G.M. is a 61-year-old male who decided to do intermittent fasting after I discussed with him the benefits of fasting.
He started out weighing 172 lbs with a waistline of 36 inches. At that time, he was also having frequent nonspecific vague abdominal pains. He saw his primary care physician and several specialists and had a CT scan of the abdomen and pelvis and abdominal ultrasound. All work up and consultation did not reveal anything significant.
At that time, he was also having frequent attacks of gout precipitated by meat intake, sardines, and dried fish. The attacks were quite painful and made him call in sick for work several times. He was prescribed colchicine and ibuprofen. He has to be careful with the ibuprofen because it can make his gastric reflux worse. Aside from that, his medical bills started to rack up from all the tests and doctors’ visits.
His intermittent fast on working days will consist of breakfast at 9:00 am, and dinner at 4:30 am. His fasting schedule was flexible from 12 to 16 hours, sometimes lasting up to 22 hours.
After 7 and a half months, he weighed 142 lbs after losing 30 pounds. The last pair of pants he bought has a 29-inch waistline.
His gout attacks have not come back even after eating meat, sardines, dried fish, and “dinuguan.” Dinuguan is a Filipino stew made up of pork meat, blood, and intestines. Just the perfect ingredients to precipitate an acute gout flare. His abdominal pains have not returned, and he feels much more energetic now.
Discussion: Before fasting, G.M. had 3 problems. Being overweight (BMI 28.6), abdominal pains, and frequent gout attacks.
A waist circumference of 36 is a sign of the metabolic syndrome. Visceral fat explains the increased waistline of 36 inches. Compared to the fat underneath the skin (subcutaneous), visceral fat is not as rigid. Any changes in the intraabdominal pressure like bearing down, coughing, and sneezing can lead to rupture (1) of the fat cells resulting in the release of substances (pro-inflammatory cytokines) that can produce inflammation.
The rupture of the fat cells in the abdomen leads to inflammation, which may explain his abdominal pains. Since GM reduced his visceral fat and his abdominal pains are now gone, most probably, the pain he was experiencing is from the inflammation caused by the rupture of the fat cells. This article (1) states,
“Whereas subcutaneous adipocytes can also become hypertrophic, and most probably do also rupture, visceral adipocytes, besides being supported by much less dense connective tissue in comparison with subcutaneous adipose tissue, are frequently subject to sudden pressure variations associated with a cough, physical exercises, and sleep apnea.”
Redness, swelling, warmth, and pain are signs of inflammation and can be seen in a joint with a gout flare-up. A gout attack is secondary to the formation of uric acid crystals in the joints in the big toes, ankles, or knees. A high level of uric acid is called hyperuricemia. Hyperuricemia is associated with metabolic syndrome.
The metabolic syndrome as defined by NCEP ATP* III as 3 or more the following.
| Component | Criteria |
| Abdominal obesity: Increased waist circumference |
Men: > 40 inches, Asians >35 inches Women: > 35 inches, Asians >31 in |
| Elevated triglycerides | > 150 mg/dL or drug treatment for elevated triglycerides |
| Reduced HDL-Cholesterol (HDL-C) | Men: |
| Elevated blood pressure | > 130/85 mm Hg or drug treatment for elevated blood pressure |
| Elevated fasting glucose | > 100 mg/dL or drug treatment for elevated glucose |
The metabolic syndrome, characterized by chronic inflammation, is a clustering of risk factors that put a person at risk to develop heart attacks, strokes, diabetes, and gout.
With intermittent fasting, G.M. was able to reduce his waistline and reduce his risk of developing metabolic syndrome. In so doing, he lowered his inflammation and made himself less prone to gout attacks.
If he continued to have gout attacks, he would have to take NSAIDs for the inflammation and the pain. NSAIDs like ibuprofen are usually prescribed for such gout attacks and can aggravate his gastric reflux. NSAID intake can also increase his risk of cardiovascular side effects. If he is started on allopurinol to prevent gout attacks, then he will be exposed to allopurinol’s side effects like anemia, decreased blood platelets (bleeding), and deficiency of white blood cells (infections).
In conclusion, using intermittent fasting, G.M. was able to reduce his risk to develop a gout flare-up, heart attack, and stroke, resolve his long-standing abdominal pains, avoid exposure to the side effects of medications, increase his energy level, and look younger and fit in the end.
No drug available can do all of that.
Related Readings:
- How to Do Intermittent Fasting
- The Kaizen Way of Fasting
- The Science of Fasting
- 10 Unbelievably Easy Ways to Screw Up Intermittent Fasting!
- Will Fasting Make My Muscles Shrink?
- Are You Skipping Breakfast?
- Rheumatoid Arthritis and Metabolic Syndrome
- Diseases Associated with Metabolic Syndrome Part 16.2 Osteoarthritis
- The 20/80 Rule for Health
- Diseases Associated with the Metabolic Syndrome
Reference
Photo credits:
- https//unsplash.com
- * National Cholesterol Education Program Adult Treatment Protocol
© 2019 Asclepiades Medicine, LLC All Rights Reserved
DrJesseSantiano.com does not provide medical advice, diagnosis or treatment
Dr, jesse, when you say “44 hour fasting”, does that mean 2 days of not eating?
G.M. actually fasted for 22 hours. I corrected the post but it is possible to fast for 2 days. Hydration is important. Some fast for 7 days straight for cancer prevention through autophagy.
Yes, but you can drink water, black coffee, and unsweetened tea.