy as a man of forty." The outward manifestations of regeneration are quite noticeable in many cases of fasting. The rejuvenating effect upon the skin in particular is important. Lines and wrinkles become less apparent, and blotches, discolora- tions and pimples tend to disappear. In the words of Dr. Shelton: "The skin becomes more youthful, acquires a better color and better texture. The eyes clear up and become brighter. One looks younger. The visible re- juvenation in the skin is matched by manifest evidences of similar but invisible rejuvenescence throughout the body." i r . . T Literally the word, autolysis, means self-loosing, in physiology it is used to denote the process of digestion or disintegration of animal tissue by ferments and enzymes which are generated by the body cells themselves. Thus it is a process of self-digestion or intra-cellular digestion. Autolysis forms a normal part of the physiological activities of the body. The action of enzymes upon such substances in the body as glycogen, fatty tissue and bone marrow, in preparing these materials for entry into the blood stream, is normal autolysis. Likewise when an ab- scess "points" to the surface of the body to empty is con- tents, autolysis was involved when the flesh between the abscess and the surface was digested by enzymes. While recognizing the existence of autolysis as a com- mon fact of everyday life, it has been generally believed that the process could not be made subject to human con- trol and put to practical use. Though it has been under- stood that abnormal growths in the body might be ab- sorbed through self-disintegration, the profound change in metabolism necessary to bring about such autolysis has Physiological Reactions 9 been thought to result only in very rare cases following such conditions as extreme cachexia, the puerperium, or menopause. Such conditions, not always being within the realm of voluntary control, and only occasionally produc- ing the changes in question, offer no method whereby autolysis can be instituted at will and put under control. A complete revolution in such orthodox concepts nec- essarily follows consideration of fasting. The fact is that fasting, in producing a profound change in metabolism, serves as an immediate inducement to the development of autolysis and can thus act as a control of this process. This is no new discovery in physiology, but has been rec- ognized for over a century by those who employed fast- ing. In the early part of the nineteenth century, Sylvester Graham wrote that "it is a general law of the vital eco- nomy" that "the decomposing absorbents always first lay hold of and remove those substances which are of least use to the economy; and hence, all morbid accumulations, such as wens, tumors, abscesses, etc., are rapidly dimin- ished and often wholly removed under severe and pro- tracted abstinence and fasting." During the fast, the body has the opportunity to re- distribute its nutritive supplies—the surpluses and non- vital supplies being consumed and utilized first. The absorption of normal muscles and tissues on a fast is readily observable, and the flesh, blood and bone of a tumor, being less important to the needs of the body, are absorbed much more rapidly, with the essential tissues being utilized in nourishment and the remainder per- manently removed. On the fast the assimilative powers of the body are in- creased. This is shown both in the improvement of the blood during the fast and the rapid assimilation of food after the fast. Patients who suffer from conditions such as anemia, with either an insufficiency of red blood cells or an excess of white cells, are generally normalized by fast- IO T H E R A P E U T I C F A S T I N G ing. In some cases fasting has brought about an increase in the number of erythrocytes from only one million to the normal five million count. The explanation lies in the improvement in assimilation which the fast affords. The iron and other elements which are stored in the body are taken up by the blood and used. Prior to fasting, general physiological inefficiency prevented this. Perhaps this also explains why dental decay is often arrested during the fast. In some cases teeth that were loose become firm- ly fixed in their sockets while fasting, and swollen, in- flamed and bleeding gums are also restored to health. The improvement in assimilation during the fast actually brings about recovery of certain "deficiency" diseases. Assimilation after the fast is at the highest possible level. Kagan observed that after rabbits were fasted 17 days they gained 56 per cent in weight on a diet which, under usual conditions, would barely be sufficient to maintain a state of equilibrium. People who are chroni- cally underweight in spite of eating very heavily, often gain weight to the normal level after a fast, even though large quantities of food are not taken. The improved as- similation enables the body to utilize more of its food intake. It may be mentioned that it is really a normalization of assimilation which occurs on a fast. Patients who fast to rid themselves of excessive weight may gain weight to normal after the fast, but that is usually where the gain ends if nutrition is proper. Thus both people who assim- ilate too much of their food intake, and those who as- similate too little, are helped by fasting. Fasting affords the organs of the body the closest pos- sible approach to a complete physiological rest. Many organs are overworked and overstimulated, and hence weakened, through the constant use of defective foods and excessive quantities of foods. During a fast, the nec- essary work done by the organs is reduced to the lowest Physiological Reactions 11 possible minimum. As there is no further intake of food, assimilation in the body only involves the redistribution of the elements already stored there. Thus the organs are given a chance to recuperate and restore their vital powers. Repair of damaged structures may take place. Broken bones, wounds and open sores heal much more rapidly. If inflammation is present it tends to subside. The body undergoes a general healing process. Associated with physiological rest of an organ is in- creased elimination. This, according to some observers, is the most important advantage of fasting. Part of the energy which would normally be devoted to the work of assimilation may, during a fast, be used to expell the ac- cumulations of waste and toxins. Decomposing food in the digestive tract, which is often an important source of toxins, is quickly eliminated. The entire alimentary canal becomes almost free from bacteria. The nourishment of cells on a fast is first derived from the less essential tis- sues and portions of impaired and diseased tissue. The surplus material on hand is utilized first. The effusions, dropsical swellings, fat, infiltrations, etc., are absorbed with great rapidity on a fast. The body thus gradually releases itself from a former burden of superfluous and waste material. Increased elimination of toxins is noted on the very first days of the fast. The breath becomes very offensive, and the skin may also emit an offensive odor, possibly because of greater eliminative effort on the part of both the lungs and skin. Catarrhal eliminations usually increase during the early days of the fast, until towards the end of the fast elimination is completed and recovery occurs. The toxicity of the urine is increased, perhaps due to greater elimination via the kidneys. In some cases, considerable waste material is lost through the process of vomiting. Of course each of these symptoms do not occur in all cases, but there is always some outward indication IO T H E R A P E U T I C F A S T I N G of increased elimination. The primary elimination, how- ever, brought about simply by internal absorption and autolysis, is not apparent in outward reactions, except perhaps the loss of weight and general weakness. Fasting thus serves many purposes in terms of physi- ology and chemistry. It produces rejuvenation of tissues, induces autolysis of abnormal growths, improves the power of digestion and assimilation, affords the organs of the body a physiological rest, increases elimination, re- establishes normal chemistry and secretion, and perhaps improves functions in various ways which we do not yet understand. Obviously these factors are of considerable importance in determining the physical condition of the body. They may mean the difference between strength and weakness, health and disease, and perhaps even life and death. Physiological Reactions 13 E F F I C I E N C Y O F F A S T I N G ON T H E BASIS OF OUR K N O W L E D G E regarding the physiological effects of fasting, we are justi- fied in assuming that, theoretically at least, fasting should be a very efficient therapeutic agent. However, important as this is, it is not enough. A measure may be theoretical- ly correct, and have a logical and reasonable basis in all respects, and yet in the treatment of disease it does not fulfill expectations. Thus it is necessary that fasting be given thorough consideration from the standpoint of statistics and available records of its use in the treatment of diseases of all types. The employment of fasting for therapeutic purposes has been very extensive. There are a number of prom- inent physicians who can be referred to, each of whom has had experience in conducting thousands of fasts. Among these is Dr. Herbert M. Shelton, who has con- ducted over 30,000 fasts at his institute ranging in length from a few days to as many months. This record involves more experience with fasting than that of any other liv- ing physician, and perhaps also exceeds that of any phys- ician of history. The work of the renowned Dr. William Howard Hay, while director of the great Pocana Haven sanatorium in Mount Pocana, Pa., included the super- vision of several thousand fasts. Dr. George S. Weger listed the number of patients whom were treated at his 14 sanatorium at approximately 5,000. The experience of Dr. Linda Burfield Hazzard covered nearly 2,500 pa- tients. For decades Dr. John M. Tilden treated patients at his fasting institute in Denver, Colorado, and the large Bergholtz Clinic, in Milwaukee, Wisconsin, founded by Dr. Eugene A. Bergholtz, published the case histories of many of its thousands of fasting patients. Other physi- cians have likewise been active in this work, each con- ducting scores, hundreds or thousands of fasts, and they have reported the detailed results of their experiences with fasting. Most of the patients who have been treated at fasting institutes and sanatoriums had for years suffered from ill health. Many of them tried all other forms of healing— drugs, surgery, manipulation, massage, artificial fever treatments, electrical treatments, autosuggestion etc.— all to no avail. Finally, as a last resort they decided to try fasting. Heart disease, cancer, ulcers, colitis, asthma, sinusitis, arthritis, tumors, gall bladder infection and other ailments, which are so seldom completely and per- manently remedied by orthodox means, were common among the afflictions of the patients. Yet the percentage of recoveries has been amazingly high—exceeding that resulting from the use of any other therapeutic measure. Many patients, after suffering for years from so-called incurable ailments, have been com- pletely restored to health. All physicians caring for the fasting patients have pointed out the unusual efficiency of the fasting treatment. Dr. Shelton, for instance, has reported that 95 per cent of the patients at his institute have recovered health or claimed benefit, and others who have made lengthy observations of his patients under care do not deny the accuracy of his figure. Dr. William L. Esser has given statistics regarding the treatment of 155 patients that were cared for at his sana- torium. These included all the patients who were fasted Efficiency of Fasting 15 during a two year period. A total of 31 different types of disease were treated. These included, among others, ulcers, tumors, tuberculosis, sinusitis, pyorrhea. Parkin- son's disease, heart disease, cancer, insomnia, gallstones, epilepsy, colitis, hay fever, bronchitis, asthma and arth- ritis. The length of the shortest fast was five days; that of the longest fast was 55 days. In many cases the length of the fasts was restricted by time and financial limitations, with only about 20 per cent of the patients remaining in the sanatorium long enough to fast as long as recom- mended. Of the 155 patients, 113 were completely restored to health; 31 were partially recovered, and 12 patients were not helped at all. Thus the rate of complete recovery was 71 per cent; of partial recovery, 20 per cent, and of fail- ure, 9 per cent. In view of the character of diseases treat- ed, this represents a very high degree of efficiency, as compared to other therapeutic measures. Sinclair collected statistics of people who had fasted without professional supervision. In some cases their dis- eases were diagnosed