The Nature Cure

by Andreas Michalsen

  FASTING STRENGTHENS IMMUNE DEFENSE

  Children possess the natural impulse to refuse food when they are sick, such as with the flu. Parents then often try—with good intentions—to cajole them: “You have to eat, you need to get your strength back!” Scientific studies, however, have shown that fasting during sickness doesn’t weaken a person but instead stimulates immune defenses. In 2016, immunologists at Yale University led by Ruslan M. Medzhitov were able to prove that the immune system fights bacteria more efficiently during periods of fasting. This is likely due to the increased number of ketone bodies our body produces when there is a lack of energy, i.e., hunger during fasting. Not so for viruses: Here, the immune cells require energy from glucose to fulfill their defensive function. “Feed a cold and starve a fever,” as the saying goes. In short, fasting helps against feverish and purulent infections.

  Physicians throughout the ages, from Hippocrates to Kneipp, have observed that refraining from eating—as long as it’s not overdone—can promote health. The latter said: “When you notice that you have eaten, you have already eaten too much.” When I started to research naturopathic traditions around the world, I observed that fasting is practiced in all cultures. It’s fascinating that so many therapeutic methods from around the globe can be strikingly similar, often without the existence of direct contact or exchange. This is similarly true for cupping as a way to treat pain.

  The Japanese city of Okinawa is one of the legendary “blue zones” where people on average live to an especially old age. In Okinawa, the rule is that one should only eat until one is about 80 percent full—“Hara hachi bun me.” There is a similar saying in Traditional Chinese Medicine: “Chi fan qi fen bao, san fen han”—if you want to stay healthy, you should “only eat until you are 70 percent full and wear only a third of the clothes you would want to put on.” In Ayurveda, there is the principle that you should fill one third of the stomach with liquid, another third with food, and leave the rest empty.

  FASTING REGULARLY MEANS LIVING A HEALTHIER AND LONGER LIFE

  As a resident, I watched as almost all patients with chronic diseases who were admitted to the naturopathic ward of the Moabit Hospital underwent periods of fasting. Among those diseases were, as I mentioned before, diabetes, high blood pressure, rheumatism, enteropathies, and many pain syndromes, in particular migraines, arthroses, and back pain. I quickly realized that therapeutic fasting is much more than just the absence of food. The applied fasting technique is a sophisticated system of specific meals, accompanied by therapies such as liver compresses and Scotch hose treatments as well as baths, exercise, and breathing techniques. Special emphasis was put on the correct way to transition into fasting and then back to normal eating afterward. To transition to fasting slowly and gently, we start with relief days where patients eat fruit or rice to prepare the body and bowel. Fast-breaking correctly is even more important, and involves a careful, step-by-step build-up to meals with a normal number of calories. Patients would often revel in their first bite after fasting, a small ritual celebrated by mindfully chewing freshly cut pieces of apple.

  For people who are fasting for the first time, this moment is surprising—how incredibly delicious and stimulating eating a piece of apple can be! This sensation is an important motivating factor for eating healthfully and moderately later on because a good opportunity presents itself after fasting: All senses, particularly the taste receptors, are especially alert and sensitive. Something that may have tasted good before, such as salty sausage or fatty pizza, now seems overly seasoned and hard to digest. Thus, the transition after fasting, which is best done over the course of three days, is very important.

  Since I didn’t know this when I was a student, my first attempt at fasting—a self-experiment, so to say—went awry. I had decided, with my girlfriend at the time, to undergo a small fasting cure in our apartment in Kreuzberg. We prepared the juices and soups properly. But after the period of fasting ended on the sixth day, we were impatient and celebrated the fast-breaking with pizza. We followed the pizza with cake and coffee. The rest of the day was spent with stomachaches and nausea.

  When you look at the tongue, face, and complexion of people who are fasting, you can observe the wonderful effect of this treatment. The facial muscles loosen, connective tissue is drained of excess water, and skin is soothed. In patients with back pain it’s possible to see how much the tissue has relaxed by looking at the connective tissue and the back muscles. In many patients, back pain that had persisted for months or even years disappears completely within days.

  One should not confuse fasting with dieting for weight loss—weight reduction is only a side effect of fasting. Fasting is not about reducing calories—if you simply eat less, the effect is not the same as fasting. Fasting is about using food deprivation to expose the body to small doses of stress, which leads to a stimulus reaction that detoxes the body and regulates it anew.

  Only in recent years has therapeutic fasting finally received scientific recognition. Shortly before December 2015, my colleagues at the Charité and I invited Valter Longo to come to the Max Delbrück Center in Berlin to deliver a guest lecture. Longo holds one of the most important professorships for gerontology—the study of aging—at the University of Southern California. The lecture hall was packed. Mesmerized, many scientists considered the data presented by Longo. Over the course of many years, Longo had been conducting systematic research on the effect of eating less and fasting in numerous experiments on bacteria, baker’s yeast, worms, and rodents. What emerged at the end of this elaborate (due to its many small, isolated parts) research were astonishingly consistent results. His finding was that there is a method by which all living organisms on Earth can prolong their lifespan and remain as healthy as possible while doing so—by fasting at regular intervals or, as an alternative, by refraining from eating one’s fill every day and instead reducing the intake of calories by about 20 to 40 percent.

