During that time I also had times of deep sadness as I watched hundreds of women with eating disorders relapse repeatedly. Treatment teams are frequently dismayed, families are in debt for thousands of dollars, and patients themselves feel as if they’ve failed yet one more time.

I became aware early on as an eating disorder therapist that the medical model of treatment, which is cognitive-behavioral therapy and nutritional education with some equine therapy tossed in occasionally, simply doesn’t work. Stuart Agras (1993) stated that only 32% of all people who have had eating disorder treatment are eating disorder free after a year. This is simply not good enough!

It was when I was studying for my PhD at Saybrook in San Francisco that I finally figured out what was missing. Attention to what I call my holy trinity – mind, body, spirit was missing. In the medical model of eating disorder treatment, the body and the spirit were left out!
Treating eating disorders is serious. Eating disorders affect a significant number of Americans, an estimated 5 million every year (Kreipe, Golden, Katzman, Fisher, Rees, Tonkin, et al., 1995). These disorders include anorexia nervosa, bulimia nervosa, binge-eating disorders and several other variants. Although these disorders are more common in adolescent girls or young women, approximately 7 million girls and adult women struggle with eating disorders and approximately 1 million boys and men will struggle with eating disorders this year (Katz, 2003). 10%-25% of all those battling anorexia will die as a direct result of the eating disorder. Anorexia nervosa has the highest mortality rate of any DSM diagnoses.

We often say that there’s no such thing as a client with JUST an eating disorder. Nearly all eating disorder clients present with a host of issues that may include anorexia, bulimia and compulsive eating, but also attention deficit disorder, anxiety, depression, trauma, substance abuse, obsessive compulsive disorders, sleep disorders, and a host of other conditions. Almost all eating disordered patients have a dual diagnosis.
Given the complexity of eating disorders, holistic treatment is the one of the few ways to successfully treat eating disorders and their co-occurring conditions.

Holistic eating disorder treatment takes into account the whole person (body, mind, spirit), including all aspects of lifestyle. It makes use of all therapies, both conventional and alternative.

Integrative medicine and holistic eating disorder treatment are partners in treating the whole person, knowing that one part of a person cannot become either ill or well without all of the other parts being affected. Holistic eating disorder treatment depends on a partnership between the patient, therapist, the doctor, and all of the practitioners where the goal is to treat the mind, body, and spirit, all at the same time. While some of the therapies used might be considered unconventional, a guiding principle within holistic and integrative medicine is to use therapies that have some high-quality evidence to support them, such as some therapies used in holistic eating disorder treatment as well.

In a holistic eating disorder treatment center, a multidisciplinary treatment team consists of practitioners from traditional psychiatry, psychotherapy, and medicine who work closely with complementary medicine practitioners. Every member of the staff needs to be an experienced, caring professional who is certified and/or licensed in his or her area of practice and is knowledgeable in the field of eating disorders.

In holistic eating disorder treatment, many types of experiential therapies are used. Clients who have had various traumatic events in their lives are treated through the use of experiential therapies. These therapies include Eye Movement Desensitization and Reprocessing (EMDR), cognitive-behavioral interventions, Gestalt Therapy, Traumatic Incident Reduction (TIR), Emotional Freedom Techniques (EFT) and Neural-Linguistic Programming (NLP). Trauma, Post-Traumatic Stress Disorder and sexual abuse issues are addressed in a professional, respectful, and gentle manner.

Clients in holistic eating disorder treatment are treated as individuals with the utmost dignity and respect.

Holistic eating disorder treatment covers quite a wide range of options for treatment. One eating disorder expert said it like this, “We’re going to knock on a lot of little doors with and for a patient. Some of those doors will open with CBT, others with acupuncture, bodywork, or neurofeedback. But we at least have such a wide variety of little doors that we’ll find whatever it is that will be the way that will take an individual towards healing, health, and wellness.”

This is the first of a series of articles where I will explain the types of alternative therapies that are used in the holistic treatment of eating disorders, why they’re used and, their effectiveness.

A study from the University of Minnesota found that adolescent vegetarians were more weight- and body-conscious, and more likely to have been diagnosed with an eating disorder, and to have tried a variety of healthy and unhealthy weight-control practices such as diet pills, laxatives and vomiting. They were also more likely than their peers to have contemplated or attempted suicide.

The findings also indicated that adolescents were more likely than adults to be vegetarians for weight-control rather than for health or moral reasons.

Although the authors acknowledge that a vegetarian diet can be more healthy than one that contains red meat, they also note that, in some teens, being a vegetarian may be taken as a red flag for eating and other disorders related to self-image (J Adolesc Health, 2001; 29: 406-16).

Scientists reckon they know why some of us go on wild and reckless binge-eating benders, an eating disorder that affects up to 90 per cent of obese people. It’s all down to our genes.

Now, researchers at the Klinik Hirslanden in Zurich believe that a mutation in the gene MC4R is responsible for the binges. It was discovered in 5 per cent of obese patients they studied, but also in 4 per cent of controls, which would seem to counter the finding.

It also doesn’t explain why the vast majority of people still binge-eat.

Undeterred, the pharmaceutical industry is already mounting its campaign to counter the errant MC4R gene. At the moment, they try to treat obesity with antihypertensive agents, hypoglycaemic drugs and lipid-lowering medications, none of which seem to work too well.

So look out for melanocortin agonists – the mutant busters – at a surgery near you in the not-too-distant future.

(Source: New England Journal of Medicine, 2003; 348: 1096-103).

Eating disorders, whether they be the starvation regimes of anorexia and bulimia or the compulsive eating which leads to overweight and in some cases morbid obesity, are on the rise. Medical research has, frustratingly, not kept pace with the increase. For years the theory that people who suffer from these problems are mentally unstable, slothful or undisciplined has prevailed so much so that it is now difficult to find any practitioner who will acknowledge a possible biological basis for these disorders.

