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. 1982 Nov;137(5):379–399.

Fasting: The History, Pathophysiology and Complications

Peter R Kerndt 1,2, James L Naughton 1,2, Charles E Driscoll 1,2, David A Loxterkamp 1,2
PMCID: PMC1274154  PMID: 6758355

Abstract

An appreciation of the physiology of fasting is essential to the understanding of therapeutic dietary interventions and the effect of food deprivation in various diseases. The practice of prolonged fasting for political or religious purposes is increasing, and a physician is likely to encounter such circumstances. Early in fasting weight loss is rapid, averaging 0.9 kg per day during the first week and slowing to 0.3 kg per day by the third week; early rapid weight loss is primarily due to negative sodium balance. Metabolically, early fasting is characterized by a high rate of gluconeogenesis with amino acids as the primary substrates. As fasting continues, progressive ketosis develops due to the mobilization and oxidation of fatty acids. As ketone levels rise they replace glucose as the primary energy source in the central nervous system, thereby decreasing the need for gluconeogenesis and sparing protein catabolism. Several hormonal changes occur during fasting, including a fall in insulin and T3 levels and a rise in glucagon and reverse T3 levels. Most studies of fasting have used obese persons and results may not always apply to lean persons. Medical complications seen in fasting include gout and urate nephrolithiasis, postural hypotension and cardiac arrhythmias.

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Selected References

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  1. Adibi S. A. Metabolism of branched-chain amino acids in altered nutrition. Metabolism. 1976 Nov;25(11):1287–1302. doi: 10.1016/s0026-0495(76)80012-1. [DOI] [PubMed] [Google Scholar]
  2. Azizi F. Effect of dietary composition on fasting-induced changes in serum thyroid hormones and thyrotropin. Metabolism. 1978 Aug;27(8):935–942. doi: 10.1016/0026-0495(78)90137-3. [DOI] [PubMed] [Google Scholar]
  3. BECK P., KOUMANS J. H., WINTERLING C. A., STEIN M. F., DAUGHADAY W. H., KIPNIS D. M. STUDIES OF INSULIN AND GROWTH HORMONE SECRETION IN HUMAN OBESITY. J Lab Clin Med. 1964 Oct;64:654–667. [PubMed] [Google Scholar]
  4. BLOOM W. L. Fasting as an introduction to the treatment of obesity. Metabolism. 1959 May;8(3):214–220. [PubMed] [Google Scholar]
  5. Beumont P. J., George G. C., Pimstone B. L., Vinik A. I. Body weight and the pituitary response to hypothalamic releasing hormones in patients with anorexia nervosa. J Clin Endocrinol Metab. 1976 Sep;43(3):487–496. doi: 10.1210/jcem-43-3-487. [DOI] [PubMed] [Google Scholar]
  6. Bistrian B. R., Blackburn G. L., Stanbury J. B. Metabolic aspects of a protein-sparing modified fast in the dietary management of Prader-Willi obesity. N Engl J Med. 1977 Apr 7;296(14):774–779. doi: 10.1056/NEJM197704072961402. [DOI] [PubMed] [Google Scholar]
  7. Bistrian B. R. Clinical use of a protein-sparing modified fast. JAMA. 1978 Nov 17;240(21):2299–2302. doi: 10.1001/jama.1978.03290210081040. [DOI] [PubMed] [Google Scholar]
  8. Blackburn G. L., Bistrian B. R., Maini B. S., Schlamm H. T., Smith M. F. Nutritional and metabolic assessment of the hospitalized patient. JPEN J Parenter Enteral Nutr. 1977;1(1):11–22. doi: 10.1177/014860717700100101. [DOI] [PubMed] [Google Scholar]
  9. Bloom W. L., Azar G., Clark J. E. Electrolyte and lipid metabolism of lean fasting men and women. Metabolism. 1966 May;15(5):401–408. doi: 10.1016/0026-0495(66)90080-1. [DOI] [PubMed] [Google Scholar]