  PATIENT HISTORY

  Rheumatism

  Fasting Changes Lives

  Pale skin; short, dark hair; heavy shadows under her eyes. About fifty years of age, this patient was a doctor herself. Rheumatoid arthritis had attacked her unexpectedly; her slender fingers were swollen and aching. She could no longer perform surgery. Over the course of a lengthy conversation in which her patient history was taken, this woman revealed many worries. She had been trapped in a years-long, expensive divorce battle with her husband. The practice she had opened with another doctor was in a lot of debt. The patient talked about stress, loneliness, and existential fear.

  The rheumatologist prescribed the cytotoxin Methotrexate (MTX) and cortisone. Both drugs can be highly effective in treating rheumatoid arthrosis—but for this patient, her condition didn’t improve by taking them. She did, however, suffer from the severe side effects the strong medication entailed. That’s why she came to our internistic-naturopathic department.

  I asked the patient whether she would be willing to fast. She hesitated and asked if that wasn’t utter nonsense. She also wasn’t sure if she would be able to manage it. Ultimately, though, she was willing to try. After only a few days, the swelling of her hands subsided—a common effect. Her mood improved, which in turn had positive effects on her overall health and well-being.

  After completing the fasting cure, the patient completely changed her diet. Today, she only eats meat or fish about once every two weeks. Moreover, she has been seeing a therapist about the conflicts in her life, in particular about the question of what money and her standard of living are worth to her. These conversations can’t necessarily solve problems, but they can help patients learn to examine their priorities and reduce the pressure they put on themselves.

  The patient’s rheumatologist had originally told the patient that she would have to come to terms with the fact that she wouldn’t be able to stay in her job for much longer. Her disease was chronic and would only get worse. But things turned
out differently. Though she stopped taking the MTX and cortisone, the patient is completely pain-free today. It’s only when the stress around her becomes too overwhelming that the swelling of the fingers returns, if only temporarily. That’s why the patient made the decision to leave the conflict-ridden practice she shared with another doctor and to go back to leading her own, smaller practice. Of course, the disease lies dormant within her still, but the patient has found a way for herself to keep it in check. X-rays of her joints show no damage today, three years after her first fasting treatment.

  AN EXPERIMENT WITH A SURPRISING OUTCOME

  Valter Longo was mentored by Roy Walford, the very physician and pathologist who had, together with seven other scientists, lived in a domed building in the Arizona desert, completely isolated from the outside world, for two years starting in 1991. The project, “Biosphere 2,” which came to international fame, had been financed by an investor and was meant to test whether an artificially created ecosystem could sustain itself. NASA supported it, because they thought it might shed light on whether it would be possible to populate inhospitable planets like Mars.

  But the experiment failed miserably. The concrete construction of the habitat absorbed oxygen, so air soon became scarce and had to be pumped in from the outside. Then there were problems with cockroaches and spiders. But most devastating of all, the crops of vegetables, fruits, and grains turned out worse than expected. And so, the first two years of “Biosphere 2” meant two years of hunger for the participants.6

  Valter Longo was there when the scientists left the compound, exhausted and emaciated. Yet even though Roy Walford and his colleagues were only skin and bones, medical examinations showed that they were not malnourished. Almost all the risk parameters—from blood pressure to cholesterol levels—had reached an incredibly low and healthy level. Longo was so impressed that he decided to dedicate his time to gerontology instead of playing jazz guitar (a passion that the two of us share).

  After his experience with “Biosphere 2,” Walford began advocating a restriction of calories, i.e., a permanent state of slight starvation, as an effective way of reaching one hundred twenty years of age (he himself died at seventy-nine from the genetic disease ALS, which is a considerable age for sufferers from this illness). A community of adherents to this lifestyle was formed, the CRONERs (Calorie Restriction with Optimal Nutrition), some of whom continue to practice the principle of daily calorie restriction, among them Walford’s daughter, Lisa. I met her in Mumbai in 2008, at the ninetieth birthday celebration of the Indian yoga guru B. K. S. Iyengar. Lisa is a well-known yoga instructor in the United States and has barely an ounce of fat on her body. On average, CRONERs eat 1,800 calories a day (instead of the standard 2,000 to 2,500 calories).