No one would deny the psychological component of eating disorders, but as a total diagnosis it is unsatisfactory. For instance, family background is often cited as a risk factor in eating disorders, with those coming from abusive or dysfunctional families having the highest risk. But we have to ask: how is it that there are women who come from abusive or dysfunctional families who do not develop into anorexics or turn to compulsive eating as a way of dealing with unresolved problems?

To the minds of many clinicians, “fat phobia” is still the central defining characteristic of anorexia and bulimia (Soc Sci Med, 1995; 15: 25-36; Int J Eat Dis, 1996; 1594: 317-34). But entrenchment in this attitude hasn’t moved us much closer to a cure. In one study, only 29 per cent of treated anorexics had shown significant recovery 20 years later, and approximately 15 per cent died from suicide or starvation (Br J Psych, 1991; 58: 495-502).

Equally, since there is not yet a medical cure for obesity, it is often easier to explain it away by blaming some weakness in the individual. Yet we know that simplistic solutions such as eating less and/or exercising more do not always produce results. Some theorists believe that exercise contributes little to weight loss (AM J Clin Nutri, 1993; 57: 127-34). This is because physical activity normally only accounts for a small proportion of an individual’s total energy expenditure. About 80 per cent of a person’s energy is used to maintain the resting physiological processes of the body and to digest food (Am J Clin Nutr, 1992; 55: 533S-7S).

At the same time, individuals can vary enormously in the way they can dissipate energy through diet induced thermogenesis (fat burning). When one study looked at pairs matched for sex, weight, age, height and activity level, it found that it was not uncommon for one member of a pair to be consuming twice as many calories as the other member without gaining more weight than the other (Br J Nutri, 1061; 15: 1-9).

It’s time to take a wider view.

Slimming Disorders

Anorexia and bulimia affect nearly 1.2 million adolescent and young adults in the US, but only 5-10 per cent of these are males. In the UK, an estimated 1 per cent of teenagers are anorexic and 3 per cent, bulimic. Estimates of mortality can range from 1 to 5 per cent and are usually due to kidney failure, heart attack, dehydration or suicide (Nurse Pract, 1990; 15: 12-18, 21).

As stated before, recovery rates are not very encouraging. Although in one study over six years, 77 per cent of patients were classified as “recovered”, at the end of the study period the total risk of relapse among recovered anorexics was 48 per cent though none had more than one relapse. More worrying, the mortality rate was 17.8 times higher than expected, with bulimic patients having twice the risk of premature death as anorexics (Acta Psychi Scand, 1993; 19: 437-44).

Recent data suggests that imbalances in serotonin the hormone involved in the regulation of feeding and mood remain altered in anorexia patients, even after weight restoration (Arch Gen Psychi, 1991; 48: 556-62).

Few studies have explored potential links between multiple chemical sensitivity and anorexia. Women use more highly perfumed products (toiletries and household cleaners) than men, and it is possible that an assault on the olfactory nerves from petrochemicals, which cross the blood brain barrier, can create chronic problems physical and psychological (Toxicol Ind Health 1992; 8: 181-202), in much the same way as glue sniffing. These things may be causes in their own right, or they may simply be the things which increase an individual’s vulnerability.

Although many of the symptoms of anorexia mimic those of mercury poisoning, there is little information other than anecdotal on any possible links with sources of mercury toxicity, such as from dental amalgam and vulnerability to slimming disorders. WDDTY panellist Jack Levinson has commented that he has seen young girls diagnosed with eating disorders recover once their amalgam fillings were removed. Excess mercury, he says, blocks the body’s absorption of zinc, and there are many studies which confirm that zinc deficiency could be a biological cause of anorexia.

Zinc deficiency and anorexia are similar conditions. Both tend to affect females between ages 12 and 25, and both are characterized by weight loss, changes in appetite and taste, yellowish skin pigmentation, depression and loss or irregularity of menstruation.

When Dr Rita Bakan and her colleagues at the British Columbia Institute of Technology conducted a clinical trial that used zinc supplementation to treat anorexia, they found that patients who received the supplement gained weight “significantly faster” than those who received a placebo (Townsend Letter for Docs, Nov 1993: 1154). In another study, those taking supplements also showed weight gain (Acta Psychi Scand, 1990; 361 (Suppl): 14-17).

Other practitioners have also assessed the zinc link (see Schauss, AG et al, Nutrients and Brain Function: 1987: 151-62; Ann Nutri Metab, 1992; 36: 197-202; J Clin Psychi, 1993; 54: 63-6) and found it a relevant factor in anorexia. One study concluded that anorexics have a lower intestinal uptake of zinc than normal subjects (Lancet, 1985; 1: 1041-42). Other studies have shown that anorexics and bulimics are deficient in zinc due to a variety of reasons lower dietary intake, impaired absorption, vomiting, diarrhea or binging on low zinc foods. Since zinc deficiency results in decreased food intake, it can be concluded that the acquired zinc deficiency of bulimics and anorexics could exacerbate their altered eating behaviour (J Clin Psychi, 1989;50: 456-9; see also J Am Coll Nutri, 1992; 11: 694-700).

Many bulimics perceive themselves as being uncomfortably full thus the rationale behind induced vomiting or abusing laxatives. In one study, normal weight female bulimics who had abstained from binge eating and purging for at least a month were studied. What the researchers found was that they had irregularities in the hormonal process that regulates fluid volume in the body a fact which may be relevant to their behaviour (J Clin Endocrinol and Metab, 1992; 74: 1277-83).

Pre existing hormonal imbalances are also common in anorexics. Indeed, amenorrhea develops in many patients before the onset of substantial weight loss has occurred, and age inappropriate gonadotrophin secretion patterns are present in some patients who are weight recovered (see Pirke, KM et al, The Psychobiology of Anorexia Nervosa, New York: Springer-Verlag, 1984; 46-57).

