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Original Article · Originalarbeit

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Metabolic and Psychological Response to 7-Day Fasting in Obese Patients with and without Metabolic Syndrome

Li C.a, b · Ostermann T.c · Hardt M.d · Lüdtke R.e · Broecker-Preuss M.f · Dobos G.d · Michalsen A.b, g

Author affiliations

a Department of Traditional Chinese Medicine, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China b Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, c University of Witten/Herdecke, Center for Integrative Medicine, Herdecke, d Department of Complementary and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, e Karl and Veronica Carstens Foundation, Essen, f Department of Endocrinology and Division of Laboratory Research, University Hospital of Essen, University of Duisburg-Essen, g Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Germany

Corresponding Author

Andreas Michalsen, MD, PhD

Zentrum für Naturheilkunde, Immanuel Krankenhaus Berlin

Am kleinen Wannsee 5, 14106 Berlin, Germany


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Forsch Komplementmed 2013;20:413-420

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Background: Extended modified fasting is a frequently practiced tradition in Europe. It is claimed to improve the cardiometabolic state and physical and psychological well-being by an evolutionary co-developed adaptation response. We aimed to investigate the cardiometabolic and psychological effects of a 7-day fast and differences of these responses between patients with or without metabolic syndrome (MetS). Methods: We investigated 30 female subjects (49.0 ± 8.1 years, BMI 30.4 ± 6.7 kg/m2) with (n = 12) and without (n = 18) MetS. All subjects participated in a 7-day fast according to Buchinger with a nutritional energy intake of 300 kcal/day and stepwise reintroduction of solid food thereafter. Outcomes were assessed baseline and after fasting and included measures of metabolic and glucoregulatory control, adipokines as well as psychological well-being as assessed by Profile of Mood States (POMS) and Hospital Anxiety and Depression Scale (HADS). Results: Mean weight decreased from 85.4 ± 18.8 kg to 79.7 ± 18.2 kg accompanied by systolic/diastolic blood pressure (BP) reduction of -16.2 mm Hg (95% CI: -9.1; -23.3 mm Hg) and -6.0 mm Hg (95% CI: -1.8; -10.3 mm Hg), each p < 0.001 and p = 0.005. Fasting led to marked decreases of levels of LDL-cholesterol, leptin, and insulin and increases of levels of adiponectin, leptin receptors, and resistin. Fasting-induced mood enhancement was reflected by decreased anxiety, depression, fatigue, and improved vigor. Patients with MetS showed some greater changes in B P, LDL-cholesterol, triglycerides, adiponectin, leptin, and sleep quality. Fasting was well-tolerated. Conclusions: Our results point to marked beneficial responses to 7-day modified fasting and a potential role in the prevention of the MetS. Randomized trials with longer observation periods should test the clinical effectiveness of fasting in metabolic diseases.