  10. Bloom W. L., Azar G., Clark J., MacKay J. H. Comparison of metabolic changes in fasting obese and lean patients. Ann N Y Acad Sci. 1965 Oct 8;131(1):623–631. doi: 10.1111/j.1749-6632.1965.tb34825.x. [DOI] [PubMed] [Google Scholar]
  11. Boulter P. R., Hoffman R. S., Arky R. A. Pattern of sodium excretion accompanying starvation. Metabolism. 1973 May;22(5):675–683. doi: 10.1016/0026-0495(73)90239-4. [DOI] [PubMed] [Google Scholar]
  12. Boyar R. M., Katz J., Finkelstein J. W., Kapen S., Weiner H., Weitzman E. D., Hellman L. Anorexia nervosa. Immaturity of the 24-hour luteinizing hormone secretory pattern. N Engl J Med. 1974 Oct 24;291(17):861–865. doi: 10.1056/NEJM197410242911701. [DOI] [PubMed] [Google Scholar]
  13. Burman K. D., Smallridge R. C., Osburne R., Dimond R. C., Whorton N. E., Kesler P., Wartofsky L. Nature of suppressed TSH secretion during undernutrition: effect of fasting and refeeding on TSH responses to prolonged TRH infusions. Metabolism. 1980 Jan;29(1):46–52. doi: 10.1016/0026-0495(80)90097-9. [DOI] [PubMed] [Google Scholar]
  14. Burman K. D., Wartofsky L., Dinterman R. E., Kesler P., Wannemacher R. W., Jr The effect of T3 and reverse T3 administration on muscle protein catabolism during fasting as measured by 3-methylhistidine excretion. Metabolism. 1979 Aug;28(8):805–813. doi: 10.1016/0026-0495(79)90206-3. [DOI] [PubMed] [Google Scholar]
  15. CRISTOFORI F. C., DUNCAN G. G. URIC ACID EXCRETION IN OBESE SUBJECTS DURING PERIODS OF TOTAL FASTING. Metabolism. 1964 Apr;13:303–311. doi: 10.1016/0026-0495(64)90057-5. [DOI] [PubMed] [Google Scholar]
  16. CUBBERLEY P. T., POLSTER S. A., SCHULMAN C. L. LACTIC ACIDOSIS AND DEATH AFTER THE TREATMENT OF OBESITY BY FASTING. N Engl J Med. 1965 Mar 25;272:628–630. doi: 10.1056/NEJM196503252721208. [DOI] [PubMed] [Google Scholar]
  17. Caddell J. L., Goddard D. R. Studies in protein-calorie malnutriton. I. Chemical evidence for magnesium deficiency. N Engl J Med. 1967 Mar 9;276(10):533–535. doi: 10.1056/NEJM196703092761001. [DOI] [PubMed] [Google Scholar]
  18. Caddell J. L., Goddard D. R. Studies in protein-calorie malnutriton. I. Chemical evidence for magnesium deficiency. N Engl J Med. 1967 Mar 9;276(10):533–535. doi: 10.1056/NEJM196703092761001. [DOI] [PubMed] [Google Scholar]
  19. Cahill G. F., Jr, Herrera M. G., Morgan A. P., Soeldner J. S., Steinke J., Levy P. L., Reichard G. A., Jr, Kipnis D. M. Hormone-fuel interrelationships during fasting. J Clin Invest. 1966 Nov;45(11):1751–1769. doi: 10.1172/JCI105481. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Cahill G. F., Jr, Owen O. E. Starvation and survival. Trans Am Clin Climatol Assoc. 1968;79:13–20. [PMC free article] [PubMed] [Google Scholar]
  21. Cahill G. F., Jr Starvation in man. N Engl J Med. 1970 Mar 19;282(12):668–675. doi: 10.1056/NEJM197003192821209. [DOI] [PubMed] [Google Scholar]
  22. Cahill G. J., Jr, Owen O. E., Morgan A. P. The consumption of fuels during prolonged starvation. Adv Enzyme Regul. 1968;6:143–150. doi: 10.1016/0065-2571(68)90011-3. [DOI] [PubMed] [Google Scholar]
  23. Carter W. J., Shakir K. M., Hodges S., Faas F. H., Wynn J. O. Effect of thyroid hormone on metabolic adaptation to fasting. Metabolism. 1975 Oct;24(10):1177–1183. doi: 10.1016/0026-0495(75)90154-7. [DOI] [PubMed] [Google Scholar]
  24. Consolazio C. F., Matoush L. O., Johnson H. L., Nelson R. A., Krzywicki H. J. Metabolic aspects of acute starvation in normal humans (10 days). Am J Clin Nutr. 1967 Jul;20(7):672–683. doi: 10.1093/ajcn/20.7.672. [DOI] [PubMed] [Google Scholar]
  25. Consolazio C. F., Nelson R. A., Johnson H. L., Matoush L. O., Krzywicki H. J., Isaac G. J. Metabolic aspects of acute starvation in normal humans: performance and cardiovascular evaluation. Am J Clin Nutr. 1967 Jul;20(7):684–693. doi: 10.1093/ajcn/20.7.684. [DOI] [PubMed] [Google Scholar]