In addition, both anorexics and bulimics have been shown to have delayed gastric emptying in other words it takes longer for food to leave the stomach (Int J Eating Disor, 1992; 11: 163-72; see also Robinson, PH, Gastric Function and Eating Behaviour in Anorexia and Bulimia Nervosa, in Walsh, BT (ed), Eating Behaviour in Eating Disorders, American Psychiatric Press, 1988; 125-40). This can also contribute to feelings of fullness and motivate the individual to diet or to purge more strenuously.

In one study, delayed gastric emptying was linked, not to the effects of starvation or vomiting, but to factors not related to nutrition such as high rates of depression and anxiety. This was particularly true in bulimics (Lancet, 1995; 364: 1240).

Obesity/obsessive eating

The American public spends $33 billion each year in weight control efforts without any real effect (BMJ, 1995; 346: 134-5). Some researchers have estimated that by the year 2030, 100 per cent of adults in the USA will be overweight (JAMA, 9194; 272: 205-11). In many ways, obesity is a more insidious disorder. Its prevalence in some 15 per cent of the adult population in the UK and some 33 per cent of the adult population in the US (JAMA, 1994; 272: 205-11) means we often do not treat it as a serious illness.

Often the results of research into fat busting drug cures resemble the same kind of yo yo between poles which obese individuals experience when they diet. For instance, two major trials done around the same time on cimetidine (Tagagel), a wonder substance which promised to melt the pounds away, showed either that it had no effect at all (BMJ, 1993; 306: 1093-96) or that it led to reduced hunger, reduced food intake and subsequent weight loss (BMJ, 1993; 306: 1091-93).

Similarly inconsistent results have been found with investigations of a genetic explanation for obesity. Only a few years ago the papers were ablaze with the miracle story of fat laboratory mice who, when injected with leptin, the byproduct of the Ob gene, lost 12 per cent of their body weight and practically all of their body fat in four days (Science, 1995; 269: 540-3, 543-6, 546-9). The conclusion was that within obese individuals this gene is defective and so they have less leptin circulating in their bodies.

Not long after this study appeared, two other studies showed that very obese people, particularly women, have 80 per cent more leptin circulating in their bodies (Nature Med, 1995; 1: 905-53, 953-6). These findings were further echoed by a study in the New England Journal of Medicine which found that obese men and women have leptin levels up to four times higher than healthy controls (N Eng J Med, 1: 1996; 334: 292-5).

As if to underline the fact that data from animal studies cannot be easily extrapolated to humans, scientists have yet to explain why it is that the mice bred to produce no leptin were fat, while “normal” fat people seem to overproduce it.

Further, the theory that fat people have high levels of leptin and anorexics have low levels of leptin was disputed when one research team measured leptin levels in a group of anorexics.

What they found was that a third of the group had leptin levels in the normal range one of these individuals had the lowest body mass index of the group (BMJ, 1995; 346: 1624-5).

Perhaps the most fruitful avenue of exploration for obese individuals is that of food sensitivities. Obesity can be linked, for instance, to persistent hunger. According to Charles E Bates, author of Beyond Dieting: Relief from Persistent Hunger, Victoria, Canada: Tsolum River Press, 1994), delayed, or non IgE, food allergy may be at the root of obsessive eating habits. He believes obesity may be a symptom of an immune mediated eating disorder, or IMED, which is caused by a combination of digestive system and immune system errors.

This process of errors is cumulative, says Bates, and may begin in infancy. Signs of IMED are apparent in babies who have feeding problems, colic or some kind of chronic indigestion, diarrhea, allergies, eczema and an inability to tolerate certain foods such as cow’s milk. Later they may show a tendency towards chronic bronchitis and middle ear infections.

In school they may have learning disabilities or hyperactive behaviour. The process takes its toll over the years. By adulthood there may be more complaints: irritability, joint pain, noticeable fatigue, depression and migraines, gastritis, ulcers and heartburn. Any chronic inflammatory disease of the upper or lower gastrointestinal tract is a significant sign.

Bates’ theory sits well with the inroads made into the link between blood type and diet. The theory goes that dietary lecithins can trigger different allergic responses in different individuals, depending on their blood type (J Nutri Med, 1991; 2: 45-64; Am J Clin Nutri, 1980; 33: 2338-45; see also D’Adamo, J, One Man’s Food is Someone Else’s Poison, Marek, 1980). If food lecithins pass undigested into the gastrointestinal tract, they are either recognized as self or non self by the body’s immune system. Cooking eliminates a large percentage of dietary lecithins, but not all. Some, such as those present in wheat, tomato, carrot, corn, banana, peanuts, pumpkin seeds and avocado, are highly heat resistant.

Although not specifically centred around obesity, the research into serotyping and diet shows that certain blood groups react badly to certain types of foods, resulting in allergies, inflammation and leaky gut as well as wasting diseases such as Crohn’s disease (Townsend letter for Docs, Nov 1996: 74-7).

Another theory is that, for a variety of reasons we wrongly interpret our body’s needs. Dr. Fereydoon Batmanghelidj, author of Your Body’s Many Cries for Water (Global Health Solutions, 1994) believes that many common illnesses today are the result of a profound kind of dehydration. Infants recognize thirst and cry out when they need liquid. But, he says, as we grow older we become unused to drinking water, and gradually the thirst signals are misinterpreted or over ridden. As they grow up, children learn to drink sodas, colas and juices instead of simple water. Adults respond to the body’s thirst with tea, coffee and alcohol all of which dehydrate the body further (Independent, January 11, 1994. The body then responds by releasing more anti diuretic hormone, and a vicious cycle is instigated.

If food sensitivity and/or dehydration theories are correct, obesity could be seen as not just excess fat, but a kind of waterlogging which occurs as the body tries to restore balance.