by physicians but the fasts were usually undertaken on the patients' own initiative. The fasts covered 117 people; the total number of fasts taken was 277, and the average number of days per fast was six. Ninety of the fasts exceeded four days in length, and six were 30 days or longer. Many of the fasts lasted only a few days. One hundred of the 117 people reported complete re- covery or some benefit from fasting, indicating a total percentage of slightly more than 93 per cent who were helped. A total of 116 diseases, of 30 different types, were listed as completely or partially remedied. As some of the people suffered from more than one disease, the num- ber of diseases helped was higher than the number of pa- tients. Of those who were not helped, about half had fasted only a few days and some of the rest gave wrong IO T H E R A P E U T I C F A S T I N G breaking of the fast as the reason for the failure. The therapeutic record of fasting can be further seen in con- sidering the use of this measure in the treatment of a number of specific diseases. Prognosis in the case of many eye diseases is good if fasting is employed. Numerous cases of visual defects have been completely remedied by fasting, though some mechanical defects cannot be corrected of course, and certain eye ailments require aid which fasting cannot give. When the muscles of the eyes suffer from a lack of tone, strength, flexibility, suppleness and coordination, special eye exercises will give more benefit than fasting, or eye- glasses will afford temporary relief, though fasting may be used to supplement these measures. Among the eye conditions for which fasting is often a specific remedy are cataract, congestion of the conjunc- tiva, catarrhal and granular conjunctivitis, glaucoma, iritis, keratitis and stye. Early cataract generally disap- pears on the fast; advanced cases may disappear, but recovery is. much less certain. Dr. Shelton records one case in which blindness of one eye (due to cataract) com- pletely disappeared on a fast of 18 days. Dr. Gerald Benesh reports equal success in treating a complete cata- ract, which yielded to a 21 day fast. The forms of conjunc- tivitis require only cleanliness and fasting for r e c o v e r with short fasts in acute cases and long fasts in chronic cases. When glaucoma exists, the hardness of the eye tends to disappear, with the excessive fluid being absorbed, on fasts of two to three weeks in duration. In advanced cases, when complete atrophy is present, the prognosis is not favorable, with blindness the usual result. Iritis, keratitis and stye need only fasting, cleanliness and rest, with re- covery the general rule unless previous suppressive treat- ment leaves permanent damage to sight. Respiratory ailments respond quickly to the fast. Hay fever disappears in virtually all cases without any change Efficiency of Fasting 17 of climate. Patients with catarrh recover on the fast, although eliminations may increase temporarily on the early days of the fast. Polyps, which may be present, are absorbed; the thickened membranes return to their nor- mal thickness, though the atrophied structures of ad- vanced catarrh cannot be rebuilt. Sinusitis responds readily to the fast; only a few days of fasting will bring relief in some cases; in others long fasts may be necessary. Chronic laryngitis yields quickly to the fast. Chronic cases of asthma usually attain much relief within just a few days of fasting, with complete recovery in a matter of weeks. Those asthmatics who are unable to sleep lying in bed and consequently sleep in a sitting position are usually relieved sufficiently within 36 hours without food to sleep in bed. Dr. Benesh refers to different patients re- covering from severe and long-standing asthma on fasts of different duration. One case required two fasts of 15 and 21 days; another responded to several short fasts of 2, 5, 6 and 7 days; the third fasted 26 days, and two fasts of 23 and 26 days were necessary in the most advanced case. Of the hundreds of asthmatics treated by Dr. Shel- ton with fasting, only three failed to recover. Congestion of the lungs is rapidly and safely remedied in all cases through fasting, and bronchitis responds equally well to treatment. The most important respiratory disease, tuber- culosis of the lungs, has often been treated with the fast. When the disease is in its acute state the prognosis is often unfavorable, but chronic tuberculosis in the early stages is almost always remediable by fasting. A series of short fasts is given preference over a single fast of long dura- tion in these cases. This is due to the difficulty some tubercular patients have in gaining weight after long fasts. Various forms of gland diseases have been treated by fasting. Chief of these are Addison's disease and goiter. In virtually all cases the former disease is regarded as in- IO T H E R A P E U T I C F A S T I N G curable when treated by orthodox means, with all pa- tients expected to succumb within a few months to several years. When fasting is employed, complete recovery is not the usual rule, but the life is generally prolonged and rendered more comfortable. Treatment of the various forms of goiter is usually more successful. Dr. Weger states that "most hypertrophic goiters can be made to absorb," and that "almost without exception, exophthal- mic goiter is curable without surgery." Dr. Tilden also points to the ease of curing exophthalmic goiter with fast- ing. The cystic goiter does not respond as well to fasting and its complete absorption is quite rare. Fasting is important to all patients with pernicious anemia. Dr. Tilden remarked that "cases of pernicious anemia taken off their food will double their blood count in a week." Dr. Weger reports a less rapid increase and refers to one case in which hemoglobin increased 50 per cent and white cells were reduced 50 per cent on a 12 day fast. Dr. Hay's experience has been equally satisfactory, and he reports that, of the 101 pernicious anemia pa- tients he had treated with fasting, only eight failed of initial recovery. Some who relapsed, presumably because of defective nutritional habits after the first fast, once again fasted and recovered. Another blood disease, leukemia, which has never, in recorded medical history, yielded to the usual methods of treatment, responds favorably to fasting. Leukemia is generally associated with an excess of white cells in the blood, an impairment of the cells of bone marrow, and in some cases, impairment of the lymphatic glands, with enlargement of the spleen. It was Tauszk who discovered that the number of white cells in the blood decreases on the fast, and since then Dr. Weger has reported the same thing with respect to his patients. Soltz, Meyers and Roger et Josue have described the changes fasting pro- duces in the bone marrow, and Prof. Morgulis states that Efficiency of Fasting 19 "the chemical changes of the marrow are most profound" while fasting. Prof. Morgulis also refers to the "rather abrupt diminution of the spleen" which occurs on the early part of the fast. Mann, Drip and Miescher have also studied fasting animals and pointed out the impor- tant effect which fasting has on the spleen. In view of these facts, it is not surprising to hear that both Dr. Weger and Dr. Tilden report good results in treating leukemia with fasting. Dr. Shelton reports that his experience with leukemia, though limited, has shown satisfactory results. Recovery, however, is not often im- mediate while fasting, but proceeds gradually after the fast during a period of correct nutrition and frequent sunbathing. Dr. Tilden claims that if patients suffering from leukemia in its advanced state "get well in six months or a year" they are "going very rapidly toward recovery." Fasting is of supreme importance in the treatment of all cases of poliomyelitis. In the acute form the prognosis as regards life is good, with a much lower death rate than follows either the Kenny treatment or orthodox treat- ment. Cases of permanent disability are almost unknown when fasting is employed, with all paralysis rapidly dis- appearing within a few weeks in most cases. In an aver- age of 98 per cent of all cases recovery is complete while fasting or shortly after the fast. When chronic anterior poliomyelitis is present the prognosis is less favorable, though further degeneration is usually checked and the life is prolonged. Bulbar paralysis, a less common form of poliomyelitis, usually ends fatally no matter what form of treatment is given. Fasting, however, still gives the best chance of recovery and prolongation of life. Literally thousands of abnormal growths have under- gone dissolution and absorption on fasts. Most of these were benign tumors; others were malignant tumors—or cancer. Shelton, Hazzard, Tilden, Weger and Rabag- IO T H E R A P E U T I C F A S T I N G liati, among others, report many such cases. As a general rule, benign tumors disappear more rapidly than those which have become malignant. Armstrong, of England, writes that he has "seen lumps in female breasts treated to a fast, some after diagnosis by experts, the bulk after self-diagnosis, and to disappear, on water only, in from four to twenty days." Macfadden remarks that his experience has shown "beyond all pos- sible doubt that a foreign growth of any kind can be ab- sorbed into the circulation by simply compelling the body to use every unnecessary element contained within it for food." Dr. Shelton reported recovery of one case diagnosed as cancer in as little as three days of fasting. Dr. Hazzard records a case in which 55 days of fasting were required before recovery was complete. In most cases the neoplasm of cancer is absorbed slowly on fasts. In certain cases there is not complete absorption, though further growth is usually checked. Complete recovery may or may not occur. Early cancer is usually completely remedied by fasting. Patients with late cancer are much less fortunate and the death rate is higher, though fasting under such conditions still gives the best chance of a cure. Fasting is of exceptional value in the treatment of ap- pendicitis. Recovery generally takes place within a few days to two weeks of fasting. The advantage of fasting over surgery in such cases, especially those which are most severe, is seen by the fact that the mortality rate in cases of acute, gangrenous, ruptured appendicitis with peritonitis is only 1.43 per cent when the operation is de- ferred. Immediate operations for the same condition have provided a mortality rate of 10.64 per cent (Reference: Journal of the American Medical Association, Dec. 5, 1936, page 1910). Further, the average death rate in all forms of appendicitis when surgery is resorted to is slight- ly less than 4 per cent, with 25,000 of an average of Efficiency of Fasting 21 520,000 patients dying annually in the United States. The efficiency of fasting in such cases is shown by the experi- ence of Dr. Hay, who treated over 400 patients who were afflicted with acute and chronic appendicitis. In nineteen cases the appendix had already ruptured. Yet complete recovery occurred in every case without a single failure or fatality. In no instance was surgery resorted to. Each patient was fasted until .recovery was complete. Fasting has been used with success in the treatment of various forms of sexual disorders and venereal diseases. Dr. Hazzard points out that the bacillus of gonorrhea "cannot long exist if the products of elimination are nor- mal, and if cleanliness, especially of the female, is proper- ly observed." She states that the "irritating symptoms of local venereal infection yield to treatment (fasting) in a few days, and convalescence brings no supervening an- noyance as expressed in urethral stricture, prostatic con- gestion, etc." Regarding syphilis, Dr. Shew wrote that "The hunger- cure is nowhere more applicable." The great medical authority, Dr. Robert Bartholow, also pointed out the value of fasting in such cases. Dr. Shelton states that "without exception" his patients with syphilis "have got- ten well in four to eight weeks under hygienic care." Dr. Tilden refers to recovery from syphilis "in from six weeks to two months without aftermaths of any kind" when the fasting treatment, followed by correct diet, is employed. Dr. Weger claims that the "local lesions of the first-stage heal with startling rapidity," and that "pharyngeal, labial, and buccal ulcerations frequently disappear before the tenth day of fasting." Diabetes was first treated with fasting by the famous French clinician, A. Guelpa, of Paris. Dr. Guelpa noted that fasting for three or four successive days rendered the urine of the patient with severe diabetes sugar-free, and effected pronounced improvement in the state of IO T H E R A P E U T I C F A S T I N G health, with no aggravation of the disease in any case. The American physician, Dr. Heinrich Stern, was next to treat diabetes with fasting and reduced nutritional in- take, and his many hundreds of patients as a