The Nature Cure

by Andreas Michalsen

  Specific hormones and foods presumably also play a role in the potential cancer-preventing effect of fasting. Many epidemiological studies attest to the carcinogenic effect of animal proteins.12 That’s why meats and, in particular, sausages were classified as carcinogenic by the World Health Organization in 2015. Numerous animal studies have demonstrated that sulfur-containing animal proteins like methionine and cysteine are carcinogenic—but methionine and cysteine in the body can be reduced by fasting at regular intervals and following a vegan diet.13

  Sugar also seems to play a significant role in the metabolism of cancer cells. When we cut sugar and quickly resorbable carbohydrates (such as white flour and alcohol) from our diet, we lower the blood levels of insulin and IGF-1, two factors that affect cancer growth. IGF-1 levels can also be lowered substantially through repeated fasting.14 Additionally, fasting or giving up carbohydrates leads to the production of ketone bodies, which have an anti-inflammatory and antiproliferative effect.15

  HOW THE BODY CLEANSES AND DETOXES ITSELF

  The positive effects of fasting are thought to be the result of two things that occur in the body: ketone metabolism and autophagy.

  When we starve or fast, our metabolism adapts within a few days and slows itself down—it uses less energy. In order to maintain important body functions, we draw upon our body’s “storage”—first glycogen in the liver, then fat in the fat stores, and to a lesser extent protein in the muscles and connective tissue. When this happens, our body releases molecules called ketone bodies. Ketones are essentially a second fuel source for cells and the brain. You can detect ketone increase after a few days of fasting by a slight smell of acetone in the breath.16

  Ketone bodies are also produced during exercise, when fat is burned. Fasting and exercise show surprising similarities here. One of the best ways to prevent degenerative brain diseases like Parkinson’s or dementia might be running or walking in a park before breakfast, after fasting overnight.17 Both fasting and exercise also improve our cognitive ability. Scientists at the University Hospital of Schleswig-Holstein discovered that ketone bodies not only nourish the brain, they also protect the brain from inflammatory cells (which play an important role in degenerative brain diseases).18

  A prolonged ketogenic diet—a diet in which one eats very few carbohydrates—however, can feel joyless. Even though the ketogenic diet is quite popular at the moment, most people can’t imagine a life completely devoid of bread, pasta, rice, potatoes, or sweets. Ultimately, we need proteins and fats to meet our energy requirements. And that’s where it’s hard to avoid animal products. But in the long run this is counterproductive, because animal proteins are a harmful factor for most diseases of affluence and for cancer.

  At the moment, there is some speculation as to whether it’s possible to augment ketone balance by consuming coconut oil and palm oil. Coconut and palm oils contain up to 10 percent of medium-chain fatty acids that can be metabolized directly in the liver and lead to the creation of ketone bodies. For a long time, coconut and palm oils were considered unhealthy since they contain a lot of saturated fatty acids, more than butter or meat. But these saturated fatty acids may need to be evaluated differently from a health perspective and might not be as unhealthy as animal saturated fats. Yet whether this outweighs the disadvantages is still questionable. According to most existing studies, the consumption of ample amounts of coconut and palm oils leads to an increase of LDL cholesterol, which is detrimental to a healthy heart.19 In my opinion, we need to wait for the results of further studies on the matter. At this time, I would not advise consuming large quantities of either coconut or palm oil.

  IT’S NOT ABOUT WHAT YOU EAT BUT WHEN YOU EAT

  When Yoshinori Ohsumi won the 2016 Nobel Prize in Medicine it was a surprise to many, but others thought the recognition was long overdue. Ohsumi, a Japanese scientist specializing in autophagy (from the Greek, meaning “self-devouring”), discovered that somatic cells possess a kind of recycling program that enables them to deconstruct old, damaged, or incorrectly folded proteins into the smallest structures (organelles) and then rebuild them into new complexes. Over years of experiments, Ohsumi was able to show that a cell recognizes when parts of itself have stopped functioning, and that the cell consequently surrounds the nonfunctioning area with a skin (lysosome) and dismantles it piece by piece with the aid of enzymes. This process is initiated in instances where the cell is in distress—during fasting, for example. That’s when the cell deconstructs components that have become unnecessary in order to release energy. This energy is then used to form urgently needed molecules. About thirty-five genes control the process of this internal digestion.