!APat Thomas

Could you tell me what you know about Zoladex. The side-effects are possible damage to my liver and osteoporosis. Do you think this drug is effective, or is taking it a waste of time? – MH, Essex

A: Do see our response to another reader with a similar worry in WDDTY, vol 4, no 12, Q&A (available on our website http://www.wddty.co.uk). The drug’s side-effects include fatigue and lethargy, changes in hair growth patterns, breast-swelling and, rarely, osteoporosis. However, if you have cancer, these side-effects may be worth putting up with compared with the risks of surgery, which hasn’t been proved worthwhile.

Chaos and clinical controversy rage at hospitals worldwide over the best way to treat prostate cancer. Doctors are unsure whether to treat, and those who do take positive action are uncertain about the type of treatment (Br J Urol, 1997; 79: 749- 55; BMJ, 1998; 316: 1919-20; Med J Aust, 1998; 168: 483-6).

Prostate cancer is very slow-growing and doesn’t spread; two studies have shown that 86 per cent of patients with prostate cancer survive 10 years after diagnosis and, in two-thirds of cases, the cancer hadn’t spread (N Engl J Med, 27 January 1994; JAMA, 22-29 April 1992).

It’s not exactly news to most of us, perhaps, but medical researchers have provided compelling evidence that adds to the picture. They have found that women who suffered from anorexia nervosa as teenagers and young women are far less likely to suffer from breast cancer in later life.

In fact, women who had serious anorexia – which required hospital care – were only half as likely, on average, to develop breast cancer as those who had never starved themselves.

Researchers from Harvard Medical School made the discovery after they studied the records of 7,300 women in Sweden who had hospital care for anorexia nervosa before the age of 40. The protective effect increased to 76 per cent if the woman went on to have a child, while the effect dropped to 23 per cent among those who never had children.

There were no cases of cancer among the women who were anorexic before they were 20, when nearly three cancer cases would usually be expected.

So does this mean we have to starve our teenage daughters if they are going to avoid breast cancer in later life? It’s probably enough to reduce the calories, and to keep watching the intake thereafter, and it should provide plenty of other health benefits besides.

(Source: Journal of the American Medical Association, 2004; 291: 1226-30).

Take, for instance, eating disorders such as anorexia, bulimia and binge eating. Any parent or close friend worth his or her salt knows that these conditions are invariably psychological, and need to be treated with understanding and great care.

The average family doctor, however, has traditionally thrown powerful antidepressants at the problem, and that’s assuming he has taken it seriously in the first place. As one expert has said, treatment at the hands of the GP has been ‘idiosyncratic’. This idiosyncratic approach has, on occasions, involved abuse, blame and mockery.

Now that august medical institution, the UK’s National Institute for Clinical Excellence (NICE), has decreed that eating disorders do have a psychological base after all, and the family doctor should: a) take the condition seriously, b) refer the patient for special counselling, and c) lay off the antidepressants.

The trouble is that, because antidepressants have always been the trusted stand-by, there aren’t too many specialist counsellors out there. In fact, at the last count, there were roughly, er, 25 teams available in Britain.

(Source: British Medical Journal, 2004; 328: 245).

A diet rich in leafy green vegetables, fiber, low in fat, and of course, high in calcium (among the other 72 trace minerals, according to Dr. Joel Wallach) is the first step in prevention. Exercise Ð especially strength training, is the second most important step. A properly prescribed program will increase density in the femoral neck and lumbar vertebrae, where it is needed most. This section will concentrate on the most important areas of the body to strengthen, what types of exercises to perform, and the proper progression to perform them in to enhance muscular and bone development.

Section #1 – hip area. Comprising the largest muscles in the body, the hip area is the foremost section to train. The most important types of machines to condition this area are the leg press, and total hip machine. The leg press is a compound exercise, working the muscles of the hip and thigh. The hip machine is an isolation exercise, concentrating the gluteus maximus. These machines are preferable to free weights to start out with because the learning curve is less, and improvements can be made with less chance of injury.

Section #2 – upper body. Working the upper body major muscles (chest, shoulders, back) comprises section #2, and provides resistance to the bones of the upper vertebrae, long bones of the arms, and ribs. Photo #2 illustrates a weight-assisted machine for working the chest area (dip exercises), and the back (pull up exercises).

The most important element of program design for this group is training progression, as the goal is to strengthen weak and porous bone to its natural density. A beginning program would start with low intensity, and more repetitions. It would look something like this:

The goal is to progress to a level that is is perceived as difficult, strengthens the musculature, and over time (4-8 months), has a positive effect on the bone density (as seen by DEXA scan). According to the sports medicine literature, the MES (minimal essential strain) is about 1/10th the amount of force required to fracture a bone, so the amount of stress placed on bones through strength training does not have to be in maximal exertions. Medically, the density should improve from Ð10% loss to normal (0% loss in bone).

Both of the phases of training can be manipulated by the therapist depending on the initial conditioning level of the participant. Training should proceed in phases, as staying with the same level of resistance will not improve bone density or muscle strength.

Rehab in Women’s Cardiovascular Diseases

As women are increasing their risks for developing both heart disease and lung cancer, rehabilitation programs should play an important role in both reducing the complications of these diseases, and health care costs associated with long term affliction.

In the area of cardiovascular therapy, this area is not as pronounced as orthopedic rehabilitation. None the less, basic cardiovascular education and treatment programs are necessary for the following reasons: First Ð more women are being diagnosed with cardiovascular events (heart disease, emphysema, cancer, peripheral vascular disease). With this increase in the number of cases, the health care costs also rise concomitantly. Second Ð the current medical system is ill prepared to give patients the necessary time for information regarding therapy and education strategies. This is where allied health professionals (physical therapy, dietetics, exercise physiology, occupational therapy, etc.) play such a vital role. The cost of a referral, assessment, education, and therapy plan is far less than medical intervention that may occur within one year of the initial diagnosis.