rule re- sponded favorably. Dr. Stern found that, though there were certain cases of the severest types of diabetes "which no amount of fasting would render sugar-free," the ma- jority of patients "cease to excrete sugar within forty- eight to sixty hours," with an occasional patient fasting six days or longer before the glycosuric symptom disap- peared. In approximately seventy-five per cent of all cases the urine was also rendered free from ketones, though this required a longer period of fasting. Dr. Frederick Allen, of the Rockefeller Institute, has also employed the "starvation treatment" of diabetes, and his important work with fasting and restricted diet in 1915 effected a 60 per cent reduction in deaths from diabetic coma. Also treated in many instances by fasting is the serious disease, epilepsy. Several decades ago Dr. Rabagliati noted that fasting "seems to be of very great efficacy in the treatment of epilepsy." In 1932 Dr. C. Climmessen came to a similar conclusion as a result of his work at the Hospital for Nervous and Mental Diseases in Dianlund, Denmark. On the basis of 155 fasting treatments for epilepsy, Dr. Climmessen found that in the great ma- jority of cases, fasting caused the epileptic attacks to cease within four to five days, irrespective of the previous duration of illness. Fasting was equally effective whether the epilepsy was of organic nature or cryptogenetic, and it seemed to be most effective in cases with very frequent seizures. Other diseases appear to respond in the same effective and consistent manner to fasting. Dr. Shew noted that "There is nothing in the world that will produce so great relief in hemorrhoids as fasting," and Carrington stated: Efficiency of Fasting 23 "I may add that I have observed some most striking ex- amples of such cures myself." Arthritis and related diseases are usually speedily remedied by fasting, with gradual disappearance of the severe pains and swelling and the complete or partial absorption of the deformity by autolysis, providing complete ossification of the joint is not present. Fasts of one to four weeks usually alleviate acute arthritis, with longer fasts being employed if de- formities are present. Simple acne disappears on short fasts. The more severe forms, and also eczema, require longer fasts, often ranging in length up to three or four weeks. Both colitis and ulcers respond favorably to fasting, with disappearance of pain after the first few days, and complete recovery within a matter of weeks. Patients with heart disease are often helped by fasting. Angina pectoris, acute myocarditis, fatty overgrowth of the heart, endocarditis and ordinary pericarditis are those forms which respond most favorably. Dilation of the heart, hemopericardium (blood in the pericardium), and calcified pericardium can usually be remedied only partially when any form of help is possible. Simple gall bladder and bile duct infection is generally completely remedied on fasts of one to three weeks in duration, with somewhat longer fasts required when stones have formed in the gall bladder. High blood pressure is cured by the fast, and one case has been reported in which a systolic pressure of 295 was brought down to 115 after three weeks of fasting. Even leprosy has yielded to fasting— Shelton reporting one case of complete recovery from this disease in as little as 21 days. Other diseases, such as arteriosclerosis, Hodgkin's disease, varicose veins, catar- rhal deafness and mental disorders, have been in success- fully treated by fasting. In particular it is true that fasting is of extraordinary value in the treatment of all acute diseases. Regardless of the forms such ailments have taken, fasting has been IO T H E R A P E U T I C F A S T I N G employed as the first requirement and continued until the acute symptoms subsided. Not only is recovery much more rapid than when the customary treatments are given, but the mortality rate is much lower than usual. Indeed, some fasting practitioners report no mortality rate at all for the acutely-ill, and Dr. Shelton states that, of the hundreds of such patients he has cared for, "not a single one" has "died or failed to recover" or de- veloped complications of any kind. Typhoid fever patients recover in about two weeks while fasting, in absence of most of the distressing symp- toms which result from feeding and giving medication to such patients. Smallpox takes only the form of a light disease when fasting is instituted immediately. There is only very slight itching, no complications, and very rarely any pitting at all. In cases of scarlet fever, the rash disappears within four to seven days and the fever is gone by the fourth day. Mumps disappear within six to ten days of fasting, with no danger of complications. Regarding rheumatic fever, Dr. Weger claims that "in no case in which food was withheld from the onset did the temperature remain above normal for longer than ten days, and recovery was prompt without merging into the sub-acute and chronic stage." In the case of influenza, Dr. Weger points to the "rapid decline of all symptoms and abatement of temperature usually within three days," while fasting, with no mortality rate at all. Erysi- pelas, he declares, is "readily checked without pursuing its usual round-trip course." Fever disappears on the third or fourth day, with no abscesses or secondary infec- tions. Dr. Weger not only refers to recovery from malaria "in all stages," but states that no relapses "have been reported on return from fever-infested surround- ings." j . I There are no age barriers to fasting. Both aged indi- viduals and young children have fasted with great bene- Efficiency of Fasting 25 fit. Even infants may be placed on short fasts, and there is one record of a 2-year-old child fasting to recovery from poliomyelitis, with paralysis, on a 47-day fast, during which time the weight fell from 32 pounds to 15 pounds. Obviously such long fasts in children are the exception rather than the general rule, and they are not always to be recommended. Nor is long fasting often necessary during childhood, most children's diseases disap- pearing rapidly during short fasts. The only periods of life in which the use of fasting may be questioned are those of lactation and pregnancy. Fasting stops the secretion of milk and hence prevents the mother from nursing her child. During pregnancy long fasts to remedy chronic diseases are certainly inad- visable, though when acute disease exists, there may be a short fast until most or all of the symptoms subside. Clearly, in terms of strict efficiency, fasting is of excep- tional value as a therapeutic measure. It is in no sense a cure-all, nor is it the only method whereby health can be restored. As was noted, some conditions in their ad- vanced stages do not always recover on the fast. Further, the same results which often occur while fasting may occur by employing certain diets, though the latter method frequently is much less certain and incomparably slower than the fast. For speed and certainty in recovery the fast has no equal in the cases of most diseases, as the employment of fasting in thousands of cases has clearly shown. As regards efficiency, it is in a class by itself. IO T H E R A P E U T I C F A S T I N G 5 T H E C O M P L E T E F A S T IT IS T H E COMMON A N D POPULAR opinion that fasting and starvation are synonymous. Upon first hearing of therapeutic fasting, many speak of it as the "starvation cure." Actually, there is an important differ- ence between fasting and starvation, and though both imply abstinence from food, the physiological effects are in no sense similar. When food is consumed at regular intervals, the body stores sufficient quantities of nutritive matter to last for a considerable period of time during later periods of ab- stinence. From the start of every fast, the body com- mences to nourish and feed itself upon such reserves. The cells accordingly diminish in size and there are changes in the colloidal condition of the protoplasm. Cell proliferation itself continues. The chief weight losses consist of fat, muscle, tissue, blood and water. Such vital body parts as the brain, spinal cord, nerves, teeth and bones are well sustained on the fast with practically no losses. In children the skeletal structure continues to grow, the marrow being drawn upon for nourishment for this purpose. Such is the nutritive aspect of fasting. The body con- tinues to receive, from its reserves, the sustaining mate- rials of life. There is of course a limit to this supply. When all normal food reserves have been exhausted the 27 body must derive other means of nourishment. It then enters a period of true starvation and feeds upon the vital tissues and hitherto unchanged body parts. This is the stage which Prof. Morgulis states "is characterized by the predominance of pathological phenomena caused by the prolonged stringency of nour- ishment and exhaustion of tissues." Morgulis further points out that "the morphological changes observed in advanced starvation are practically identical with those found in every pathological condition and present noth- ing peculiar." During this period the healthy tissues are wasted, the vitality is depleted, and the body is ema- ciated. The blood atrophies; the cells of the liver, heart, kidneys, pancreas and other organs become the seat of degenerative processes. As the conditions reach their ad- vanced stages, death occurs. Fasting begins with the omission of the first meal and ends with the exhaustion of all food reserves. Starvation begins at this time and ends with death. Thus where the one process ends, the other begins. Whereas scientific fasting is accompanied by beneficial results, the elimina- tion of pathology, and rejuvenation, starvation is accom- panied by the development of pathology, degeneration, and the most disastrous consequences. When the food reserves of the body have been con- sumed, certain symptoms occur which indicate the end of the fasting period. There is invariably a return of hunger and a removal of coating from the tongue. The edges and tip of the tongue clear first, with the rest quickly following. The bad taste in the mouth and the offensive breath likewise disappear at this time. The pulse and temperature, which may have been abnormal, become normal. The eyes frequently brighten, salivary secretion is normalized, and the urine, which may have been discolored, becomes clear. Of these symptoms, the return of hunger and clearing of the tongue are the most IO T H E R A P E U T I C F A S T I N G important, and are regarded by some as the only certain and unmistakable signs which denote the completion of the fast. The others are usually present also, but it is the return of hunger and the condition of the tongue which are regarded as the determining factors. The return of hunger and the clean tongue do not always arrive at exactly the same time. One may arrive a few hours or more before the other. Under any condi- tions the fast should be broken at the appearance of either symptom. One should not, for instance, hesitate to break the fast if there is an unmistakable desire for food even though the tongue is not clean, and vice versa. In those very rare cases in which hunger is not lost on the fast, the clearing of the tongue will suffice as a guide in determining the completion of the fast. Dr. Hereward Carrington describes the feelings of the fasting patient at the completion of the fasting period in these words: " A sudden and complete rejuvenation; a feeling of lightness, buoyancy, and good health steals over the patient in an irresistible way, bringing contentment and a general feeling of well being, and the possession of a superabundance of animal spirits." Recognition of the great difference between fasting and starvation, and the symptoms which denote the end of one period and the beginning of the other, is of vital importance in the employment of therapeutic fasting. Abstinence from food can be exceedingly dangerous if one attempts to set in advance , the length of a period of fasting without regard to the differences between the two phases of inanition. On the other hand, an under- standing of these points eliminates all danger of true starvation. The symptoms which indicate the end of the fasting period are easily recognizable in all cases, and the simple knowledge of what these are can be of assurance to both the physician and layman that the fast will not be extended too long. The Complete Fast 29 The fast which lasts to the return of hunger and the consequent end of the fasting period is said to be "com- plete." It has carried the work of renovation, rejuvena- tion and cleansing to its final consummation. The pa- tient has then undergone the most thorough therapeutic treatment that is possible to provide. His body has lost most or all of its superfluous materials, waste matter and diseased or dead tissues. It is then in an ideal condition upon which to build new healthy protoplasm, with con- sequent vigorous health. The tune