  26. DRENICK E. J., SWENDSEID M. E., BLAHD W. H., TUTTLE S. G. PROLONGED STARVATION AS TREATMENT FOR SEVERE OBESITY. JAMA. 1964 Jan 11;187:100–105. doi: 10.1001/jama.1964.03060150024006. [DOI] [PubMed] [Google Scholar]
  27. Dale E., Gerlach D. H., Wilhite A. L. Menstrual dysfunction in distance runners. Obstet Gynecol. 1979 Jul;54(1):47–53. doi: 10.1097/00006250-197907000-00013. [DOI] [PubMed] [Google Scholar]
  28. DeHaven J., Sherwin R., Hendler R., Felig P. Nitrogen and sodium balance and sympathetic-nervous-system activity in obese subjects treated with a low-calorie protein or mixed diet. N Engl J Med. 1980 Feb 28;302(9):477–482. doi: 10.1056/NEJM198002283020901. [DOI] [PubMed] [Google Scholar]
  29. Drenick E. J., Alvarez L. C., Tamasi G. C., Brickman A. S. Resistance to symptomatic insulin reactions after fasting. J Clin Invest. 1972 Oct;51(10):2757–2762. doi: 10.1172/JCI107095. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Drenick E. J., Fisler J. L., Dennin H. F. The effect of allopurinol on the hyperuricemia of fasting. Clin Pharmacol Ther. 1971 Jan-Feb;12(1):68–72. doi: 10.1002/cpt197112168. [DOI] [PubMed] [Google Scholar]
  31. Drenick E. J. Hyperuricemia, acute gout, renal insufficiency and urate nephrolithiasis due to starvation. Arthritis Rheum. 1965 Oct;8(5):988–997. doi: 10.1002/art.1780080509. [DOI] [PubMed] [Google Scholar]
  32. Duncan G. G., Duncan T. G., Schless G. L., Cristofori F. C. Contraindications and therapeutic results of fasting in obese patients. Ann N Y Acad Sci. 1965 Oct 8;131(1):632–636. doi: 10.1111/j.1749-6632.1965.tb34826.x. [DOI] [PubMed] [Google Scholar]
  33. Ellis L. B. ELECTROCARDIOGRAPHIC ABNORMALITIES IN SEVERE MALNUTRITION. Br Heart J. 1946 Apr;8(2):53–61. [PMC free article] [PubMed] [Google Scholar]
  34. Feicht C. B., Johnson T. S., Martin B. J., Sparkes K. E., Wagner W. W., Jr Secondary amenorrhoea in athletes. Lancet. 1978 Nov 25;2(8100):1145–1146. doi: 10.1016/s0140-6736(78)92294-8. [DOI] [PubMed] [Google Scholar]
  35. Felig P. Four questions about protein diets. N Engl J Med. 1978 May 4;298(18):1025–1026. doi: 10.1056/NEJM197805042981813. [DOI] [PubMed] [Google Scholar]
  36. Felig P., Marliss E. B., Cahill G. F., Jr Metabolic response to human growth hormone during prolonged starvation. J Clin Invest. 1971 Feb;50(2):411–421. doi: 10.1172/JCI106508. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Felig P., Owen O. E., Wahren J., Cahill G. F., Jr Amino acid metabolism during prolonged starvation. J Clin Invest. 1969 Mar;48(3):584–594. doi: 10.1172/JCI106017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Felig P. The glucose-alanine cycle. Metabolism. 1973 Feb;22(2):179–207. doi: 10.1016/0026-0495(73)90269-2. [DOI] [PubMed] [Google Scholar]
  39. Flier J. S., Kahn C. R., Roth J. Receptors, antireceptor antibodies and mechanisms of insulin resistance. N Engl J Med. 1979 Feb 22;300(8):413–419. doi: 10.1056/NEJM197902223000808. [DOI] [PubMed] [Google Scholar]
  40. Flink E. B. Nutritional aspects of magnesium metabolism. West J Med. 1980 Oct;133(4):304–312. [PMC free article] [PubMed] [Google Scholar]
  41. Forbes G. B., Drenick E. J. Loss of body nitrogen on fasting. Am J Clin Nutr. 1979 Aug;32(8):1570–1574. doi: 10.1093/ajcn/32.8.1570. [DOI] [PubMed] [Google Scholar]
  42. Forbes G. B. Weight loss during fasting: implications for the obese. Am J Clin Nutr. 1970 Sep;23(9):1212–1219. doi: 10.1093/ajcn/23.9.1212. [DOI] [PubMed] [Google Scholar]