© 2014 S. Karger GmbH, Freiburg


  1. Meshkani R, Adeli K: Hepatic insulin resistance, metabolic syndrome and cardiovascular disease. Clin Biochem 2009;42:1331-1346.
  2. Ford ES, Giles WH, Dietz WH: Prevalence of the metabolic syndrome among US adults: findings from the Third national Health and Nutrition Examination Survey. JAMA 2002;287:356-359.
  3. Redon J, Cifkova R, Laurent S, Nilsson P, Narkiewicz K, Erdine S, Mancia G; Scientific Council of the European Society of Hypertension: The metabolic syndrome in hypertension: European Society of Hypertension position statement. J Hypertens 2008;26:1891-1900.
  4. Lafortuna CL, Adorni F, Agosti F, De Col A, Sievert K, Siegfried W, Sartorio A: Prevalence of the metabolic syndrome among extremely obese adolescents in Italy and Germany. Diabetes Res Clin Pract 2010;88:14-21.
  5. Mattson MP, Wan R: Beneficial effects of intermittent fasting and caloric restriction on the cardiovascular and cerebrovascular systems. J Nutr Biochem 2005;16:129-137.
  6. Michalsen A: Prolonged fasting as a method of mood enhancement in chronic pain syndromes: a review of clinical evidence and mechanisms. Curr Pain Headache Rep 2010;14:80-87.
  7. Michalsen A, Hoffmann B, Moebus S, Backer M, Langhorst J, Dobos GJ: Incorporation of fasting therapy in an integrative medicine ward: evaluation of outcome, safety, and effects on lifestyle adherence in a large prospective cohort study. J Altern Complement Med 2005;11:601-607.
  8. Hartel U, Volger E: Inanspruchnahme und Akzeptanz klassischer Naturheilverfahren und alternativer Heilmethoden in Deutschland - Ergebnisse einer repräsentativen Bevölkerungsstudie. Forsch Komplementarmed Klass Naturheilkd 2004;11:327-334.
  9. Dessi-Fulgheri P, Sarzani R, Serenelli M, Tamburrini P, Spagnolo D, Giantomassi L, Espinosa E, Rappelli A: Low calorie diet enhances renal, hemodynamic, and humoral effects of exogenous atrial natriuretic peptide in obese hypertensives. Hypertension 1999;33:658-662.
  10. Wilhelmi de Toledo F, Gaisbauer M, Hölz G, Kronsteiner W, Kuhn C, Lischka E, Lischka N, Lützner H, May W, Melchart D, Michalsen A, Müller H, Peper E, Resch K-L, Ritzmann-Widderich M, Wessel A, Wichert H, Stange R: Leitlinien zur Fastentherapie. Forsch Komplementärmed Klass Naturheilkd 2002;9:189-198.
  11. Müller H, Wilhelmi de Toledo F, Resch KL: Fasting followed by vegetarian diet in patients with rheumatoid arthritis: a systematic review. Scand J Rheumatol 2001;30:1-10.
  12. Kjeldsen-Kragh J, Haugen M, Borchgrevink CF, Laerum E, Eek M, Mowinkel P, Hovi K, Forre O: Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet 1991;338:899-902.
  13. Müller H, Wilhelmi de Toledo F, Schuck P, Resch KL: Blutdrucksenkung durch Fasten bei Adipösen und nichtadipösen Hypertonikern. Perfusion 2001;14:108-112.
  14. Goldhamer AC, Lisle DJ, Sultana P, Anderson SV, Parpia B, Hughes B, Campbell TC: Medically supervised water-only fasting in the treatment of borderline hypertension. J Altern Complement Med 2002;8:643-650.
  15. Schubmann R: Therapeutisches Fasten bei Adipositas und metabolischem Syndrom. Z Komplementärmed 2009;1:14-17.
    External Resources
  16. Schwartz MW, Seeley RJ: Seminars in medicine of the Beth Israel Deaconess Medical Center. Neuroendocrine responses to starvation and weight loss. N Engl J Med 1997;336:1802-1811.
  17. Palmblad J, Levi L, Burger A, Melander A, Westgren U, von Schenck H, Skude G: Effects of total energy withdrawal (fasting) on the levels of growth hormone, thyrotropin, cortisol, adrenaline, noradrenaline, T4, T3 and rT3 in healthy males. Acta Med Scand 1977;201:15-22.
  18. Michalsen A, Schneider S, Rodenbeck A, Ludtke R, Huether G, Dobos GJ: The short-term effects of fasting on the neuroendocrine system in patients with chronic pain syndromes. Nutr Neurosci 2003; 6:11-18.
    External Resources
  19. Ahima RS, Lazar MA: Adipokines and the peripheral and neural control of energy balance. Mol Endocrinol 2008;22:1023-1031.
  20. Albani C, Blaser G, Geyer M, Schmutzer G, Brahler E, Bailer H, Grulke N: The German short version of ‘Profile of Mood States' (POMS): psychometric evaluation in a representative sample (in German). Psychother Psychosom Med Psychol 2005;55:324-330.
  21. Barth J, Martin CR: Factor structure of the Hospital Anxiety and Depression Scale (HADS) in German coronary heart disease patients. Health Qual Life Outcomes 2005;3:15.
  22. Finucane FM, Luan J, Wareham NJ, Sharp SJ, O'Rahilly S, Balkau B, Flyvbjerg A, Walker M, Hojlund K, Nolan JJ; European Group for the Study of Insulin Resistance: Relationship between Insulin Sensivity and Cardiovascular Disease Risk Study Group, Savage DB: Correlation of the leptin: adiponectin ratio with measures of insulin resistance in non-diabetic individuals. Diabetologia 2009;52:2345-2349.
  23. Malandrucco I, Pasqualetti P, Giordani I, Manfellotto D, De Marco F, Alegiani F, Sidoti AM, Picconi F, Di Flaviani A, Frajese G, Bonadonna RC, Frontoni S: Very-low-calorie diet: a quick therapeutic tool to improve beta cell function in morbidly obese patients with type 2 diabetes. Am J Clin Nutr 2012;95:609-613.