Information from the Women’s Health Data Book (1992 Ð Jacob’s Institute, Washington, DC) states that although women make more frequent visits to physician offices than do men, they do not receive as much intervention. This may be seen in the fact that many oncologists do not refer women who have had surgery for breast cancer for physical therapy. It would seem a logical extension of their health care, but it is not routine.

Rehab and Health Care Costs

In 1994, futurist John Naisbitt predicted a $188 billion cost savings by the implementation of wellness programs in major businesses in the US. If this amount may be extrapolated to include the health care system, might we see an even greater savings. Although rehab per se is not primary prevention, any type of patient education may have a preventive effect on patients in the future. Rehab programs that promote healing for an acute event, but also give education on ADL may save unforeseen medical costs.

The Importance of Women’s Health Issues

As issues of prevention and cost savings become more of a fixture in women’s health, professionals who wish to work with in this area should have an understanding of the elements that comprise a complete women’s health package. Some of the most important areas are summarized below:

1. Reproductive Health – From nutritional information, to moderate exercise, to sexuality issues, to post partum guidance, many health promotion topics during pregnancy are not discussed in the physician’s office. Therefore, a complete strategy on diet, stress reduction, posture and mobility, exercise, hygiene, etc. should be made available during pregnancy, and perhaps should be the responsibility of allied health care professionals.
   

   
   

2. Infectious Diseases – Sexually transmitted diseases such as syphilis and antibiotic-resistant gonorrhea have risen in the past 25 years in women of all ethnic backgrounds. The increased risk of acquiring HIV from heterosexual contact is up in women in alarming rates. Many women who may be at increased risk (due to ethnic background, economic status, etc.) may not even be aware of their risks. Again, health education is important as an intervention strategy to disseminate information in schools, health clinics, and in private practices to alert women to risks with infectious diseases.
   

   
   

3. Menopause – The issue of medical intervention in menopause is still controversial, because many treatments themselves may have adverse effects on health (such as estrogen therapy and the increased risk of cancer, and oophorectomy and the increased risk of heart disease). For over five years it has been stated that a diet low in fat and high in vitamin supplements, and regular exercise may actually lower (or eliminate) estrogen therapy in many women.
   

   
   

4. Mental Health – From anorexia to bulemia, to stress, to depression, mental health disorders affect millions of women each year, and lead to decreased productivity in the work place, problems at home and with children, and account for many suicides each year. In 1988, suicide was the eighth leading cause of death in the United States. Although many do not associate these types of conditions as so serious that they cause death, but their seriousness cannot be overstated. The ability to treat these conditions will improve the health of almost 10% of high school students with eating disorders, 8% of women who suffer from depression, and almost 1 out of 3 women in this country who suffer from stress great enough to cause physical or emotional problems in their lives.
   

   
   

5. Addictive Behaviors – Smoking has been on the rise with teenage women for over a decade. Alcohol use is also more prevalent in certain age and socioeconomic groups. As stated by former surgeon general C. Everett Koop, MD; “If we as a nation are to affect the overall health of the general public, we must first strive to reduce the incidence of smoking and drinking in all segments of our society”. Addictive behaviors also includes drug abuse (cocaine, marijuana, amphetamines, etc.). For some women, addictive behaviors sets in motion their reliance of the medical system to deal with their problems (low birth weight babies, overdoses on drugs, etc.). The obvious but hard to achieve self reliance and empowerment is the goal of mental health workers who deal with these conditions.
   

   
   

6. Violence – The murder of Nicole Brown Simpson has raised the national consciousness about domestic violence. The issue of abuse, rape, incest, and other violent acts against women are major parts of a total women’s health package, and should be understood by all allied health care workers. By understanding the elements of abuse, appropriate referrals may take place, and a complete recovery may be set in motion.
   

   
   

7. Health Promotion – All of the above conditions could be improved by the implementation of health promotion strategies into treatment. Improper diet has been associated with everything from poor school performance to violent crime. Regular exercise not only improves physiological parameters, but also has profound effects on psychological aspects of health (such as depression). Many medical treatments involve drugs, which themselves have side-effects. True health promotion may have positive influences upon patient care, and health care costs, which leads us to our next section.
   

   
   

8. Access to Health Care – Access to proper health care is determined on need (and perceived need), ability to pay, health status, and acceptability of services. Health promotion experts agree that health promotion at any level may reduce the overall costs of health care, and our system that in many cases rewards persons for being sick (free emergency room care) is creating a burden on our society that may soon overwhelm us financially.

References

1. Greenwald, S. Menopause, Naturally. Volcano Press, Volcano, CA, 1984.

2. Whitney, E.N., Hamilton, E.M.N. Understanding Nutrition, 3rd Edition. West Publishing Company, St. Paul, MN, 1984.

3. Bompa, T.O. Periodization of Strength: The New Wave in Strength Theory. Veritas Publishing, Toronto, Canada 1993.

4. A Profile of Women’s Health in America. Women’s Health Data Book. Coyright 1992 by the Jacobs Institute, 409 12th St.,Washington, DC 20024.

5. Baechle, T. (ed). Essentials of Strength and Conditioning. Human Kinetics Publishers, Champaign, IL 1994.

About the Author

Eric Durak is the director of Medical Health and Fitness, a research and consulting firm based in Santa Barbara. He specializes in exercise programs for special population groups, and has published scientific articles in: The American Journal of Obstetrics and Gynecology, Diabetes Care, and The Somatics Journal. He is the author of Cancer, Exercise, Wellness, and Rehabilitation, published this year.