required for the fast to reach completion varies in the individual cases. Some have exhausted their food reserves after as little as 20 per cent of the body weight was lost, with others remaining in the fasting period when over half—even up to 60 per cent—of the body tissues were consumed. It is easily understood, of course, that the overweight individual can fast longer than one who is thin. Among those who are particularly obese, the extra layers of fat and other tissue will pro- vide the body with nourishment long after the normal patient would reach the termination of the fasting period. Measuring the fast in terms of days, weeks and months, we find that some patients have fasted as long as ninety days before experiencing the return of hunger and other symptoms denoting the end of the fast. Sinclair reported what was perhaps the shortest complete fast on record, that of his wife, in which case the tongue rapidly cleared after only ten days of abstinence from food. For most patients, however, the completion of the fasting period is not reached at such extremes. Though exact statistics listing the length of the average complete fast are not available, an estimate of from four to seven weeks is probably fairly close. A number of physicians have maintained that every fast should be carried to completion, unless adverse symp- toms force other action. Among these were Dewey, Car- IO T H E R A P E U T I C F A S T I N G rington and Hazzard. Dr. Dewey mentioned cases in which the patients broke their fasts prematurely and were unable to digest the foods, vomiting everything that was eaten. Upon resumption of fasting, and continuance to the return of hunger, normal digestive powers were restored and foods could be handled with ease. Dr. Car- rington referred to the artificial breaking of a fast before the return of hunger as "an abomination, and an outrage upon the system which cannot be too strongly depre- cated." Dr. Hazzard believed that "Not until hunger indicates the need for food is the organism in condition to receive and transform it into tissue structure." Today the majority of practitioners accept, with re- servations, the advisability of carrying the fast to its natural termination. The complete fast is looked upon as an ideal, but seldom as a necessity. Cases in which digestion is difficult or impossible until the fast is "com- plete" are very rare and most present-day physicians have not encountered them. If the correct foods are given, a fast for chronic disease can be broken at almost any time without trouble. When acute disease is present, digestion is often impossible for a time and the fast must continue, though this is due to the disease itself rather than the fast. Certainly it is true that the utmost benefit is derived from a complete fast. In the case of some severe degener- ative diseases recovery is impossible without such a fast, and in rare instances one complete fast may not even be sufficient, with fasting again being resumed after a long period of eating to rebuild the food reserves of the body. For the majority of acute diseases, on the other hand, a complete fast is very seldom necessary, with re- covery usually taking place long before the termination of the fasting period is reached. For chronic diseases in their early stages, a short fast of a week or two often gives the desired results. When the patient is very weak The Complete Fast 31 or emaciated, certainly a complete fast is not called for. It is apparent that no strict rule applying to all pa- tients and diseases can be applied here. The length of each fast must be determined individually; it cannot safely and effectively be called in advance. All that can first be given is a general estimate; as the fast progresses and the symptoms subside, the correct time to give food can be chosen. For those whose condition and circum- stances are most favorable, the fast can perhaps be car- ried to completion if this is so desired. For others—no doubt the majority—this will be considered neither nec- essary nor desirable. Each physician or individual must give judgment in these cases as he sees fit. The problem is not a difficult one; with adequate knowledge, observa- tion and care, the fast may be broken at the most oppor- tune time, without danger, and with the possible bene- fits and objects in view having been secured. IO T H E R A P E U T I C F A S T I N G 6 S A F E T Y O F T H E F A S T W H I L E RECOGNIZING T H E V A L U E OF fasting as a specific remedy for certain diseases, it is also nec- essary to consider the question of safety. It is one thing to be given the possibility or probability of recovery; it is an- other to be given this without any attendant danger, with assurance that a gamble is not being made which may involve disadvantages as well as advantages. A valuable therapeutic measure should both provide good results in treating disease and at the same time be associated with a minimum of danger. In the case of many thera- peutic measures this requirement is not met, and one disease is being cured, while perhaps more serious ones are being created through the toxic influences of drugs or the loss of important organs through surgery. It is important to understand the position of fasting in these respects. Generally speaking, initial consideration of fasting is associated with fear both of death and the possibility of doing serious harm to the body. On the surface, at least, such fear may have a logical and reasonable basis, con- sidering the fact that tradition has provided the almost universal impression that just a week or two of absti- nence is associated with grave danger and possible death. This has led to analysis of fasting by many physicians who considered any observations of actual fasting to be 33 completely out of the question. The conclusions thus drawn inevitably were completely theoretical and specu- lative, there being no actual cases of fasting present upon which practical deductions could have been made. Unfortunately reports of fasting all too frequently are founded upon the very basis mentioned, with the result that objections to fasting have been made which, though they may sound logical from the theoretical evidence at hand, are completely fantastic to those who have done either laboratory or therapeutic work with fasting. In consequence statements have been made that fasting weakens the heart, causes the heart to collapse, causes the stomach to atrophy or makes the digestive juices di- gest the stomach, produces deficiency disease, causes the teeth to decay, lowers the resistance of the body to dis- ease, causes degeneration of cells, is opposed to our nat- ural instincts, causes edema, causes acidosis, and last but not least, creates a grave danger of death. In actual experience not a single one of these objec- tions to fasting has been found to have any basis in fact. Quite apart from being weakened or collapsed by fast- ing, the heart is given a rest and thus allowed to gain new strength. Serious cases of heart disease have actually recovered while fasting. The stomach, in fact the entire digestive tract, is strengthened by fasting. There is no atrophy or impairment whatsoever. Patients who have always suffered from digestive weakness fully recover while fasting. As for deficiency diseases—these do not occur while fasting. Beliefs to the contrary have resulted from studies of deficient diets. As a result, nutritionists speak of the "probable appearance of deficiency disease" on long fasts. It is assumed that if diets lacking sufficient min- erals and vitamins produce deficiency diseases, a fast, which supplies no additional minerals and vitamins, must do likewise. During a fast, when the body's energy 34 IO T H E R A P E U T I C F A S T I N G is not used in the work of digestion and assimilation, the need for minerals is lowered. The reserves of these ele- ments in the body are sufficient to meet all needs. It is for this reason that no deficiency diseases, including dental decay, occur on the fast, though they often follow a diet of refined foods. Man can live much longer on water alone than he can on a diet of white flour and water simply because use of the flour increases the need for other elements to enable to the body to digest, assimi- late and metabolize the flour. Hence, not one, but many, severe deficiency diseases quickly arise on such a diet. Deficiency diseases frequently even recover on the fast, due to better assimilation of elements already stored in the body. In this connection, the contrast between defi- cient diets and fasting is pointed out by Prof. Morgulis, who states that "our observation that the chronically underfed dog became debilitated in a measure not com- monly noted in animals which undergo a straight fast is also borne out by more extensive study of this matter by Benedict, Miles, Roth and Smith." Claims that fasting causes degeneration of cells result from studies of animals in the last stages of starvation. Kellogg, for instance, refers to the work of Statkewitsch, who found that prolonged fasting in many animals was associated with degeneration. Not distinguishing between the periods of fasting and starvation thus leads to wrong impressions. Rejuvenation rather than degeneration is the result of fasting. Quite apart from lowering resistance to disease, and producing diseases such as tuberculosis, which are be- lieved to follow low resistance, fasting increases the resist- ance to disease and has been used successfully as a specific remedy of tuberculosis. Resistance depends upon chemical balance, abundant nerve force and all of the physiological conditions which fasting produces. The nu- merous complete recoveries from disease which occur Safety of the Fast 35 while fasting are in themselves evidence that the power to overcome infection is raised on the fast, rather than susceptibility increased. Animal experiments substantiate these points. Roger and Jause found that fasting produces an increased tol- erance toward bacilli coli in rabbits. Three to eleven days after the animals had fasted for five to seven days, the inoculation of bacterial culture took place. Without exception all control rabbits developed the infection, whereas the rabbits which had been fasted escaped all symptoms of infection. Though instinct is not given as a scientific reason for fasting or anything else, it is only fair to point out that fasting is not opposed to our natural instincts in the sense that is often reported. It is said that to fast is to thwart our normal sensations of hunger. The implication here is that hunger is normal throughout the fast, whereas the fact is that it only exists for the first few days, and when acute disease is present, it often does not exist at all. Unquestionably the customary practice of forced feeding in the case of acute disease is opposed to our nat- ural instincts. Even among wild and domestic animals fasting appears to be an instinctive practice. In case of an occasional illness, or a serious wound resulting from accident or battle, they frequently fast until recovery is well under way or complete. Beliefs that fasting produces edema have resulted from the misuse of fasting. Frederick Hoelzel writes that he has "not known of any case of fasting, even when for only days, where some post-fasting edema was not pres- ent." In Mr. Hoelzel's experience, cotton fibre, lemon juice, and salt were given as food after fasting. It is quite surprising that the aftereffects were not more serious than actually occurred. The development of edema under such a regime, with liberal amounts of water, is to be expected. On salt-water fasts, or when salt is used liber- IO T H E R A P E U T I C F A S T I N G ally with water immediately after fasts, the tissues be- come water-logged, as the body attempts to protect it- self from the irritating effects of the salt by holding it in solution, even though this calls for an excess of water in the tissues. The objection here is to salt, not fasting. In the general use of fasting, no salt-water is ever used, and edema has not developed, except in very rare in- stances when the fasts were broken on incorrect food or when excessive amounts of food were ingested immedi- ately after fasting, practices which of course are avoided by all physicians experienced with fasting. It may be added here that fasting is frequently used as a remedy for edema, and results have proven very satisfactory. Quite apart from causing the ailment, it is the most effective means of causing its disappearance. It is true that blood alkalinity is slightly lowered dur- ing the fast. However, this never reaches the point that true "acidosis" exists. There are always sufficient alka- line reserves in the body to prevent this condition. In all cases the blood is rapidly restored to its normal alkalinity when eating is resumed, and there is no evidence to indicate that the slightly lowered alkalinity during the fast has any detrimental effects. The mortality rate of patients who fast is extremely low. It