  43. Frisch R. E., McArthur J. W. Menstrual cycles: fatness as a determinant of minimum weight for height necessary for their maintenance or onset. Science. 1974 Sep 13;185(4155):949–951. doi: 10.1126/science.185.4155.949. [DOI] [PubMed] [Google Scholar]
  44. Frisch R. E. Population, food intake, and fertility. There is historical evidence for a direct effect of nutrition on reproductive ability. Science. 1978 Jan 6;199(4324):22–30. doi: 10.1126/science.199.4324.22. [DOI] [PubMed] [Google Scholar]
  45. Frisch R. E., Wyshak G., Vincent L. Delayed menarche and amenorrhea in ballet dancers. N Engl J Med. 1980 Jul 3;303(1):17–19. doi: 10.1056/NEJM198007033030105. [DOI] [PubMed] [Google Scholar]
  46. GARROW J. S., FLETCHER K., HALLIDAY D. BODY COMPOSITION IN SEVERE INFANTILE MALNUTRITION. J Clin Invest. 1965 Mar;44:417–425. doi: 10.1172/JCI105155. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. GLICK S. M., ROTH J., YALOW R. S., BERSON S. A. THE REGULATION OF GROWTH HORMONE SECRETION. Recent Prog Horm Res. 1965;21:241–283. [PubMed] [Google Scholar]
  48. GOLDFINGER S., KLINENBERG E., Jr, SEEGMILLER J. E. RENAL RETENTION OF URIC ACID INDUCED BY INFUSION OF BETA-HYDROXYBUTYRATE AND ACETOACETATE. N Engl J Med. 1965 Feb 18;272:351–355. doi: 10.1056/NEJM196502182720705. [DOI] [PubMed] [Google Scholar]
  49. Gambert S. R., Garthwaite T. L., Pontzer C. H., Hagen T. C. Fasting associated with decrease in hypothalamic beta-endorphin. Science. 1980 Dec 12;210(4475):1271–1272. doi: 10.1126/science.6254156. [DOI] [PubMed] [Google Scholar]
  50. Garber A. J., Menzel P. H., Boden G., Owen O. E. Hepatic ketogenesis and gluconeogenesis in humans. J Clin Invest. 1974 Oct;54(4):981–989. doi: 10.1172/JCI107839. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Gardner D. F., Kaplan M. M., Stanley C. A., Utiger R. D. Effect of tri-iodothyronine replacement on the metabolic and pituitary responses to starvation. N Engl J Med. 1979 Mar 15;300(11):579–584. doi: 10.1056/NEJM197903153001102. [DOI] [PubMed] [Google Scholar]
  52. Garnett E. S., Barnard D. L., Ford J., Goodbody R. A., Woodehouse M. A. Gross fragmentation of cardiac myofibrils after therapeutic starvation for obesity. Lancet. 1969 May 3;1(7601):914–916. doi: 10.1016/s0140-6736(69)92546-x. [DOI] [PubMed] [Google Scholar]
  53. HALES C. N., RANDLE P. J. Immunoassay of insulin with insulin-antibody precipitate. Biochem J. 1963 Jul;88:137–146. doi: 10.1042/bj0880137. [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Halmi K. A. Anorexia nervosa: recent investigations. Annu Rev Med. 1978;29:137–148. doi: 10.1146/annurev.me.29.020178.001033. [DOI] [PubMed] [Google Scholar]
  55. Heymsfield S. B., Bethel R. A., Ansley J. D., Gibbs D. M., Felner J. M., Nutter D. O. Cardiac abnormalities in cachectic patients before and during nutritional repletion. Am Heart J. 1978 May;95(5):584–594. doi: 10.1016/0002-8703(78)90300-9. [DOI] [PubMed] [Google Scholar]
  56. Hurd H. P., 2nd, Palumbo P. J., Gharib H. Hypothalamic-endocrine dysfunction in anorexia nervosa. Mayo Clin Proc. 1977 Nov;52(11):711–716. [PubMed] [Google Scholar]
  57. Isner J. M., Sours H. E., Paris A. L., Ferrans V. J., Roberts W. C. Sudden, unexpected death in avid dieters using the liquid-protein-modified-fast diet. Observations in 17 patients and the role of the prolonged QT interval. Circulation. 1979 Dec;60(6):1401–1412. doi: 10.1161/01.cir.60.6.1401. [DOI] [PubMed] [Google Scholar]
  58. KEKWICK A., PAWAN G. L., CHALMERS T. M. Resistance to ketosis in obese subjects. Lancet. 1959 Dec 26;2(7113):1157–1159. doi: 10.1016/s0140-6736(59)91737-4. [DOI] [PubMed] [Google Scholar]
  59. Knochel J. P. Hypophosphatemia. West J Med. 1981 Jan;134(1):15–26. [PMC free article] [PubMed] [Google Scholar]