  Frank Madeo from the University of Graz is one of the world’s experts in the field of autophagy. The German-Italian gerontologist has been researching the chains of signals that lead to autophagy in the body. The recycling process, he found, is set in motion when the body isn’t producing insulin. The pancreatic hormone that is released after every meal puts a stop to the molecular autophagy machinery.20

  The biologist Satchidananda Panda at the Salk Institute in La Jolla, California, conducted an experiment on this topic. He fed high-fat food to mice around the clock. The mice developed fatty livers and released high amounts of insulin until their pancreases were exhausted, and they subsequently developed diabetes. During this process, the mice developed the same kind of inflammation that is also involved in arteriosclerosis in the vessels. A second group of mice were fed the exact same number of calories as the mice in the first group—but only over the course of eight hours a day. Surprisingly, those animals stayed slimmer and healthier for much longer.21

  Findings like these show that it’s not only about what you eat, but how you eat. In his work, Madeo draws the conclusion that we should reduce the number of our daily meals to a minimum—because the cells need time to cleanse themselves. There’s not enough time for cells to “cleanse” if the body is constantly releasing insulin as a reaction to food.

  As we have seen, a permanent reduction of calories may be joyless, and a meat-heavy ketogenic diet over a long period of time is counterproductive. Research into autophagy and the metabolism of insulin and growth hormones, however, indicates that there’s a promising alternative: intermittent fasting. That is, going hungry at regular intervals. By not consuming any calories (including in liquid form) for fourteen to sixteen hours a few times a week, you can achieve a positive health effect.22

  Autophagy might even contribute to preventing degenerative geriatric diseases. Madeo and his team discovered, rather by accident, a substance that stimulates the cellular cleansing process, even when there is insulin coursing through the bloodstream. This substance is spermidine, a liquid that is found in all somatic cells, but particularly in sperm cells. Spermidine diminishes with age. In elaborate experiments, the scientists in Graz fed yeast cells, and subsequently worms, fruit flies, and mice with spermidine. These organisms lived longer than control groups.

  Madeo discovered that spermidine slows down cell aging by stimulating autophagy. In fruit flies, spermidine also increases brain performance. Since in patients with Alzheimer’s disease it’s the proteins that agglutinate and thus incapacitate nerve cells, scientists are looking for mechanisms that reactivate the cell’s cleansing processes—the aim is to use the cell’s cleansing process to stop further damage to brain cells.23 But a lot more research is necessary in order for us to confirm whether spermidine might help the human brain.

  THE TIMING OF MEALS IS THE KEY

  The times at which we eat are crucial. In the to-go society we live in, we often don’t pay attention to when we take our meals. Yet it is important to not eat uncontrolled all day long, but to restrict yourself to two proper meals a day if possible.

  The bowel needs breaks to repair itself: The digestive tract moves in a succession of muscle contractions that extend from the stomach over the entire small intestine and parts of the la
rge intestine in varying phases of intensity. After eating, the gastrointestinal system is inactive so that the food can be macerated. After that, contractions set in at irregular intervals and finally culminate in powerful movements. Like brushstrokes they “sweep” the entire digestive tract in order to cleanse it of food residue. This is called the housekeeper effect. It’s this cleaning process that we experience as our stomach rumbles, because air is pressed through the pyloric orifice and causes turmoil. The entire process lasts for up to two and a half hours and is repeated as long as nothing is eaten. The process is interrupted whenever we eat—whether that be treats and nibbles or healthy snacks.