is true, of course, that in rare instances people have died while fasting, though this cannot rightly be ascribed to the fast unless improper care was taken of the fasting patient or the fast was broken on improper food. The fact is that there is no record of death from a properly conducted fast. Deaths while fasting are gener- ally due to the presence of organic disease. Of the 2,500 fasting patients of Dr. Linda Burfield Hazzard, eighteen died, indicating a mortality rate of only seven-tenths of one percent. In the case of each death an autopsy was performed, and in no instance was the death found due to fasting. In each case the medical examiners gave the Safety of the Fast 37 presence of organic disease as the cause of death. It must be remembered that people who have fasted usually were victims of the most serious diseases. Most of them tried many forms of other medical and drugless treatment before ever considering fasting. It is generally as a last resort that the fasting method is employed. Many are near death when they start the fast. It is obvious that, under such conditions, some of the patients will die whether they fast or not. The development of pathology has simply gone too far, and nothing, not even fasting, can always prevent death in such cases. Actually the percentage of deaths while fasting is unquestionably much lower than is the case when the same diseases are treated by the usual orthodox means. In terms of safety, fasting is without doubt one of the best and most practical therapeutic agents. There are virtually no contradictions in fasting, in the sense that one part of the body is helped while another is harmed. In this respect it differs from so many other methods of treatment, which suppress one symptom, only to create others. Fasting helps the diseased organ in the same sense that it helps all other organs and tissues. Thus in securing a remedy for one disease, the body is made less liable to be afflicted by others. Health is restored by the safest and most effective means. IO T H E R A P E U T I C F A S T I N G 7 S Y M P T O M S O F T H E F A S T FASTING INVOLVES A C O N T I N U A L physiological change in the body. Rejuvenescence, auto- lysis, increased assimilation, elimination and other pro- cesses are taking place. Under these conditions it is to be expected that there will be outward manifestations of the changes occurring in the body. Such manifestations may be either pleasant or discomforting, more often the latter, and, though in no sense a cause for concern, they should be understood and expected. During the first day of the fast, a marked desire for food is usually present by afternoon or evening. On the second day the desire is often greatly increased, with the degree of hunger reaching its climax. On the third day the hunger usually abates and in some cases it entirely disappears. In nearly all cases the disappearance of hun- ger is complete by the fourth or fifth day. From this time onward there is not only no desire for food, but marked repugnance for food. Nausea and vomiting can even occur at the sight and smell of food. This state continues until natural hunger returns weeks or months later, or until the fast is broken, when appetite rapidly returns. Dr. Weger reported that about one in each forty of his patients failed to lose their hunger on the fast. Other physicians also reported similar experiences. No reason is known to account for this abnormal reaction, and 39 though it in no way diminishes the effectiveness of the fast, it does make fasting rather difficult. Fortunately such cases are the exception rather than the general rule. The tongue usually becomes heavily coated, and the breath very offensive, within the first few days of fast- ing. Here too there are very rare exceptions. Dr. Shel- ton reports three cases in his experience in which the tongue remained clean throughout the fast. Patients have also been observed who exhibited a clean and sweet breath while fasting. In the usual cases, when the reac- tions of the tongue and breath are normal, the tongue gradually becomes clean, and the breath sweet, as the hunger returns toward the end of the fast, or when the fast is broken. Both of these symptoms while fasting appear to be manifestations of the increased elimination within the body. The reactions of body temperature vary to some de- gree with different fasting patients. When there is acute disease, with fever, the temperature gradually drops to normal during the fast. When the temperature is below normal at the beginning of the fast, as is often the case when chronic disease is present, it gradually rises to normal and remains there, although the rate of rise is not always the same, with some patients fasting two, three or more weeks before the rise is to be noted. In rare cases, when no acute disease exists, the temperature rises above normal for short periods. A rapid fall in body temperature has been recorded in a few instances during the very last stages of fasting. Such reaction calls for immediate breaking of the fast and the application of external heat. As a rule the rapid fall in body tempera- ture is a symptom of only the starvation period, marking the complete exhaustion of the body's food reserves. Among animals in the starvation period, the temperature falls rapidly for two to six days before death. Even though body temperature may be normal while IO T H E R A P E U T I C F A S T I N G fasting, there is occasionally a slight tendency towards chilliness. This is presumably due to decreased cutaneous circulation, and requires additional clothing or bed covering. The feet often become cold, and in such cases a hot water bottle may be applied to maintain comfort during sleep. There is usually some variation in the pulse rate dur- ing the fast. In some cases it has risen as high as 120, and Macfadden records one case in which it dropped to 20. In most cases of chronic disease, the pulse rises slightly at first, then falls to about 40 or slightly more, after which it rises again to about 60. When there is a disease of the heart present, the pulse rate often varies con- siderably from the standard. An erratic pulse is quite frequent while fasting. Only when there is a persistent very erratic pulse, or when the pulse remains very high or very low for long periods should the fast be broken. The usual variations and short periods of erratic pulse should be taken for granted. Most fasting patients sleep less than usual. In some instances no more than three or four hours a day are spent sleeping. Others, especially those who have previ- ously suffered from insomnia, sleep longer during the fast, with insomnia patients having slept as much as 20 out of each 24 hours in some cases. During the first few weeks of fasting there is occa- sionally an actual increase in strength. Prof. Luciani found that his fasting subject, Succi, registered a stronger grip on the dynamometer on the twenty-first day of the fast than when it began, and he further stated that the fatigue curve obtained by Succi was the same on the twenty-ninth day of the fast as is obtained from individuals under normal conditions. Dynamometric tests taken of Agnostino Levanzin, on his experimental thirty-one day fast at the Nutrition Laboratory of the Carnegie Institute, showed no decrease in strength. The Symptoms of the Fast 41 one-time famous boxers, heavyweight Harry Wills and lightweight Freddy Welsh, both used short fasts during their training periods. In 1913 Macfadden supervised seven days of fasting of athletes who then appeared on the eighth day at Madison Square Garden to perform athletic feats, primarily weight-lifting, which would have been exceptional for even the best athletes while eating. It was on this occasion that Gilbert Low, after breaking his fast at the end of the eighth day, established nine world records for strength and endurance. An increase in strength is especially noticeable for those who are very weak at the beginning of the fast. Patients have been carried into fasting institutions on stretchers and gained strength so rapidly while fasting that they were walking about again within a few weeks. Macfadden, Carrington, Shelton and others have re- ported increases in strength among their fasting patients. As a rule they have found that in these cases the increase in strength generally lasts to about three weeks, after which there is a gradual lessening of strength. Though cases such as have been mentioned are fre- quent occurrences on the fast, there are many, perhaps the majority, of fasting patients who gradually lose strength from the beginning of the fast to the very end. There are others who maintain strength while fasting, as shown in tests, but who feel weak and languid when not exercising. This feeling appears to be the general rule among many fasting patients. In nearly all cases, there is a much greater feeling of weakness in the ad- vanced stages of prolonged fasting than at the beginning of the fast. While recognizing the variation in strength and weak- ness during the fast, it should be understood that this is not an important determining factor in the recovery of most fasting patients. In any event strength which may have been lost on the fast is rapidly regained when IO T H E R A P E U T I C F A S T I N G food is again taken. Only in those very rare cases of extreme weakness need concern be given. Extreme ema- ciation, with weakness to the point of frequent fainting and inability to walk alone, is of course an indication that the fast should be broken. A loss of weight while fasting is of course normal and to be expected. The average loss is perhaps about one pound a day, with a greater loss in the beginning of the fast than towards the end. Usually overweight patients lose weight most rapidly. Dr. Rabagliati and Dr. Car- rington have reported cases in which a slight gain of weight was registered during short fasts. Such occur- rences are very rare and difficult to explain. There is of course no danger from the loss of weight while fasting; it is rapidly regained when eating is again resumed. After the last meal is digested the digestive tract be- comes inactive and there is usually very little bowel action. The intestines become empty, in fact, sterile, and bowl movements are infrequent or altogether absent. Benedict reported that his fasting subject, Levanzin, passed no feces during his fast. People have fasted as long as fifty days with no bowel action, and though this is exceptional, it indicates the tendency here given men- tion. The lack of frequent bowel action on the fast is quite normal and no cause for concern. Bowel action is quickly restored after the fast. There is considerable variation in the sexual desire and activity of fasting patients. In most cases the desire is either reduced or abolished, with temporary impotency developing during long fasts. Occasionally patients con- tinue to indulge sexually throughout the fast, and in rare cases fasting has produced an increase in the sexual desire. After the fast the sexual powers return with re- newed vigor. Men who had been impotent prior to fast- ing have often regained virility, and sterility among women is also frequently corrected. Symptoms of the Fast 43 To the most important symptoms given may be added literally dozens of others which may or may not occur, and which are quite unimportant insofar as the progress of the fast is concerned. Among these are vomiting, spit- ting crises, skin eruptions, headaches, backaches, dizzi- ness, hiccoughs, fainting spells, sore throat, slight colds and cramps. Though such symptoms are discomforting to a degree, they are no cause for concern. Many are simply indicative of increased efforts of elimination. Of course, practically no patients experience all of these symptoms; many experience none at all, and others expe- rience them on a few short periods during the fast. The therapeutic action of the fast is exactly the op- posite of that of drugs. Whereas the latter often suppress the symptoms of disease, it is the purpose of fasting to "bring out" such symptoms, eliminate all toxins present, and thus provide permanent recovery. A disease which in the past has been inactive, or suppressed with drugs, may become active through fasting, as tissues are healed and elimination increased. It has been said that we "have to live our diseases over again" while fasting, and this is true to the extent that the weakest parts of the body are being rejuvenated and cleansed, and thus given imme- diate renovative activity. People, for instance, who have been susceptible to catarrhal conditions in the past, may eliminate streams of mucus from the colon, vagina, throat, sinuses and nose, depending upon the location of their original catarrhal condition, while fasting. After elimination is complete, or the fast is broken, such symp- toms cease and the patients are much the better for the experience, generally being cured of future catarrhal ail- ments. A disease may become more intense during the early