  60. Knudsen K. B., Sparberg M., Lecocq F. Porphyria precipitated by fasting. N Engl J Med. 1967 Aug 17;277(7):350–351. doi: 10.1056/NEJM196708172770706. [DOI] [PubMed] [Google Scholar]
  61. Kolanowski J., Bodson A., Desmecht P., Bemelmans S., Stein F., Crabbe J. On the relationship between ketonuria and natriuresis during fasting and upon refeeding in obese patients. Eur J Clin Invest. 1978 Oct;8(5):277–282. doi: 10.1111/j.1365-2362.1978.tb00842.x. [DOI] [PubMed] [Google Scholar]
  62. Landsberg L., Young J. B. Fasting, feeding and regulation of the sympathetic nervous system. N Engl J Med. 1978 Jun 8;298(23):1295–1301. doi: 10.1056/NEJM197806082982306. [DOI] [PubMed] [Google Scholar]
  63. Lantigua R. A., Amatruda J. M., Biddle T. L., Forbes G. B., Lockwood D. H. Cardiac arrhythmias associated with a liquid protein diet for the treatment of obesity. N Engl J Med. 1980 Sep 25;303(13):735–738. doi: 10.1056/NEJM198009253031305. [DOI] [PubMed] [Google Scholar]
  64. Lawlor T., Wells D. G. Fasting as a treatment of obesity. Postgrad Med J. 1971 Jun;47(Suppl):452–458. [PubMed] [Google Scholar]
  65. Lee D. B., Zawada E. T., Kleeman C. R. The pathophysiology and clinical aspects of hypercalcemic disorders. West J Med. 1978 Oct;129(4):278–320. [PMC free article] [PubMed] [Google Scholar]
  66. Lentz R. D., Brown D. M., Kjellstrand C. M. Treatment of severe hypophosphatemia. Ann Intern Med. 1978 Dec;89(6):941–944. doi: 10.7326/0003-4819-89-6-941. [DOI] [PubMed] [Google Scholar]
  67. Lotz M., Zisman E., Bartter F. C. Evidence for a phosphorus-depletion syndrome in man. N Engl J Med. 1968 Feb 22;278(8):409–415. doi: 10.1056/NEJM196802222780802. [DOI] [PubMed] [Google Scholar]
  68. Malina R. M., Spirduso W. W., Tate C., Baylor A. M. Age at menarche and selected menstrual characteristics in athletes at different competitive levels and in different sports. Med Sci Sports. 1978 Fall;10(3):218–222. [PubMed] [Google Scholar]
  69. Merimee T. J., Felig P., Marliss E., Fineberg S. E., Cahill G. G., Jr Glucose and lipid homeostasis in the absence of human growth hormone. J Clin Invest. 1971 Mar;50(3):574–582. doi: 10.1172/JCI106527. [DOI] [PMC free article] [PubMed] [Google Scholar]
  70. Merimee T. J., Fineberg S. E. Growth hormone secretion in starvation: a reassessment. J Clin Endocrinol Metab. 1974 Aug;39(2):385–386. doi: 10.1210/jcem-39-2-385. [DOI] [PubMed] [Google Scholar]
  71. Merimee T. J., Fineberg S. E. Homeostasis during fasting. II. Hormone substrate differences between men and women. J Clin Endocrinol Metab. 1973 Nov;37(5):698–702. doi: 10.1210/jcem-37-5-698. [DOI] [PubMed] [Google Scholar]
  72. Merimee T. J., Misbin R. I., Pulkkinen A. J. Sex variations in free fatty acids and ketones during fasting: evidence for a role of glucagon. J Clin Endocrinol Metab. 1978 Mar;46(3):414–419. doi: 10.1210/jcem-46-3-414. [DOI] [PubMed] [Google Scholar]
  73. Merimee T. J., Tyson J. E. Stabilization of plasma glucose during fasting; Normal variations in two separate studies. N Engl J Med. 1974 Dec 12;291(24):1275–1278. doi: 10.1056/NEJM197412122912404. [DOI] [PubMed] [Google Scholar]
  74. Michiel R. R., Sneider J. S., Dickstein R. A., Hayman H., Eich R. H. Sudden death in a patient on a liquid protein diet. N Engl J Med. 1978 May 4;298(18):1005–1007. doi: 10.1056/NEJM197805042981807. [DOI] [PubMed] [Google Scholar]
  75. Moshang T., Jr, Parks J. S., Baker L., Vaidya V., Utiger R. D., Bongiovanni A. M., Snyder P. J. Low serum triiodothyronine in patients with anorexia nervosa. J Clin Endocrinol Metab. 1975 Mar;40(3):470–473. doi: 10.1210/jcem-40-3-470. [DOI] [PubMed] [Google Scholar]
  76. Moszczyński P. Cancer and leukaemia. Lancet. 1968 Jun 22;1(7556):1378–1378. doi: 10.1016/s0140-6736(68)92086-2. [DOI] [PubMed] [Google Scholar]