“And the word of the Lord came unto me in the tenth month in the government of Oliver Cromwell, in the year 1653 when I was walking among my sheep, saying, ‘Thou shalt not eat nor drink for the space of 14 days anything but water. But fear not for I will feed thee with the dew of heaven and with the sweet incense of my love, and my word shall be unto thee sweeter than honey, and I will make thee to know that I am able to keep thee fresh and strong, and able to do my work without the creatures as well as with it!”
Miles Halhead – (1)

In this chapter consideration will be given to a review of the medical literature from 1967 to 1977, in which approximately 160 papers dealt in some way with the aspects of the subject. Fifty-two of these, which were felt to be the most pertinent, were reviewed by the author. For several reasons, not much information could be gained from them. Much was too scientific for the general reader, and almost exclusively the subject dealt with obesity and the disease concept
(2), not with the healing of the whole person, which is our overriding concern here. Also in this chapter is a brief consideration of the fast as it has been practiced through the ages; and there are extensive comments on the use of the fast in the therapeutic setting at Meadowlark, where several hundred guestpatients have been involved.

Few physicians have seriously considered the fast as a technique worthy of study; and most of those who did, concentrated on its used only in the treatment of obesity. Two notable exceptions, however, are psychiatrists Allan Cott, M.D., and Robert Meiers, M.D. The latter was associated with my work at Meadowlark for a period of three months and initiated my interest in fasting. Dr. Cott spent time in Russia studying the program of Professor Serge Nikoliav of the Moscow Psychiatric institute where, as of 1972, 6,000 patients had fasted under Nikoliav’s direction, resulting in a very high success rate for treatment of chronic refractory schizophrenia, and without a fatality. These patients had not responded to the more usual types of psychiatric therapy. Their fasts were on water, lasted 25 to 30 days, and included much aerobic exercise in the form of long periods of daily walking.

Most attention to the medical fast has been given outside the United States. Paavo Airola’s studies of the European clinics cite many successful fasts for a wide variety of human ailments. My own acquaintance with the Bircher-Benner Clinic of Zurich has been a strong incentive toward the use at Meadowlark of vegetable juices and the role of raw vegetables and fruits in the therapeutic armamentarium.

The notable work in this country has been carried on by a small group of Naturopathic physicians. Especially useful is the work of Herbert Shelton, who has been employing this modality in his center in Texas for 40 years, guiding many thousands of patients through fasts. His book, The Hygienic System, Fasting and Sun Bathing, Vol. III, is the most complete discussion of the physical aspects that I have encountered.(4)

The New Health Model

Nuclear physics and the new health model view human life with its supporting energy systems as a part of a great continuum. Health is thus seen as a mark of one’s resonance with great and universal systems of energies. Disease is a sign of being out of touch. It has always been of interest to me to note that the sicker the individual, the more isolated he or she has become from family, friends and business associates. Thus the role of the physician must be to become increasingly aware of these discordant energies and their sources.

This new challenge is being met by individual physicians, most commonly outside of university settings where they are individually investigating such alternative therapies as acupuncture, homeopathy, polarity therapy, yoga, clairvoyance and psychosynthesis.

These modalities, and I now add fasting as one of the most important on the list, require establishing a contact with the patient, and the future physician accordingly must see his new role as being involved in this interpersonal relationship. He must become absorbed to the limit of his ability in the problems of his patient by listening to the words of that patient and learning even what is behind those words that possibly the patient cannot yet share. Only through this type of empathy can one get beyond the usual objective view of the results of a disease process and begin to get down to causes, many of which are frequently buried in the patient’s subconscious. But by being aware, the empathetic physician can gain evidence from the tone of speech, the look in the eyes, in the gestures of the hands, and in those tears that are so obviously being held back. How often in such a time of attunement has a patient said, “I have told you what I have never before shared with anyone, not even my spouse.”

To help his patients regain resonance with the universal system, the physician of the new medicine may have to look to areas not often enough considered. He should study the patient’s environment, for one example. The physical body’s loss of sensitive attunement may be due to such external causes as environmental sources of pollution. These might include chemicals in the air, fallout from atomic testing, more than minimal diagnostic x-ray exposure or other forms of medical radiation, long hours in front of television or microwave ovens, or under fluorescent lights. It might come from drinking fluorinated and chlorinated water, from medically prescribed as well as psychedelic drugs, from synthetic foods along with additives, and in the cases of quite a number of people, even from the artificial materials used in the clothing they commonly wear.

The fast can be most helpful in treatment of patients whose problems have such causes, for it tends toward freeing the body from having to ward off these conflicting sources of energy, and toward freeing the mind from the power of much of the negativity that is all about us today. Once freed, the patient is in a far better position than he was to use his vital energies in a constructive way and so restore homeostasis.

A person needs all of the energy he can healthfully derive, for much is required simply to break down food into its nutritive components, convert the carbohydrates and proteins into glycogen for storage in the liver, and to provide the ready energy needed for healing and optimal physical and mental functioning. type of empathy can one get beyond the usual objective view of the results of a disease process and begin to get down to causes, many of which are frequently buried in the patient’s subconscious. But by being aware, the empathetic physician can gain evidence from the tone of speech, the look in the eyes, in the gestures of the hands, and in those tears that are so obviously being held back. How often in such a time of attunement has a patient said, “I have told you what I have never before shared with anyone, not even my spouse.”

To help his patients regain resonance with the universal system, the physician of the new medicine may have to look to areas not often enough considered. He should study the patient’s environment, for one example. The physical body’s loss of sensitive attunement may be due to such external causes as environmental sources of pollution. These might include chemicals in the air, fallout from atomic testing, more than minimal diagnostic x-ray exposure or other forms of medical radiation, long hours in front of television or microwave ovens, or under fluorescent lights. It might come from drinking fluorinated and chlorinated water, from medically prescribed as well as psychedelic drugs, from synthetic foods along with additives, and in the cases of quite a number of people, even from the artificial materials used in the clothing they commonly wear.

The fast can be most helpful in treatment of patients whose problems have such causes, for it tends toward freeing the body from having to ward off these conflicting sources of energy, and toward freeing the mind from the power of much of the negativity that is all about us today. Once freed, the patient is in a far better position than he was to use his vital energies in a constructive way and so restore homeostasis.