days of fasting, and as renovation continues to com-- pletion, all symptoms gradually subside until the patient has fully recovered. Thus many, if not most, of the symp- toms of fasting may be ascribed to the curative action of IO T H E R A P E U T I C F A S T I N G the fast itself. On no instance can we consider them the development of new pathology, as is shown by their rapid disappearance and failure to return after fasting. Obviously this sort of analysis may give indication that the nature of disease itself is somewhat different than has been generally believed. In the past we have been accus- tomed to speak of disease as "attacking" the body as some sort of destructive force, and as such have at- tempted to "destroy" or suppress the disease itself with equally destructive agents, and even to remove the part of the body in which the disease was present. Here we see, in fasting, the action of disease as being curative in nature, which is intensified and brought to its culmina- tion. Perhaps it is this which has induced many physi- cans who employed fasting to claim that disease itself may be a defensive mechanism that induces an "elimina- tive" crisis in the case of acute disease, or an "adaptive" crisis in the case of chronic disease. The validity of this concept remains to be seen, and it is not our purpose to consider it here, but rather to point out its relationship to the development of symptoms on the fast. The most important danger signals of fasting, as re- gards the pulse and temperature, have been given, and there are but few other symptoms which may be con- sidered sufficient reason for breaking the fast sooner than otherwise would be desired. Even temporary delirium on the fast (which has occurred seldom) is rarely considered as reason for giving food, unless the delirium is associated with heart palpitation. The palpitation of the heart it- self, or pain in the heart, while fasting is quite uncommon and not considered dangerous. As a rule most symptoms of the fast must be considered in relation to others. Very few symptoms in themselves are sufficient reason for breaking the fast. It is the combination of many severe symptoms which, even though not always dangerous, is occasionally used as a reason for giving food. There are Symptoms of the Fast 45 no hard and fast rules in this respect, and each physi- cian must use his own judgment in considering a particu- lar case. The symptoms of fasting, quite apart from being a cause for worry or concern, can thus be seen to be only outward manifestations of the gradual recovery to health being made. Few are seriously discomforting, and one symptom, the loss of hunger, even makes the fast much more pleasant. In the final analysis, it is hunger itself which is most dreaded on the fast, and when this dis- appears, fasting is quite easy, with little annoyance or discomfort. Certainly it is not so difficult an ordeal as going through continued ill health, and many do not look upon it as an "ordeal" at all, but rather enjoy their fast to an extent not commonly expected. IO T H E R A P E U T I C F A S T I N G S U P E R V I S I N G T H E F A S T GREAT CARE IS T A K E N IN T H E administration of most therapeutic agents. Many forms of medication can be very dangerous if used by the layman without complete knowledge of technique and quantity. Massage, manipulation and other forms of physical therapy can be useless when not properly applied. Fast- ing is no exception to this principle in the sense that certain precautions must be taken by all patients. These are not as complex as one often finds in the field of medi- cine, and ignoring them usually does not have the disas- trous consequences found in the misuse of other thera- peutic agents. Yet both physician and layman should recognize certain fundamental rules which permit super- vision of fasting at maximum efficiency and a minimum degree of danger. Rest is the first recommendation to all fasting pa- tients. Some physicians require rest in bed in all cases of fasting, and whereas this is perhaps taking the extreme attitude, it is founded upon a sound physiological basis. Observations made during many long fasts show that the active individual consumes his nutritive reserves and energy more rapidly than the patient who rests most of the time. The resting patient can fast longer and emerges from the fast in better condition. People have often worked throughout long fasts. In 4 7 one instance a New York athlete received considerable attention by walking cross-country over 500 miles during 20 days of fasting. No permanent harm was observed in this or similar cases and satisfactory results were ob- tained. The question here is not what is necessary, but what is advisable. Both active and resting individuals receive benefit from fasting, though the latter perhaps recover more rapidly and are more comfortable during the fast. During short fasts, less than 10 days in duration, doing light work, and perhaps even taking a few exercises, should be quite harmless. Even on longer fasts some very light work or exercise may be permitted, but caution is much more important in such cases. The important thing here is to avoid excesses. The patient who is weak at the start of the fast can obviously be less active than the athlete or strong individual. Providing activity is not car- ried to the point of excessive weakness or exhaustion, the efficiency of the fast is perhaps not impaired. However, Puriton's recommendations of "loafing, resting, lazing along and not caring" are perhaps most appealing to any fasting patient, from the standpoint of comfort alone, and whenever possible the fast should be conducted accordingly. The second important need of fasting patients is warmth. This is especially true in the advanced stages of fasting, when the patient can freeze to death at tem- peratures which normally would be found only a little discomforting. Also, lack of warmth probably impedes the process of elimination to a degree and interferes with the efficiency of the fast. If the patient continually complains of being too hot, but has cold extremities, the fast should be broken and artificial heat applied. In event of an extreme chill the fast should not be continued and all efforts must be made to provide sufficient warmth. Under normal conditions, IO T H E R A P E U T I C F A S T I N G with proper care, conditions such as these do not arise, but when, through carelessness, warmth is not main- tained, especially during prolonged fasts, the precau- tions given mention should have immediate and careful attention. Many fasting institutions employ sunbathing with fasting. The beneficial effects of exposure to sunshine have long been well-known and sunbathing is no doubt helpful to the patient. However, it is very important to avoid extremes in this respect. Sunbaths should always be of comparatively short duration during the fast. A sunstroke is possible when there is excessive exposure, and whereas there is generally rapid recovery in such cases, a little care is certain to prevent them in the first place. While fasting it is always best to take the sun- baths during the early morning and late afternoon when the temperature is not at its highest. As the fast pro- gresses, the length of the sunbaths should gradually be decreased. It is particularly important to avoid fear and negative mental influences while fasting. The ill effects of anger, grief and shock are more pronounced while fasting than at any other time. Sinclair remarks that the faster "should not have about him terrified aunts and cousins who will tell him that he looks like a corpse, that his pulse is below forty and that his heart may stop beating in the night." Certainly this is true in all cases, and a group of well-meaning friends and relatives can be a great interference to the efficiency of fasting when they have no knowledge or understanding of the purposes and principles of the fast. If for reason of the environment, or other reasons, the patient is living in dread and fear of the consequences of fasting, the fast should not be continued. Cleanliness and fresh air are important during the fast just as at all other times. During bathing, extremes of Supervising the Fast 49 temperature should be avoided, and the bath should not last too long. When the patient is very weak, a sponge bath only should be used. There should be fresh air in the room whenever possible, though in cold climates this should not be carried to the point of interfering with warmth. There has been some controversy as to the amount of water to drink while fasting. Theoretical observers have advocated water-free fasts, and still others have recom- mended several quarts of water a day on the fast. Ex- perienced physicians have not gone to such extremes, but have instead recommended thirst as a reliable guide. There is little doubt but what several quarts of water a day while fasting is greatly in excess of actual needs, and hence probably impedes elimination. Water-free fasts, on the other hand, are dangerous and should never be em- ployed. There are no records of anyone living longer than seventeen days with neither food nor water. A certain amount of water may be regarded as essential on every long fast. Fasting two or three days without water prob- ably does no harm, but longer fasts in the absence of water are inadvisable. The actual desire for water on a fast is usually not great, but can be relied upon to meet all needs. It usually calls for about a pint to a quart or two of water each day, depending upon each individual case. Occasionally days may arise on the fast in which no water is desired, in which none need be taken if the length of time does not exceed a few days. It may be added that distilled water is to be recommended while fasting. Ordinary spring water may be a second choice, whereas chlorinated water should be avoided if any other form is available. A certain amount of debate has also centered upon the use of the enema while fasting. Though the enema has been widely used in some fasting institutions, most expe- rienced physicians today either refrain from using it alto- IO T H E R A P E U T I C F A S T I N G gether or use it very seldom. Recommendations of the enema are based upon the assumption that toxins and waste matter are being deposited in the colon during the fast, and that the same materials are in turn re-absorbed by the blood. Cleansing the lower bowel with an enema each day supposedly prevents such re-absorption. Actually the colon is not fundamentally an organ from which much absorption occurs, and experienced physi- cians have noted that the entire alimentary canal, includ- ing the colon, becomes quite free of all waste materials during the fast. There is no evidence to indicate that the supposed deposits into the colon occur. The use of the enema is to some degree a drain on the patient's vitality, which is already at a low ebb. It further tends to weaken the colon muscles and produces future constipa- tion when used habitually. It has further been noticed that bowel action is generally restored more rapidly after the fast when the enema has not been used. The chief, and perhaps only, time in which the enema may be recommended is in those few cases in which there is considerable gas in the digestive tract, and even here it should be used only often enough to afford relief. Thus the enema is perhaps best used for practical reasons only, not upon theoretical assumptions as to the function of the colon, but only upon the personal needs of certain patients. It is important to avoid all forms of drugs while fast- ing, as these are readily absorbed by the patient, who in turn does not handle them as well as the normal indi- vidual. The danger of drugs on the fast was noted in particular by Aducco, when fasting dogs were given co- caine, strychnine and phenol. In all cases the reactions were much more intense than when doses were given to well-nourished animals, with a rapid rise in temperature, pronounced motor reflexes, and occasionally violent con- vulsions resulting in such cases. Delafuoy also found Supervising the Fast 51 that fasting animals are very sensitive to drugs, and Mansfield reported that drugs which produced only slight effects on ordinary rabbits, produced severe reactions and violent convulsions when given to the animals while fasting. Other investigators indicate similar results, and with humans an equal sensitivity to drugs while fasting must be expected. Serums and injections of all forms must also be avoided while fasting, as is the case with different methods of physical therapy, such as spinal manipulations, gastric lavages, Turkish baths, cold baths, electrical treatments, etc. The fasting cure does not harmonize well with a variety of other therapeutic measures. Most of these are a further drain on the patient's vitality, and in the cases of serum or vaccine injections, there is extreme danger with possible death. It must be remembered that the physiological effects of fasting are the exact opposite in many respects of those of other therapeutic agents. A combination of such methods, quite apart from being useless, only produces complex reactions which tend to contradict each other. It can be seen that therapeutic fasting is complete in itself. It is not a procedure which is to be used along with too many adjuncts and other therapeutic devices. The principles of its technique are few and render its application both safe and practical. With a reasonable degree of care, the fasting patient may pass through a comfortable period of therapeutic treatment and regain health in the most effective and pleasant manner. 