  Personally, I try to maintain a period of fourteen hours without any food consumption every day. It’s actually not that hard, because I sleep for the majority of that time. Some people omit their dinner; but to me it’s important to sit down at the table with my family in the evenings. So instead, I don’t eat breakfast and have my first meal at lunch. Until lunch, I avoid snacks and drink a black espresso at most—Frank Madeo, by the way, found out that this increases the level of spermidine in the body—finally some good news on the topic of coffee!24

  HEALING THROUGH RESTRAINT

  The positive effects of fasting begin after a period of fourteen to sixteen hours. You get those positive effects whether you fast consistently every night, or maybe one entire day a week, or seven to fourteen days with medical supervision—as long as you do it right.

  I’ve witnessed the positive effects of fasting time and again, both during my training and in my everyday work with patients. An immediate effect can be observed particularly in cases involving rheumatoid diseases. Fasting as a therapy for rheumatism had already been scientifically proven and published in 1990, but still, to this day many rheumatologists are unaware of it. Instead of using fasting as a supplementary therapy for its anti-inflammatory effect, they prescribe cortisone or antirheumatic drugs like Ibuprofen and Diclofenac to relieve the pain. These drugs do make it easier to live with rheumatism, but over time they produce severe side effects.

  A Scandinavian research team headed by the Norwegian physician Jens Kjeldsen-Kragh randomly assigned patients with rheumatoid arthritis into two groups: One group was conventionally treated while the second group underwent a ten-day fasting cure, followed by a vegan and subsequently vegetarian diet. After one year, the second group showed a significant decline in pain, and the swelling of their joints receded, as did joint stiffness. The effect was proven in three further studies, and in 2002, a (summarizing) metanalysis on the subject was published, an important milestone on the path to scientific corroboration.

  Studies like these led us to schedule therapeutic fasting as a central therapy during my time as deputy director of the Dr. Köhler-Parkklinik rehabilitation clinic in Bad Elster. Most of the patients there suffered from chronic pain disorders and rheumatic diseases. We recommended a fasting cure for almost everyone. In the neighborhood, we came to be known as the “Fortress of Starvation.” When I left the clinic at night to go home, I often saw taxis waiting to ferry our supposedly fasting patients over to restaurants. From witnessing this, I learned that it’s crucial a fasting cure isn’t prescribed from above but is done voluntarily and carried through by a person’s own motivation.

  During this same time, I also began to conduct systematic research into therapeutic fasting. Dr. Gustav Dobos and I entered into a collaboration with the brain researcher Gerald Hüther to gain further insight into the role of stress hormones during fasting. Earlier, Hüther had found in experiments on animals that a reduction of food supply over a period of time led to an increased availability of serotonin—the “happiness hormone”—in the brain.25 I was able to observe this effect in my patients: The first couple of days of fasting were hard on them, and some were plagued by circulation issues or headaches. But after three to four days everyone was in high spirits! Their pulse slowed down and their blood pressure sank—clear signs of relaxation.

  I was, however, somewhat baffled when tests of our patients’ urine showed that stress hormones also rose during fasting. Nevertheless, the result was unambiguous, and we published it in the journal Nutritional Neuroscience. It was only later that science explained this phenomenon with the concept of hormesis. Today I understand that we’re dealing with a controlled stress here, a eustress in the original sense of the word, which induces a healthy reaction in the body, as the subsequent work of Longo, Fontana, and Madeo shows in detail.

  THE FASTING CURE IS NOT A DIET

  Even though the biological process is called “hunger metabolism,” the feeling of hunger is rare in fasting and only occurs during the first two to three days. Moreover, people sleep better while fasting. So fasting, especially under medical supervision, is easier than many patients think.