  77. NELSON G. K. The electroencephalogram in kwashiorkor. Electroencephalogr Clin Neurophysiol. 1959 Feb;11(1):73–84. doi: 10.1016/0013-4694(59)90009-4. [DOI] [PubMed] [Google Scholar]
  78. Nichols B. L., Alvarado J., Hazlewood C. F., Viteri F. Magnesium supplementation in protein-calorie malnutrition. Am J Clin Nutr. 1978 Jan;31(1):176–188. doi: 10.1093/ajcn/31.1.176. [DOI] [PubMed] [Google Scholar]
  79. North K. A., Lascelles D., Coates P. The mechanisms by which sodium excretion is increased during a fast but reduced on subsequent carbohydrate feeding. Clin Sci Mol Med. 1974 Apr;46(4):423–432. doi: 10.1042/cs0460423. [DOI] [PubMed] [Google Scholar]
  80. Nosadini R., Alberti K. G., Johnston D. G., Del Prato S., Marescotti C., Duner E. The antiketogenic effect of alanine in normal man: evidence for an alanine-ketone body cycle. Metabolism. 1981 Jun;30(6):563–567. doi: 10.1016/0026-0495(81)90131-1. [DOI] [PubMed] [Google Scholar]
  81. Owen O. E., Felig P., Morgan A. P., Wahren J., Cahill G. F., Jr Liver and kidney metabolism during prolonged starvation. J Clin Invest. 1969 Mar;48(3):574–583. doi: 10.1172/JCI106016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  82. Owen O. E., Morgan A. P., Kemp H. G., Sullivan J. M., Herrera M. G., Cahill G. F., Jr Brain metabolism during fasting. J Clin Invest. 1967 Oct;46(10):1589–1595. doi: 10.1172/JCI105650. [DOI] [PMC free article] [PubMed] [Google Scholar]
  83. Owen O. E., Reichard G. A., Jr Human forearm metabolism during progressive starvation. J Clin Invest. 1971 Jul;50(7):1536–1545. doi: 10.1172/JCI106639. [DOI] [PMC free article] [PubMed] [Google Scholar]
  84. Palmblad J., Levi L., Burger A., Melander A., Westgren U., von Schenck H., Skude G. Effects of total energy withdrawal (fasting) on thelevels of growth hormone, thyrotropin, cortisol, adrenaline, noradrenaline, T4, T3, and rT3 in healthy males. Acta Med Scand. 1977 Jan;201(1-2):15–22. doi: 10.1111/j.0954-6820.1977.tb15648.x. [DOI] [PubMed] [Google Scholar]
  85. Phillips R. W. Religious revelations and bovine ketosis (a nonsacred cow). Perspect Biol Med. 1978 Spring;21(3):398–405. doi: 10.1353/pbm.1978.0030. [DOI] [PubMed] [Google Scholar]
  86. Portnay G. I., O'Brian J. T., Bush J., Vagenakis A. G., Azizi F., Arky R. A., Ingbar S. H., Braverman L. E. The effect of starvation on the concentration and binding of thyroxine and triiodothyronine in serum and on the response to TRH. J Clin Endocrinol Metab. 1974 Jul;39(1):191–194. doi: 10.1210/jcem-39-1-191. [DOI] [PubMed] [Google Scholar]
  87. Prasad A. S., Rabbani P., Abbasii A., Bowersox E., Fox M. R. Experimental zinc deficiency in humans. Ann Intern Med. 1978 Oct;89(4):483–490. doi: 10.7326/0003-4819-89-4-483. [DOI] [PubMed] [Google Scholar]
  88. RABEN M. S., HOLLENBERG C. H. Effect of growth hormone on plasma fatty acids. J Clin Invest. 1959 Mar;38(3):484–488. doi: 10.1172/JCI103824. [DOI] [PMC free article] [PubMed] [Google Scholar]
  89. RAPOPORT A., FROM G. L., HUSDAN H. METABOLIC STUDIES IN PROLONGED FASTING. I. INORGANIC METABOLISM AND KIDNEY FUNCTION. Metabolism. 1965 Jan;14:31–46. doi: 10.1016/0026-0495(65)90079-x. [DOI] [PubMed] [Google Scholar]
  90. ROTH J., GLICK S. M., YALOW R. S., BERSON S. A. Secretion of human growth hormone: physiologic and experimental modification. Metabolism. 1963 Jul;12:577–579. [PubMed] [Google Scholar]
  91. Rooth G., Carlström S. Therapeutic fasting. Acta Med Scand. 1970 Jun;187(6):455–463. doi: 10.1111/j.0954-6820.1970.tb02970.x. [DOI] [PubMed] [Google Scholar]