5 2 IO T H E R A P E U T I C F A S T I N G 9 B R E A K I N G T H E F A S T OF VITAL IMPORTANCE TO T H E fasting patient is the method of breaking the fast. The period of abstinence may be completely successful, but if this is not terminated properly the results can be de- cidedly unfavorable. Many laymen have conducted their fasts with the greatest care, only to break them on what- ever food happened to be most convenient and find them- selves in dire distress. A few physicians, unfamiliar with the general technique of fasting, have likewise broken fasts in an experimental or careless manner, and found their patients to react in the most alarming fashion. To give inadequate attention to this matter is to court near- disaster; it may mean the difference in certain cases be- tween life and death. The many reports of fasts which have been broken incorrectly well substantiate this and give vivid illus- tration of the possible aftermaths. Dr. Shelton refers to two fasts broken by an incompetent physician on choc- olate candy, which were followed by extreme gastric and intestinal acidity and great distress throughout the body. He refers to another fast broken on toast, followed by malnutritional edema. Dr. Havard recorded a case in which a 28 day fast was broken on a meal of beefsteak, potatoes, bread and butter, after which violent vomiting spells occurred, with inability to retain even water which S3 was afterwards given. He writes of another fast, 42 days in duration, broken on coarse bread, and followed by- vomiting and extreme irritation of the stomach. Another report tells of a 31 day fast, broken on several beef sand- wiches, followed by death. Prof. Ehret has pointed to a fast by a diabetic patient, broken on dates, which ended fatally. A different case described by Ehret involved a 28 day fast, broken on boiled potatoes. An operation was necessary to remove the food, which was held in the contracted intestines, after which the patient died. Sinclair writes of a man "who fasted fifty days, and then ate half a dozen figs, and caused intestinal abrasions from which he lost a great deal of blood." Regarding one of his own fasts, Sin- clair states that it was broken on a thoroughly ripe Japa- nese persimmon which "doubled me up with the most alarming cramp—and in consequence I do not recom- mend persimmons for fasters." When intake of food is stopped, the body adjusts it- self to the new conditions. The digestive organs cease to exercise their natural function; the digestive glands do not produce the usual juices, and the stomach itself shrinks to much less than its usual size. All this is an associated requirement of the physiological rest. After many days of fasting the body thus loses its immediate power to digest and handle food in the usual manner. When foods are again taken it only gradually regains its power of normal function. If the first intake is of a solid nature and difficult of digestion, the organs may entirely rebel; there will be little or no digestive activity, and the foods will decay and ferment, causing much distress and discomfort. If this happens along the lower section of the digestive tract, in the small intes- tine, the reactions are most severe, and when peristaltic action to move the food is yet impossible, death may ensue. IO T H E R A P E U T I C F A S T I N G Hence the reason for selecting foods with the utmost care after the fast. With few exceptions there is general unanimity of opinion that the first nutriment should be of a liquid nature, for it thus is more rapidly absorbed and is easier of digestion. It is also more soothing and less abrasive to the delicate mucous membrane lining, which is especially sensitive at this time. Fruit and vegetable juices, vegetable broths, flesh broths and milk have all been employed. They have not, however, given equally satisfactory results. Milk is too difficult of digestion for some patients immediately after the fast, and, if taken in large amounts, it is not always assimilated without trouble and tends to delay the return of normal bowel action. Flesh broths have other dis- advantages, and after long fasts they may give adverse reactions, even though there is ease of digestion. The strained broth of cooked vegetables is much better, but of widest use and generally most satisfactory results are the uncooked juices of fresh fruits and vegetables. Discom- fort is practically unknown when these foods are used. There is ease of digestion, rapid assimilation and quick restoration of bowel elimination. Though both are practical, fruit juices are usually given preference over those of the vegetables. The juices of the orange and grapefruit are used most frequently; those of the tomato, grape, pineapple and melon are perhaps equally valuable. The fast should be broken on one-half glass of juice, followed by the same amount every hour, or by one glass every two hours, for the rest of the day. The first juices should be sipped very slowly. On the second day the same schedule may be followed, or the juices may be taken at less frequent intervals; a three-meal-a-day plan may be adopted if desired, about one pint of juice being taken at each meal. On the following days larger amounts of juice may be allowed, care always being taken, however, to avoid excesses Breaking the Fast 55 which might produce digestive discomfort. The length of time the diet of fruit and vegetable juices, or simply the diet of fruit juices, should continue depends chiefly upon the length of the fast. It is general- ly advisable to live upon the juices about one day for each five days of fasting. For instance, a fast of five days or less would be followed by one day of the juice diet; a ten day fast, by a two day juice diet; a fifteen day fast, by a three day juice diet, and a twenty day fast, by a four day juice diet. The same principle is applied to all fasts—the longer the food has been withheld, the longer the juice diet should be employed. These guides are general rather than specific. Slight deviations from them may be made in different cases. Some patients need not employ the juice diet quite as long as others who have fasted an equal length of time. The patient who shows a history of digestive weakness, constipation or hemorrhoids should live upon juices the longest and start consuming them in the smallest amounts. The object, in any case, should be to live upon juices until the digestive organs have regained their power of normal function and until bowel action is re- stored. Upon the conclusion of the juice diet all types of un- cooked foods may be eaten. A slow transition to a normal diet, which has frequently been recommended, is unnecessary if the juice diet is employed for the speci- fied length of time. However, the first regular meals should be quite small. It is particularly important that overeating be avoided at this time. 5 6 IO T H E R A P E U T I C F A S T I N G L I V I N G A F T E R T H E F A S T T H E PURPOSE OF THERAPEUTIC fasting is to remove the causes of ill health. Once these causes are removed, the various manifestations of disease which were present tend to disappear and the patient is said to have recovered. However, just as faulty living habits created the causes of illness in the first place, so can these same living habits, if continued after fasting, create the conditions which may produce diseases all over again. There is no therapeutic agent of any nature which is certain to offer a permanent remedy of disease if no thought is given to the mode of living after the agent is used. Most therapeutic methods, in fact, fail to preserve health permanently irrespective of the mode of living which follows their use. The suppression of symptoms with drugs, for instance, or the use of vaccine and serum therapy, are not even expected by those who employ them to remove the causes of disease. They are expected to exert important influences which will aid the patient, it is true, but in few instances can their results be expected to be permanent. Thus fasting, though its results are more permanent than is the usual rule in therapeutics, does not make one "disease-proof" in the sense that the conditions which favor the development of disease cannot be built all over 57 again. There are manifestations of disease that disap- pear during the fast and never return, no matter how the patient lives thereafter. There are other diseases that return rapidly after a fast if the mode of living is not correct. The determining factors in such cases are many and involve the character and type of disease present, and its stage of development, as well as the strength and general vitality of the patient. On the other hand, if care is taken to adhere to good living habits, a true con- trol is made over the preservation of good health; per- manence of recovery from specific manifestations of dis- ease may be regarded as probable, and in many cases, virtually certain. There are many theories as to the causes of ill health. These may be grouped into four main categories—chemi- cal, bacterial, mechanical and mental. Whereas it is not to be denied that each of these is of some importance in determining the state of physical well-being, the pre- ponderance of scientific knowledge seems to favor the viewpoint that it is primarily chemistry which dominates the efficiency of physiological functions in the body, with bacterial, mechanical and mental conditions acting chiefly as secondary causes, being dependent upon the initial chemical condition of the body. It is not our object here to go into detail regarding this matter, but simply to state that this assumption as to the causes of disease is generally accepted by physicians who employ fasting and that their consideration of the care of patients after fasting is determined accordingly. Basically the chemistry of the body is determined by nutrition. Sunshine, exercise, fresh air, mental tran- quility, as well as other factors, are also of some impor- tance. The initial intake of minerals, vitamins and other vital elements is made through our consumption of food. Sunshine adds vitamin D and also seems to act as a catalytic agent which creates certain changes in the IO T H E R A P E U T I C F A S T I N G chemistry of the blood, with the calcium and phosphorus content in particular increased during sunbaths. It thus appears that sunshine may induce the secretion of certain hormones or ferments which permit the body to use certain chemicals that it otherwise would not be able to use. Exercise stimulates the functional activities throughout the body, increases the supply of oxygen through deep breathing, and increases the flow of nutri- tive matter to the cells. The purity of air is important, with many harmful toxins being taken into the lungs when the atmosphere of cities is infiltrated with smoke and smog from industrial plants. Emotional reactions may alter the activity of various glands and stimulate or decrease their internal secretions, as the case may be. Defective nutrition after the fast results in part from consuming foods that have been altered chemically during the processes of refining, cooking, canning and pasteurization. Refined foods have lost the greater part of their mineral and vitamin content, and marked amounts of these elements are lost when foods are heated. Even prolonged storage often causes important losses of elements in foods. Many kinds of chemical treatment are also destructive, with the bleaching of flour, vege- tables and other foods, insecticide spraying of many plants, sulphering of dried fruits, and chemical additions to many meats and canned foods having the most marked effects. Many chemicals, in addition to or instead of lowering the food value, give toxic reactions in the body as well, especially when taken in large amounts. In the case of cooking there occur a number of chemi- cal changes which are probably just as important as the losses of minerals and vitamins. Many tissue enzymes are known to be heat-liable; hormones are also affected by heat. Proteins are definitely denatured in the presence of heat, with some of the protein factors rendered much less valuable for nutritive purposes. Fats, especially Living after the Fast 59 those of vegetable origin, often have toxic effects after being heated at very high temperatures. Other activa- ting substances and vitalizing factors are also changed under the presence of