A person needs all of the energy he can healthfully derive, for much is required simply to break down food into its nutritive components, convert the carbohydrates and proteins into glycogen for storage in the liver, and to provide the ready energy needed for healing and optimal physical and mental functioning.

All of this should be within the awareness of new medicine, both for the physician who accepts the new challenge, and for the person who is learning to look within for his own healing powers.

We speak of the fast as being a part of the new medicine. It is a rediscovered part, for the fast as an integral part of life is as old as life itself, and its healing power is to be seen all along evolution’s pathway. In the insect world, the feasting caterpillar is followed by the fasting butterfly. Then there are the hibernating reptiles and the bear who take their annual prolonged fasts. If nothing more, this indicates that fasting and stanation are not the same things. Many animals when sick know enough to stop eating, but few humans have retained this healthy insight that intuitively bids one eat or fast as the proper occasion arises and in its natural timing. As William Wordsworth so beautifully comments:

The world is too much with us, Getting and spending we lay waste our powers, Little we see in Nature that is ours . . . Yes, we are out of touch, and the fast provides an ideal setting for renewing this all-important contact. Allow me to quote from one of Meadowlark’s recent fasters who began the recontact: I am awakened in the morning full of quiet expectation which was deepened by an experience as I sat on the lawn after my simple breakfast of fruit. A honeybee settled on my knee and set about his elaborate grooming of his small person. I was pleased and touched at its confidence in me and extended to him the same. I was struck by his kindness and appreciation showed in every part of his body. I watched with interest and amusement at his insect version of body awareness (referring to an exercise program of that name employed at Meadowlark).

Throughout history, at some time fasts have been used by practically every culture to bring man back in touch with his source of BEING. But unfortunately, Western religion with its only occasional use of fasting has become more and more separated from actual life on an hour to hour basis and needs once more to become interwoven into life’s innermost experience, as is still taught by the Shaman of Africa and the Indian medicine man.

Reviewing Briefly Some Aspects of the Fast as Seen in History:

Jesus—“This kind (referring to the cure, probably of epilepsy) can come forth by nothing but prayer and fasting.” (Mark 9:29) Before his period of temptation, Jesus fasted for forty days in the wilderness.

Pythagoras—He commanded his disciples to abstain from all things that had life, and from certain other meats which could interfere with mental perception, and to abstain from wine, to eat sparingly, and to sleep little. (Manly Hall)

Moses—In a time of drought, he fasted for forty days on Mt. Horeb.

The Ethiopian Orthodox Church—Among its tenets, it views the stomach as the seat of the emotions and thus as having a marked effect on the personality. Strong foods such as meat are felt to strengthen emotional reactions and thus are seen as being related to violent behavior.(5)

Gandhi—In his autobiography, he describes his use of the fast and dietary restriction and its great influence on his life’s work. It was his observation that passion and the hankering after pleasures of the palate were best brought under control through this means. He goes on further to elaborate that when the senses are subordinated to the rule of the mind, the special relish disappears and man can truly function as it was intended he should.(6)

It would seem that these illustrations reinforce the idea that in times of life’s real need to find new sustenance, the fast with its physical cleansing, mental clearing and spiritual mountaintop experiences can open up new vistas on the path of life.

The Type of Fast and Its Length

The true fast is without doubt the water fast, but experience reveals that this is by no means desirable for all would-be fasters. Accordingly there are many modifications, some suitable and others that are of very questionable merit or even potentially injurious. The fast from both food and water will not even be considered because of the grave dangers that may be associated with its use. In the medical literature, as has been mentioned, the major, almost sole, subject of fasting has been in relation to the control of obesity. Here it has an important role, especially when used along with daily group therapy under staff guidance. When used on an outpatient basis, however, we would tend to restrict it to the overweight patient who has had previous experience with fasting and has been medically evaluated by a physician. Even in this instance we would feel that the patient should have available telephone contact with the guiding physician and a weekly evaluative office visit.

The water fast may also be used for patients other than those with weight problems if they have an adequate fat reserve, that is to say if the skin and subcutaneous tissues of the upper arm when pinched with a caliper measures no less than 20 mm. in the case of women and 15 in that of men. If less, consideration may still be given to a juice or a raw foods fast. In all the above instances, the fast should be supervised by a physician familiar with the procedure. Some of the problems most commonly well handled with fasting include hypertension, arthritis, allergies and headaches along with the detoxification from the use of multiple drugs or tobacco. In our experience this is a very valuable method of handling the problems of the undesirable side effects from long term cortisone therapy. However, in the latter instance, the procedure must be done very slowly, milligram by milligram over a period of time and usually will not be completed in the first fasting experience.

As cited in the medical literature, fasting for obesity has frequently been continued for sixty days and at times considerably longer. The most usually prescribed fast at Meadowlark lasts from two to three weeks. The maximum was 34 days. In that instance the patient was suffering from severe anklyosing arthritis of the spine, such that she had no possible neck motion and had to turn her body to look to the side. There was also associated moderate obesity. This particular guest discovered during the fasters’ group therapy that her body stiffness bore a striking parallel to a very unbending religious system in which she felt enmeshed. Toward the end of her fast as she was increasingly allowing herself to express pent up feelings, she began to notice a beginning of motion in the upper spine.

A further use of water fasting is in the emerging field of medical ecology pioneered by Doctors Coca, Randolph, Philpot, Dickey and others.(7) This is in the nature of what is referred to by them as presumptive food testing. That is to say, after four to five days of water fasting when symptoms have quieted down and frequently been accompanied by a drop in the pulse rate, a large meal of the suspected food is given as a single meal, symptom return is noted and the suspect food either discovered or eliminated as a source of symptoms. A case to illustrate:

P.U., a 35-year-old housewife, was seen by me a few years ago complaining of depression, irritability, excruciating headaches, rapid heartbeat, a tremor of her hands, sinus congestion and urinary problems. After a four-day water fast at Meadowlark her symptoms were relieved. Presumptive food testing revealed that following the ingestion of milk her sinuses became congested; following a meal of corn her tremor developed; a headache became evident subsequent to the ingestion of a meal of bananas, and her bladder symptoms followed both rice and strawberries. Two months later she reported no further headaches, bladder trouble nor depression and her marital relationship was vastly improved. The subsequent month, as often happens when one feels much improved, she became lax with her dietary restrictions and practically all her symptoms returned.