  THE HEALING EFFECT OF INTERMITTENT FASTING

  Calorie restriction, however, poses a number of problems: If you’re malnourished for a prolonged period of time, you pay the price of mood swings, a pronounced sensitivity to the cold, and low fertility. The constant reduction of calories is hardly appealing to most people. Malnutrition is a potential problem, and for some strict followers it’s possible that anorexia is hiding behind the lifestyle. Valter Longo also realized that a permanent reduction of calories is not a very feasible path. So, he and his colleague Luigi Fontana began looking at alternatives. In experiments involving animals, they showed that it’s not necessary to starve oneself constantly. It’s enough to fast intermittently. The scientists tested different options, such as the Every-Other-Day Diet: The test animals, rats in this case, were allowed to eat as much as they wanted for one day. On the next day, they had to fast. The rats would continue eating in this alternating pattern: eating without restriction one day, fasting the next. This caused neither weight loss nor malnutrition, but prevented most diseases of affluence. Not only did the test animals that had to undergo this intermittent fasting not suffer from diabetes or hypertension, they also had very low risk of heart attacks and strokes and were much less affected by neurological diseases such as multiple sclerosis, dementia, or Parkinson’s. Their risk of getting cancer was significantly minimized.7

  DELIBERATE FASTING IMPROVES CANCER TREATMENT

  Back to Valter Longo’s presentation at the Max Delbrück Center: What was especially impressive about Longo’s data was how it showed that in animals already affected by cancer, the progression of the tumors slowed down when the animals practiced intermittent fasting, and they ultimately lived longer. Longo was careful to emphasize that these findings from experiments on animals could by no means be simply transferred to humans. Yet he did put forward the thesis that chemotherapy and radiation might be more agreeable and less fraught with side effects when accompanied by intermittent fasting. He called this “differential stress resistance.”

  What does this tell us? Our somatic cells can manage food deprivation well—at least for a certain period of time. These cells possess a centuries-old program that was necessary for survival since food wasn’t always available. As a book title by Detlev Ganten, the long-serving CEO of the Charité Hospital, calls it: Die Steinzeit steckt uns in den Knochen (The Stone Age Is in Our Bones). Taking meals three times a day, perhaps with a snack or two in between, is measured against the long phase of our evolution, a very modern cultural achievement—and very unhealthy.

  In evolutionary history, it was the rule that if there was food available, one had to eat it quickly before it perished or someone else came to steal it away. For long periods of time, hunger would be the norm. Winters in particular were barren and were survived by sleeping a lot and eating very little. Our genes, our protein synthesis, and our hormones are, as I have already mentioned, well adapted to this ever-changing program. As soon as energy input by way of food is curbed and this state persists for more than twelve to fourteen hours, our healthy somatic cells begin to enter a mode of protection in which cell growth and metabolic activity are throttled. They enter a state of hibernation, if you will, a kind of standby, which can also protect them like a shield from external attacks such as poisons.

  This cell behavior gave Longo the idea to break a taboo: He suggested fasting as a form of cancer treatment. Until then, oncologists had agreed that cancer patients should be safeguarded from weight loss, since weight loss constitutes a bad prognosis in cancer patients. But Longo and his team presumed that during a short period of fasting, healthy cells would actually become more resilient to chemotherapy. This would mean less nausea, less diarrhea, less damage to the nerves, and a higher quality of life.

  Cancer cells, on the other hand, are programmed by their oncogenes to grow uncontrolled and uninhibited. Oncogenes are characteristic gene mutations that enable cancer cells to grow fast, without the need for growth stimuli. Unlike healthy somatic cells, cancer cells don’t observe stop signals. While the normal somatic cell switches to an ancient protection mode during periods of fasting, the cancer cell “ignores” the state of deficiency and continues to grow unchecked. In this state, the cancer cell becomes particularly vulnerable to chemotherapy, while the healthy somatic cell suffers less damage. Through fasting, chemotherapy and possibly even radiation may become more selective and thus less fraught with side effects.8, 9

  At least, that’s the theory. Whether cancer cells really become more vulnerable through fasting can only be shown after years of research. However, the question of whether fasting makes healthy cells more resilient against chemotherapy was examined in a pilot study by our research team at the Charité and the Immanuel Hospital in Berlin. It started in 2014. We included thirty-four patients who were diagnosed with breast or ovarian cancer and who planned to undergo chemotherapy. Most of them needed to undergo six scheduled treatments. At random, we instructed them to fast for at least thirty-six hours before the start of each of their first two or three rounds of infusion and to eat normally during the other two to three rounds of infusion. With elaborate questionnaires on quality of life and side effects, we gathered information on t
olerance to chemotherapy.10

  The results of our study were consistent with the results of Longo’s animal experiments: When they were fasting, patients were better able to tolerate the rounds of chemo and their quality of life was only slightly diminished. During the rounds with a normal intake of food, on the other hand, their condition was worse and their quality of life diminished significantly. In conclusion, many of the patients experienced the positive effects of fasting so clearly that they decided to continue fasting should chemotherapy become necessary again after the study had finished.

  Still, the subject of fasting and cancer requires caution. Next, we would like to answer the question of whether fasting actually makes cancer therapy more tolerable in a large-scale study and with the data of one hundred forty patients. More data would help us explore this subject more thoroughly. For example, maybe following a low-calorie diet and refraining from eating animal proteins and sugar has the same effect as fasting during chemotherapy or radiation. Only future studies can provide clear answers.

  That said, two initial, smaller pilot studies with humans seemed to confirm Valter Longo’s theory. In these studies, Longo’s own research team and scientists from Leiden University showed that fasting during chemotherapy makes side effects less severe by ensuring less damage to the genetic substance of somatic cells and impairing blood formation in the bone marrow to a lesser extent.11 Whether fasting helps the human body fight cancerous cells better can only be clarified in long-term studies.