  92. Runcie J., Hilditch T. E. Energy provision, tissue utilization, and weight loss in prolonged starvation. Br Med J. 1974 May 18;2(5915):352–356. doi: 10.1136/bmj.2.5915.352. [DOI] [PMC free article] [PubMed] [Google Scholar]
  93. Runcie J., Thomson T. J. Prolonged starvation--a dangerous procedure? Br Med J. 1970 Aug 22;3(5720):432–435. doi: 10.1136/bmj.3.5720.432. [DOI] [PMC free article] [PubMed] [Google Scholar]
  94. SCHALCH D. S., PARKER M. L. A SENSITIVE DOUBLE ANTIBODY IMMUNOASSAY FOR HUMAN GROWTH HORMONE IN PLASMA. Nature. 1964 Sep 12;203:1141–1142. doi: 10.1038/2031141a0. [DOI] [PubMed] [Google Scholar]
  95. Sapir D. G., Owen O. E. Renal conservation of ketone bodies during starvation. Metabolism. 1975 Jan;24(1):23–33. doi: 10.1016/0026-0495(75)90004-9. [DOI] [PubMed] [Google Scholar]
  96. Saudek C. D., Boulter P. R., Arky R. A. The natriuretic effect of glucagon and its role in starvation. J Clin Endocrinol Metab. 1973 Apr;36(4):761–765. doi: 10.1210/jcem-36-4-761. [DOI] [PubMed] [Google Scholar]
  97. Saudek C. D., Boulter P. R., Knopp R. H., Arky R. A. Sodium retention accompanying insulin treatment of diabetes mellitus. Diabetes. 1974 Mar;23(3):240–246. doi: 10.2337/diab.23.3.240. [DOI] [PubMed] [Google Scholar]
  98. Saudek C. D., Felig P. The metabolic events of starvation. Am J Med. 1976 Jan;60(1):117–126. doi: 10.1016/0002-9343(76)90540-4. [DOI] [PubMed] [Google Scholar]
  99. Sherwin R. S., Hendler R. G., Felig P. Effect of ketone infusions on amino acid and nitrogen metabolism in man. J Clin Invest. 1975 Jun;55(6):1382–1390. doi: 10.1172/JCI108057. [DOI] [PMC free article] [PubMed] [Google Scholar]
  100. Sigler M. H. The mechanism of the natriuresis of fasting. J Clin Invest. 1975 Feb;55(2):377–387. doi: 10.1172/JCI107941. [DOI] [PMC free article] [PubMed] [Google Scholar]
  101. Singh B. N., Gaarder T. D., Kanegae T., Goldstein M., Montgomerie J. Z., Mills H. Liquid protein diets and torsade de pointes. JAMA. 1978 Jul 14;240(2):115–119. [PubMed] [Google Scholar]
  102. Slany J., Mösslacher H., Bodner P., Irsigler K., Lageder H., Schmid P., Schlick W. Kardiovaskuläre Folgen einer Nullkaloriendiät bei Adipösen. Wien Klin Wochenschr. 1974 Aug 16;86(15):423–428. [PubMed] [Google Scholar]
  103. Spark R. F., Arky R. A., Boulter P. R., Saudek C. D., O'Brian J. T. Renin, aldosterone and glucagon in the natriuresis of fasting. N Engl J Med. 1975 Jun 19;292(25):1335–1340. doi: 10.1056/NEJM197506192922506. [DOI] [PubMed] [Google Scholar]
  104. Spaulding S. W., Chopra I. J., Sherwin R. S., Lyall S. S. Effect of caloric restriction and dietary composition of serum T3 and reverse T3 in man. J Clin Endocrinol Metab. 1976 Jan;42(1):197–200. doi: 10.1210/jcem-42-1-197. [DOI] [PubMed] [Google Scholar]
  105. Spencer H., Lewin I., Samachson J., Laszlo J. Changes in metabolism in obese persons during starvation. Am J Med. 1966 Jan;40(1):27–37. doi: 10.1016/0002-9343(66)90184-7. [DOI] [PubMed] [Google Scholar]
  106. Spencer I. O. Death during therapeutic starvation for obesity. Lancet. 1968 Jun 15;1(7555):1288–1290. doi: 10.1016/s0140-6736(68)92299-x. [DOI] [PubMed] [Google Scholar]
  107. Stegink L. D., Filer L. J., Jr, Baker G. L. Effect of aspartame and aspartate loading upon plasma and erythrocyte free amino acid levels in normal adult volunteers. J Nutr. 1977 Oct;107(10):1837–1845. doi: 10.1093/jn/107.10.1837. [DOI] [PubMed] [Google Scholar]
  108. Stewart W. K., Fleming L. W. Features of a successful therapeutic fast of 382 days' duration. Postgrad Med J. 1973 Mar;49(569):203–209. doi: 10.1136/pgmj.49.569.203. [DOI] [PMC free article] [PubMed] [Google Scholar]
  109. Suzuki J., Yamauchi Y., Yamamoto H., Komuro U. Fasting therapy for psychosomatic disorders in Japan. Psychother Psychosom. 1979;31(1-4):307–314. doi: 10.1159/000287345. [DOI] [PubMed] [Google Scholar]
