Episode 101 - Fasting Precautions

Episode 101: Fasting Precautions.  By Danish Khalid, MS4; and Sapna Patel, MS4. Ross University School of Medicine. Comments by Valerie Civelli, MD; and Hector Arreaza, MD.  Fasting is a healthy lifestyle that may impact your health but fasting is not for everyone. Sapna, Danish, Dr. Civelli, and Dr. Arreaza explain some precautions to be taken in certain populations.  We’ve talked about intermittent fasting, but we need to add a very big caveat: fasting isn’t for everyone. It carries certain risks. Some people who should absolutely not attempt fasting include those severely malnourished or underweight, children under eighteen years of age, pregnant women, and breastfeeding women. And the concern for these individuals involves providing adequate nutrition for normal growth or development. We also have to be cautious in patients with chronic heart problems, renal issues, eating disorders, fragile diabetics, or recently hospitalized patients. This is the Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it’s sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice._________________________ S: The normal growth spurt in puberty requires a tremendous amount of nutrients. Underfeeding during this period may result in stunted growth, which may be irreversible.  D: Or in pregnant women, the developing fetus requires adequate nutrients for optimal growth, and nutritional deficiency may cause irreversible harm during this critical period. It’s for this reason many women take specialty formulated pregnancy multivitamins. S: The same concept applies to breastfeeding mothers. Developing babies receive all their nutrients from the mother. So, if the mom becomes deficient in vitamins and minerals, then the baby may also be deficient. Which again would result in irreversible growth retardation.  D: Others that should take caution when fasting but don’t necessarily need to avoid it include those who have gout, diabetes, gastroesophageal reflux disease, or are taking medications.  For these individuals, it is wise to seek medical advice from a healthcare professional. A: Chances are that you may not find a physician who is pro-fast, but after reading about it and trying it myself, I think it is a safe way to lose weight or maintain a healthy weight.  S: Gout is an inflammatory arthritis caused by excess uric acid in the joints. It can be either due to decreased uric acid excretion through urine or increased production of uric acid through breakdown of nucleic acid. Fasting decreases the elimination of uric acid through urine. Thus, theoretically worsening gout. Now although most patients with a history of gout tolerate fasting without any exacerbation, knowing the potential risk is important.  D: If you have type 1 or type 2 diabetes, it's essential to be particularly careful while fasting or even just changing dietary patterns. This is especially true if you are taking medications. If you continue to use the same dose of medication but reduce food intake, you run the risk of your blood sugar getting low - a situation called hypoglycemia. Symptoms include shaking, sweating, irritability or nervousness, feeling faint, confusion, delirium, seizures, and if left untreated may even lead to death. What is even more worrisome, these symptoms may appear very rapidly, so understanding your body and the cues it provides is essential. Thus, you must consult with your physician to adjust the doses of diabetic medication before starting any dietary program to avoid having any hypoglycemic episodes as they can be potentially life-threatening.  A: The risk of hypoglycemia is high in patients with diabetes who are taking medications, but it’s less likely to happen in patients with obesity without diabetes. The body fat (stores) acts as the fuel for your body functions. Patients will not die if they stop eating.  S: If you have GERD (heartburn) this is oftentimes due to increased pressure on the stomach which forces food and stomach acid back up. This can be made worse during fasting because there is nothing in the stomach to absorb the stomach acid. Sometimes, fasting can improve symptoms because food stimulates the production of stomach acid, so fasting reduces it.  A: My GERD improves with fasting.  D: Patients who are taking regular medication for any condition need close follow-up as certain medications are best taken with meals. The most common medications that cause problems during fasting include aspirin, metformin, iron, and magnesium supplements.   S: Myth: Women shouldn’t fast. One area of specific concern with women is that fasting could affect reproductive hormones, LH and FSH, similar to that seen in anorexia. This can lead to amenorrhea and difficulty conceiving. However, these problems only arise when body fat percentages fall too low. And women with excessively low body fat should not be fasting in the first place. As mentioned earlier, these individuals are severely malnourished and should stop immediately. V: Women: 12-13 hrs. fasting, increase to 1 hr. up to 16 hrs. 8hr feeding window. 6-8 wks. for full benefit.A: Exercise is allowed during fasting. Conclusion: Now we conclude episode 101, “Fasting precautions.” Fasting is safe for most patients but be cautious in certain patients such as pregnant women and diabetics. Make sure you take the necessary steps to avoid side effects or complications during fasting. Even without trying, every night you go to bed being a little wiser. Today we thank Sapna Patel, Danish Khalid, Valerie Civelli, and Hector Arreaza. Thanks for listening to Rio Bravo qWeek Podcast. If you have any feedback, contact us by email at [email protected], or visit our website riobravofmrp.org/qweek. Audio edition: Suraj Amrutia. See you next week! _____________________References:Fung, Jason, MD; and Jimmy Moore. “The Complete Guide to Fasting.” Victory Belt Publishing. 2016. p179-189;199-209. Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at [email protected], or visit our website riobravofmrp.org/qweek. See you next week!