  Some people are concerned about the possibility of fasting triggering health issues. One allegation that is frequently brought up is that fasting damages the heart muscle and causes it to deteriorate. This can be disproven, as the basis for this claim comes from 1960s-era cases in the United States, in which severely obese patients were put on calorie-free diets or diets of protein shakes for several months. Neither things are healthy, and have nothing to do with the fasting cure as practiced by naturopathy.26

  The second allegation against fasting is the claim of the yo-yo effect, which says that the successes of fasting are nullified because patients who lose weight would just put the weight back on again afterward. This effect can be seen in many diets that use more or less arbitrary strategies to reduce weight. Studies show that weight loss diets, no matter what logic they follow, lead to weight gain over a prolonged period of time.27 But when it comes to therapeutic fasting, this seems to be different: The observational studies currently available did not detect a yo-yo effect.28

  Of course, patients who fast also generally put some of the weight they had lost back on. This is partly caused by how our tissues—based on salt intake—store water. During fasting we usually lose one or two kilos of water, which is essentially “washed out,” but which returns to a certain extent after fasting. Some people also put fat mass back on again. After the period of calorie restriction the body initially has a lower demand for energy since it has slowed down many of its “production processes” and the “operating temperature” is also lowered. So if we subsequently eat with a voracious appetite, the lost pounds quickly return. But through correctly guided therapeutic fasting, nutritional awareness changes, which is why we don’t find any indications of yo-yo effects in our ongoing collection of data. Some of the people who fast every year reach their initial weight from the year before after twelve months, but this can be classified as a success, because in Europe and the United States it’s the rule that we gain weight every year after the age of forty.

  THOSE WHO PREVAIL REAP SUCCESS

  Naturally, willpower is part of fasting. In my native Swabia, Swabian pockets were invented for the sole purpose of hiding meat in them (to be eaten surreptitiously) during religious fasting periods. The history of the art of brewing stouts in monasteries is also related to this cunning evasion of the dictates of Lent. Human nature reveals itself when it comes to fasting. But by now, plenty of scientific studies have demonstrated the enormous potential of fasting as a therapeutic method. Only ten years ago, I got nothing but condescending smiles from my colleagues when I suggested fasting as a therapy for their patients. Today, I’m met with great curiosity and willingness.

  The healing potential of fasting was explored in a documentary called The Science of Fasting a few years ago by the French filmmakers Sylvie Gilman and Thierry de Lestrade. They interviewed physicians who specialize in fasting cures as well as patients at the Immanuel Hospital in Berlin. There are about one thousand patients who fast at the Immanuel Hospital every year, but therapeutic fasting has also played a vital role at my previous worksites—the Dr. Köhler-Parkklinik in Bad Elster, the Moabit Hospital in Berlin, and the Universit
y Hospital in Essen. Over the years, I’ve accompanied approximately twenty thousand fasting patients and observed the progress of their illnesses—people afflicted with rheumatism, diabetes, hypertension, and increasingly also with multiple sclerosis and Parkinson’s disease, with irritable bowel syndrome, and all sorts of different food allergies.

  IS IT POSSIBLE TO DETOX THE BODY?

  When you fast, especially for the first time, you should do so under medical supervision. And even under medical supervision, caution is necessary. Some private clinics earn a lot of money marketing detox cures. I find these practices very troubling. A lot of people have misguided ideas about “toxins.” It’s always about dosage, about how a substance affects the body, and generally, our body has the ability to deal quite expertly with pesky substances in small doses, as illustrated by hormesis.

  But of course, there are a great many environmental toxins, and their negative influence only comes to light when the substances have already been in the environment for a while. We know today that fine particles in the air create a significant risk for cardiovascular diseases.29 Despite numerous studies conducted on the matter, the question of what amalgam does within the body is uncertain.30 And without a doubt it’s better to limit the amount of pesticides we ingest by opting for organic foods. Just like the pollution of water from lead pipes that we’ve tried to control, we should refrain from using plastic water bottles if possible. But we can’t protect ourselves from environmental toxins completely; they are too widely disseminated already—in the air, the water, and the soil.

  But it’s possible that for many of those who feel they’ve been exposed to too many pollutants, it’s not actually the substances themselves that are bothering the body, but rather stress, years of maintaining an unhealthy diet, and exercising too little. We know from research on hormesis that small doses of toxic substances aren’t necessarily harmful to the body. But where is the individual limit, or at what point are we indeed dealing with a disease caused by environmental toxins? It’s difficult to determine this in individual cases, and it’s even more difficult to answer the question of whether there is a detox method.