  24. Lützner H, Wilhelmi de Toledo F: Fasten/Fastentherapie. Physiologie des Fastens; in Bühring M, Kemper FH, Mathiessen PF (Hrsg): Naturheilverfahren und unkonventionelle medizinische Richtungen. Berlin, Springer, Loseblatt-System, 1998, pp 1-26.
  25. Steiniger J, Schneider A, Bergmann S, Boschmann M, Janietz K: Effects of fasting and endurance training on energy metabolism and physical fitness in obese patients (in German). Forsch Komplementmed 2009;16:383-390.
  26. Horne BD, May HT, Anderson JL, Kfoury AG, Bailey BM, McClure BS, Renlund DG, Lappe DL, Carlquist JF, Fisher PW, Pearson RR, Bair TL, Adams TD, Muhlestein JB: Usefulness of routine periodic fasting to lower risk of coronary artery disease in patients undergoing coronary angiography. Am J Cardiol 2008;102:814-819.
  27. Oberhauser F, Schulte DM, Faust M, Gudelhofer H, Hahn M, Muller N, Neumann K, Krone W, Laudes M: Weight loss due to a very low calorie diet differentially affects insulin sensitivity and interleukin-6 serum levels in nondiabetic obese human subjects. Horm Metab Res 2012;44:465-470.
  28. Morel O, Luca F, Grunebaum L, Jesel L, Meyer N, Desprez D, Robert S, Dignat-George F, Toti F, Simon C, Goichot B: Short-term very low-calorie diet in obese females improves the haemostatic balance through the reduction of leptin levels, pai-1 concentrations and a diminished release of platelet and leukocyte-derived microparticles. Int J Obes 2011;35:1479-1486.
  29. Teeuwisse WM, Widya RL, Paulides M, Lamb HJ, Smit JW, de Roos A, van Buchem MA, Pijl H, van der Grond J: Short-term caloric restriction normalizes hypothalamic neuronal responsiveness to glucose ingestion in patients with type 2 diabetes. Diabetes 2012;61:3255-3259.
  30. Silva JP, von Meyenn F, Howell J, Thorens B, Wolfrum C, Stoffel M: Regulation of adaptive behaviour during fasting by hypothalamic Foxa2. Nature 2009;462:646-650.
  31. Gohler L, Hahnemann T, Michael N, Oehme P, Steglich HD, Conradi E, Grune T, Siems WG: Reduction of plasma catecholamines in humans during clinically controlled severe underfeeding. Prev Med 2000;30:95-102.
  32. Spark RF, Arky RA, Boulter PR, Saudek CD, O'Brian JT: Renin, aldosterone and glucagon in the natriuresis of fasting. New Engl J Med 1975; 292:1335-1340.
  33. Maoz E, Shamiss A, Peleg E, Salzberg M, Rosenthal T: The role of atrial natriuretic peptide in natriuresis of fasting. J Hypertens 1992;10:1041-1044.
    External Resources
  34. Ahima RS, Prabakaran D, Mantzoros C, Qu D, Lowell B, Maratos-Flier E, Flier JS: Role of leptin in the neuroendocrine response to fasting. Nature 1996;382:250-252.
  35. Lord GM, Matarese G, Howard JK, Baker RJ, Bloom SR, Lechler RI: Leptin modulates the t-cell immune response and reverses starvation-induced immunosuppression. Nature 1998;394:897-901.
  36. Higami Y, Pugh TD, Page GP, Allison DB, Prolla TA, Weindruch R: Adipose tissue energy metabolism: altered gene expression profile of mice subjected to long-term caloric restriction. FASEB J 2004;18:415-417.
  37. Zhu M, Miura J, Lu LX, Bernier M, DeCabo R, Lane MA, Roth GS, Ingram DK: Circulating adiponectin levels increase in rats on caloric restriction: the potential for insulin sensitization. Exp Gerontol 2004;39:1049-1059.
  38. Harvie MN, Pegington M, Mattson M P, Frystyk J, Dillon B, Evans G, Cuzick J, Jebb SA, Martin B, Cutler RG, Son TG, Maudsley S, Carlson OD, Egan JM, Flyvbjerg A, Howell A: The effects of intermittent or continuous energy restriction on weight loss and metabolic disease risk markers: a randomized trial in young overweight women. Int J Obes 2011;35:714-727.
  39. Imayama I, Ulrich CM, Alfano CM, Wang C, Xiao L, Wener MH, Campbell KL, Duggan C, Foster-Schubert KE, Kong A, Mason CE, Wang CY, Blackburn GL, Bain CE, Thompson HJ, McTiernan A: Effects of a caloric restriction weight loss diet and exercise on inflammatory biomarkers in overweight/obese postmenopausal women: a randomized controlled trial. Cancer Res 2012;72:2314-2326.
  40. Jung KJ, Lee EK, Kim JY, Zou Y, Sung B, Heo HS, Kim MK, Lee J, Kim ND, Yu BP, Chung HY: Effect of short term calorie restriction on pro-inflammatory NF-kB and AP-1 in aged rat kidney. Inflamm Res 2009;58:143-150.
  41. Kouda K, Iki M: Beneficial effects of mild stress (hormetic effects): dietary restriction and health. J Physiol Anthropol 2010;29:127-132.
  42. Scherer T, Buettner C: Yin and Yang of hypothalamic insulin and leptin signaling in regulating white adipose tissue metabolism. Rev Endocr Metab Disord 2011;12:235-243.
  43. Piaggi P, Thearle MS, Bogardus C, Krakoff J: Lower energy expenditure predicts long-term increases in weight and fat mass. J Clin Endocrinol Metab 2013;98:E703-E707.
  44. Wadden TA, Fujioka K, Toubro S, Gantz I, Erondu NE, Chen M, Suryawanshi S, Carofano W, Johnson-Levonas AO, Shapiro DR, Kaufman KD, Heymsfield SB, Amatruda JM: A randomized trial of lifestyle modification and taranabant for maintaining weight loss achieved with a low-calorie diet. Obesity (Silver Spring) 2010;18:2301-2310.

Article / Publication Details

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Published online: June 28, 2013
Issue release date: December 2013

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ISSN: 2504-2092 (Print)
eISSN: 2504-2106 (Online)

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