heat. The complex chemical bal- ance of all food elements is altered, with the entire physi- co-chemical change being sufficient to produce serious physical impairment among those consuming large amounts of the foods. This is clearly shown, under different conditions, by both animal experiment and human experience. Nutri- tionists maintain white rats, guinea pigs, cats, monkeys and other experimental animals in perfect health by feeding them an exclusive diet of unrefined and uncooked foods in the fresh and natural state. By adding a certain percentage of foods which have been either refined or heated they are able to produce different diseases almost at will—both those of the acute and degenerative types. Eventually, if sufficient cooked foods are included in the diet over many generations, reproduction itself becomes impossible, and the strains of animal stock completely die out. With humans the effects are less severe, but they are nevertheless marked. In the civilized world, the cus- tomary dietary habits have permitted survival but in- sured a very low standard of public health. In spite of the widespread availability of medical services, and our very great improvements in sanitation, many of the de- generative diseases are rapidly increasing in number, and even some of the infectious kinds are becoming more common. What a remarkable contrast we then find among the different primitive racial groups which still retain their native dietary habits, using no refined foods and a smaller percentage of those which have been cooked. Scientists have observed and studied isolated and semi- isolated groups of such people and found them to be IO T H E R A P E U T I C F A S T I N G enjoying a state of health unheard of in civilization. Dental decay is entirely absent; the dental arches are of perfect form and regularity; infectious diseases are quite rare, and many of the degenerative processes are entirely unknown. At the same time chemical analysis of their foods shows a content of minerals and vitamins many times as high as is normally found in modern foods. Some of the typical primitive diets—those of the healthi- est groups—have been found to contain over ten times the amount of fat-soluble vitamins as in the displacing diets, with the proportion of certain minerals being from five to twenty-five times as high. This all finds a very important correlation with the experiences of patients after a period of fasting. Those which once again return to the conventional diet—this largely refined and heat-processed—often receive the surprise and disappointment of seeing their old diseases, which disappeared on the fast, return in the same inten- sity and manner. In the nineteenth century era of fast- ing, when the science of nutrition was in its early ex- perimental stages, physicians often gave little thought to the patient's diet after fasting, and the problem of obtaining a permanent cure was then very real. Today the relation between fasting and nutrition is well rec- ognized, and the usual patient is given careful instruc- tions for eating after the fast. The general nutritional requirement may be stated very simply: to the degree that foods are used in their completely natural state, without treatment or proces- sing, are they adapted to support life and maintain im- munity to disease. It is the purpose of fasting to restore health; it is then the purpose of scientific nutrition, with other hygienic factors, to maintain it. After the fast, the diet should be both unrefined and uncooked to as great an extent as possible. For some patients, com- pletely adequate nutrition may be established; others Living after the Fast 61 will doubtless deviate from the optimum nutritional standard, but all can keep the general goal in mind, and endeavor to follow it as much as the circumstances per- mit. Though correct diet is important as a permanent phase of living after the fast, it is especially so for the first few weeks or months, when the body is regaining normal weight. During this period a very high percentage of nutriment is being absorbed from the food, and if the new protoplasm being built is to be healthy and biologi- cally adequate, the source materials must be of high quality. If reconstruction is made entirely from the same foods which rendered the body ill in the first place, the eventual advantages of the fast may be virtually nulli- fied. Once the body weight is stabilized, and mainte- nance is the only requirement, the food will cease to be so vital a determining factor, though it will still affect the health in a very definite manner and should be select- ed with care. Many are disappointed to learn that permanence of recovery resulting from fasting is very largely dependent upon their manner of living thereafter, with particular emphasis upon dietary habits. The fast is regarded as a sufficiently trying ordeal in itself, without having to undertake special restrictions or health measures there- after. Upon conclusion of the fast, however, such dis- appointment is much less common. The appetite is sharpened, and pleasure is obtained from consuming foods which may formerly have been avoided. In most cases a diet composed entirely of natural foods proves completely satisfying in the post-fasting period. So long as correct nutrition is maintained do the proper foods remain a source of pleasure and satisfaction. There is usually no desire or craving for the commercially denatured and devitalized foodstuffs, and even the want for alcoholic beverages and tobacco may have disappear- IO T H E R A P E U T I C F A S T I N G ed. If change is then made, however, back to a more conventional mode of nutrition, this ceases to hold true and many of the old desires return. Appetite is chiefly a result of habit, and though it may be normalized by fasting, it can again be restored to a condition of ab- normality and perversion, insofar as the associated intake of food supplies, in adequate measure, the nutritional needs of the body. Fasting thus must be recognized only as a means of promoting the remedy of disease and the creation of health. It is not a method of maintaining health. This depends, as it always has, with both man and animals, upon the general hygienic factors of proper nutrition, sunshine, exercise, pure air, etc. The purpose of fasting is basically therapeutic, and in this sense it not only meets the requirements of most patients, but is perhaps the most effective measure ever to be employed. Clearly the extraordinary value of fasting has not been recognized by the professions of healing as a whole. In spite of the careful scientific work done with fasting by physiologists, biologists and physicians, and the almost universal recommendation of the method by these people, orthodox medicine has scarcely recognized that fasting even has therapeutic properties or has been used for any other purpose than a religious rite. The ordinary physi- cian is as completely unaware of fasting as is the layman. Hence the purpose of this short treatise. Here we have covered some of the important points of fasting, which may serve to incite inquiry for further investigation among physician and layman alike, and perhaps to some degree act as a limited guide in the employment of fast- ing for therapeutic purposes. Living after the Fast 63 B I B L I O G R A P H Y 1. ASH, J. E., The blood in inanition. Arch, inter. Med., 14:8-32, July, 1914 2. BASSLER, A., The fasting cure answered. Month. Cycle & Med. Bull. 4:332-334 3. BENEDICT, F. G., The influence of inanition on metabolism. Publications, Carnegie Institution, Wash- ington, 1907 4. BENEDICT, F. G., A study of prolonged fasting. Publications, Carnegie Institution, Washington, 1915 5. C A R L S O N , A. J., The control of hunger in health and disease. Chicago 6. C A R R I N G T O N , H., Vitality, fasting, and nutrition. Rebman Co., 1908 7. CHILD, C. M., Senescence and rejuvenescence. The University of Chicago Press, 1915 8. C L E M M E S E N , C., Inanition and epilepsy: studies on the influence of inanition upon epileptic attacks. Copenhagen, Levin and Munksgaard, 164 pp., 1932 9. DEWEY, E. H., The true science of living. London, Henry Bill Pub. Co., 1895 10. DEWEY, E. H., The no-breakfast plan and the fast- ing cure. London, L. N. Fowler & Co., 1900 11. EHRET, A., Rational fasting. Los Angeles, Ehret Pub. Co., 1926 12. F R A Z I E R , B. C., Prolonged starvation. Louisville Month. J. Med. and Surg., 15:147-254, 1908 13. G O R D O N , A prolonged fast. Montreal Med. J., 36: 482, 1907 14. GUELPA, A., Starvation and purgation in the relief of disease. Brit. Med. J., 2:1050, 1910 6s 15. GUELPA, A., Autointoxication and disintoxication. New York, Rebman Co. 16. H A Y , W. H., Health via food. Sun-Diet Health Foundation, 1929 17. H A Y , W. H., A new health era. Pocan Haven, 1933 18. H A Z Z A R D , L. B., Fasting for the cure of disease. Physical Culture Pub. Co., 1910 19. H A Z Z A R D , L. B., Scientific fasting. New York, Grant Pub., 1927 20. H O W E , P. E. and H A W K , P. B., Nitrogen partition and physiological resistance as influenced by repeated fasting. J .Am. Chemical Soc., 33:215-254, 1910 21. H O W E , P. E. and H A W K , P. B., A metabolism study on a fasting man. Proc. Am. Soc. Biol. Chem., 31, 1912 22. H O W E , P. E. and H A W K , P. B., On the differential leucocyte count during prolonged fasting. Am. J. Phy- siol., 30:174-181, 1912 23. LANGFIELD, H. S., On the psychophysiology of a prolonged fast. Psychol. Monogr., 16:5, 1914 24. M A C F A D D E N , B. A., Fasting for health. Macfad- den Publications, 1923 25. M E L T Z E R , S. and M O R R I S , C. H., On the influ- ence of fasting upon the bacteriological action of the blood. J. Exp. Med., 4:131-135, 1889 26. M E Y E R S , A. W., Some morphological effects of pro- longed inanition. J. Med. Research, 36:51-77, 1917 27. M I N O T , C. S., Senescence and rejuvenation. J. Phy- siol., 12:97-153, 1891 28. M O R G U L I S , S., Contributions to the physiology of regeneration. J. Exp. Zool., 7:595-642, 1909 29. M O R G U L I S , S., Fasting and undernutrition. E. P. Dutton & Co, 1923 30. OLDFIELD, J., Fasting for health and life. London, C. W. Daniel Co., 1924 31. P A T O N , N. D. and S T O C K M A N , R., Observations IO T H E R A P E U T I C F A S T I N G on the metabolism of a fasting man. Royal Soc. Edin- b u r g h , ^ 3,1889 32. P U R I N T O N , E. E., Philosophy of fasting. New York, Lust Pub., 1906 33. SANDS, N. J., Prolonged fasting as a factor in the treatment of acute disease, with special reference to affections of the alimentary canal. N. Y. State J. Med., 4:55, 1904 34. SHELTON, H. M., The hygienic system, vol. 3, San Antonio, 1934 35. SHELTON, H. M., The hygienic system, vol. 7, San Antonio, 1941 36. SINCLAIR, U. P., The fasting cure. M. Kennerly, 1913 37. STERN, H., Fasting and undernutrition in the treat- ment of diabetes. New York, Rebman Co., 1912 38. S Z E K E L Y , E. B., The therapeutics of fasting. Tecate, 1942 39. TILDEN, J. M., Criticisms of the practice of medi- cine. 1909 40. WEGER, G. S., The genesis and control of disease. Los Angeles, 1931 Bibliography 67 I N D E X Acute diseases and fasting, 24, 25 Age and fasting, 25, 26 Anemia and fasting, 18, 19 Appendicitis and fasting, 21 Asclepiades, 3 Autolysis, 9 Avicenna, 3 Bibliography, 65-67 Body changes in fasting, 10-13 Chemistry and nutrition, 58 Heat, maintenance of, 48 Breaking the fast, 53 Causes of disease, 58 Celsus, 3 Completion of fast, 30, 31 Contraindications to complete fast, 32 Damage to food in cooking, 59 Defective nutrition, 59 Deficiency diseases and fasting, 34, 35 Diabetes and fasting, 22, 23 Diet after fasting, 61 Drugs, use of in fasting, 51 Duration of complete fast, 30 Edema and fasting, 26 Efficiency of fasting, 14 Elimination, increase of in fasting, 40 Epilepsy and fasting, 23 Experimental fasting, 4 Eye diseases, fasting in, 17 Fasting, definition of, 1 history of, 3 recognized forms, 1 use of enema in, 50 Hippocrates, 3 Hoffman, 3 Hunger, 39 Hydra, rejuvenation of, 7 Impotence, 43 Liquids after the fast, 55 Living after the fast, 57 Mahatma Gandhi, 8 Mayer, Adolph, 4 Mental hygiene in fasting, 49 Mortality rate and fasting, 37 Nikolai, Anton, 4 Objections to fasting, 34 Origin of fasting, 2 Paracelsus, 3 Permanency of cure, 57 Planaria, experiments with, 6 Plato, 3 Plutarch, 3 Poliomyelitis and fasting, 20 Primitive diets, 60 Pulse rate, changes of, 41 Pythagoras, 3 Reaction, physiological, 6 Recoveries from illness in fasting, 15-25 69 Rejuvenation and fasting, 7-9 Resistance to disease, 35 Respiratory illness and fasting, 17 Rest during fasting, 47 Safety of fast, 33 Sleep during fast, 41 Socrates, 3 Starvation, definition, 29 Strength, increase of, 42 Sunbathing during fasting, 49 Supervision of fast, 47 Symptoms of the fast, 28, 39 Temperature, changes of, 40 Tertullian, 3 The complete fast, 27 Thessalus, 3 Toxins, elimination of, 12 Tumors and fasting, 20, 21 Venereal diseases and fasting, 22 Von Seeland, 4 Water intake and fasting, 50 Weight, loss of, 43 70