  110. Theorell T., Kjellberg J., Palmblad J. Electrocardiographic changes during total energy deprivation (fasting). Acta Med Scand. 1978;203(1-2):13–19. doi: 10.1111/j.0954-6820.1978.tb14824.x. [DOI] [PubMed] [Google Scholar]
  111. Thomson T. J., Runcie J., Miller V. Treatment of obesity by total fasting for up to 249 days. Lancet. 1966 Nov 5;2(7471):992–996. doi: 10.1016/s0140-6736(66)92925-4. [DOI] [PubMed] [Google Scholar]
  112. Thurston J., Marks P. Electrocardiographic abnormalities in patients with anorexia nervosa. Br Heart J. 1974 Jul;36(7):719–723. doi: 10.1136/hrt.36.7.719. [DOI] [PMC free article] [PubMed] [Google Scholar]
  113. UNGER R. H., EISENTRAUT A. M., McCALL M. S., MADISON L. L. Glucagon antibodies and an immunoassay for glucagon. J Clin Invest. 1961 Jul;40:1280–1289. doi: 10.1172/JCI104357. [DOI] [PMC free article] [PubMed] [Google Scholar]
  114. Ulmer D. D. Trace elements. N Engl J Med. 1977 Aug 11;297(6):318–321. doi: 10.1056/NEJM197708112970607. [DOI] [PubMed] [Google Scholar]
  115. Vagenakis A. G., Burger A., Portnary G. I., Rudolph M., O'Brian J. R., Azizi F., Arky R. A., Nicod P., Ingbar S. H., Braverman L. E. Diversion of peripheral thyroxine metabolism from activating to inactivating pathways during complete fasting. J Clin Endocrinol Metab. 1975 Jul;41(1):191–194. doi: 10.1210/jcem-41-1-191. [DOI] [PubMed] [Google Scholar]
  116. Veverbrants E., Arky R. A. Effects of fasting and refeeding. I. Studies on sodium, potassium and water excretion on a constant electrolyte and fluid intake. J Clin Endocrinol Metab. 1969 Jan;29(1):55–62. doi: 10.1210/jcem-29-1-55. [DOI] [PubMed] [Google Scholar]
  117. Vigersky R. A., Andersen A. E., Thompson R. H., Loriaux D. L. Hypothalamic dysfunction in secondary amenorrhea associated with simple weight loss. N Engl J Med. 1977 Nov 24;297(21):1141–1145. doi: 10.1056/NEJM197711242972103. [DOI] [PubMed] [Google Scholar]
  118. Vigersky R. A., Loriaux D. L., Andersen A. E., Mecklenburg R. S., Vaitukaitis J. L. Delayed pituitary hormone response to LRF and TRF in patients with anorexia nervosa and with secondary amenorrhea associated with simple weight loss. J Clin Endocrinol Metab. 1976 Oct;43(4):893–900. doi: 10.1210/jcem-43-4-893. [DOI] [PubMed] [Google Scholar]
  119. Vignati L., Finley R. J., Hagg S., Aoki T. T. Protein conservation during prolonged fast: a function of triiodothyronine levels. Trans Assoc Am Physicians. 1978;91:169–179. [PubMed] [Google Scholar]
  120. WEINER H., SCHUSTER D. B. The electroencephalogram in dementia; some preliminary observations and correlations. Electroencephalogr Clin Neurophysiol. 1956 Aug;8(3):479–488. doi: 10.1016/0013-4694(56)90014-1. [DOI] [PubMed] [Google Scholar]
  121. WEISSBEIN A. S., SCOTT N. M., Jr Postnecrotic cirrhosis without antecedent acute liver disease. Arch Intern Med. 1960 Jul;106:71–80. doi: 10.1001/archinte.1960.03820010073012. [DOI] [PubMed] [Google Scholar]
  122. Walravens P. A. Zinc metabolism and its implications in clinical medicine. West J Med. 1979 Feb;130(2):133–142. [PMC free article] [PubMed] [Google Scholar]
  123. Warren M. P., Jewelewicz R., Dyrenfurth I., Ans R., Khalaf S., Vande Wiele R. L. The significance of weight loss in the evaluation of pituitary response to LH-RH in women with secondary amenorrhea. J Clin Endocrinol Metab. 1975 Apr;40(4):601–611. doi: 10.1210/jcem-40-4-601. [DOI] [PubMed] [Google Scholar]
  124. van Itallie T. B. Liquid protein mayhem. JAMA. 1978 Jul 14;240(2):144–144. doi: 10.1001/jama.240.2.144. [DOI] [PubMed] [Google Scholar]

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