The most common of the reacting foods are those which are consumed most regularly, frequently on a daily basis giving the impression that this frequency of ingestion probably exceeds the body’s ability to supply the vitamins, enzymes and minerals required to ensure proper absorption and assimilation. The results often are the cited symptoms of toxicity. Also, life’s stresses that are not adequately being handled seem to play a role in these events. And symptoms certainly may also be brought to light by pesticides and other chemicals in the foods, water, the air, clothing, or elsewhere in the immediate environment. While all of these factors play an important role in health, let us not for a minute become imprisoned in a world seemingly controlled by the environment. A hundred years ago a leading homeopathic physician, Dr. James T. Kent, gave good counsel in this regard:

The partial or juice fast also finds a place for all the conditions previously recounted and is less threatening to many. Needless to say, the time needed for results may be longer, but the patient’s emotional attitude will be superior, particularly if there is a lack of self-confidence with its frequently accompanying feelings of self-deprivation. I prefer the patient to have a choice in the type of fast and the length of fast. For some, even a juice fast is too severe, and in such cases there is a real place for a partial fast, limited to raw fresh vegetables or fruits as practiced at the BircherBenner Clinic.(8)

Fasting, When and for Whom?

In the past the progress of life and the consciousness of one’s relationship to the universe as a whole was mirrored in the observance of the fast. Man was very conscious of the fact that he was part of a whole that far surpassed the boundaries of his physical body. He intuitively knew that if he lost sight of his own body rhythms and got out of step with the seasons of the world about him he would likely fall ill. It is of interest that we are only recently rediscovering the importance of these rhythms and their part in everyday life.(9)

In accordance with this principle, times of fasting have in the past coincided with the seasons and the solar system’s inherent rhythm. Note the Lenten fast in conjunction with the full moon of Easter in the Christian tradition, and the corresponding Passover fast associated with the same full moon of the Hebrew month of Nasar. Certain cultures have timed the planting and harvesting of their crops according to similar time schedules. Moses and Jesus were both aware of the needed season for a fast and each picked a period of forty days. In Islam, where the fast is adhered to more strictly than in the Judeo-Christian culture, Ahmad Sakr reports that the faithful Moslems all over the world are required to fast throughout the month of Ramadan, the ninth month of their calendar. In his words:

Further, not only does the season of the year but also the exact time of day have significance. When the human body approaches a state of homeostasis, it once again picks up these universal rhythms. This is obvious in the case of menstruation. It may also be observed in many blood determinations such as the pituitary clock and its maximum output of ACTH between 4 and 8 a.m. And even further, observation will reveal the relationship of the human endocrine system to this all-pervasive timepiece. The endocrine clock in association with the advent of puberty has been a time for a fast for the American Indian.” I would like to think that once again we may discover the influence of these natural rhythms and their effect on health and their relationship to times for fasting.

It is the person who has become aware of his inner environment, its discovery and cleansing, that usually benefits the most from the fast and its attendant therapy. It was from this standpoint that Moses, Jesus and Gandhi were led into their fasts. During the last decade, approaching as we are the so-called Aquarian Age, there is much evidence of a new hunger to obtain sustenance capable of replacing the spiritual vacuum so prevalent in the materialistic world. The heart is sick! Through all eternity, this centrally placed human organ has symbolized the all-powerful role of love. Could this be the reason for the increasing number of deaths from heart disease? In spite of coronary care units in hospitals, by-pass surgeries and trained resuscitation teams, the long-term results have been to accomplish little toward increasing the span of human life. And so it is not only the outward aspects of health that prompt people to come to Meadowlark, and once there to choose the fast as an aid to finding new avenues of meaning in their lives, to finding fresh contacts with their spiritual natures. This desire for the fast often comes to them as an inner feeling of guidance.

But if considering only the traditional manifestations of health problems, who should avoid the fast? The medical literature is by no means clear cut when considering the possible relative contraindications to fasting. However, I would like to list these with my own feelings:

• The hypochondriacal patient with deep emotional needs
  
• Pregnant women, and for the most part, children
  
• Severe bronchial asthma
  
• Diabetes
  
• Epilepsy
  
• Malnutrition
  
• Ulcerative colitis
  
• Terminal illness
  

In the first instance, as related in the book, Some Unrecognized Factors in Medicine,(l2) the anonymous physician authors state that the hypochondriacal, hysterical patient, as we have also found, is a poor candidate for the fast. So often these persons have never really lived a life of their own. They have tended to live at the beck and call of some other individual and as a result have never truly felt fulfilled. To ask them to make the sacrifice of their food for a period of time can be just too devastating for their inner development and growth.

Concerning pregnancy, I can see a juice fast with juices being prepared daily under a skilled nutritionist (and I am not referring to the usual hospital dietician) as a possibility in toxemia or marked obesity. Such a patient should also be evaluated daily by the physician.

A similar, partial fast may also be appropriate in the case of a child. From the physical standpoint, juvenile onset diabetes or adult type where there have been spells of coma or severe acidosis, severe asthma, frequently necessitating hospital admission, and epileptic seizures might be considered contraindications to the fast unless carried out in a suitable hospital setting. I have in the past found this possible in our own local hospital.

Ulcerative colitis can be handled but presents a number of problems and needs much emotional support for it to be successful.

Near terminal illness where fasting might lead to a starvation would not seem an appropriate line of therapy, although I feel that there can be exceptions when the patient feels a strong sense of inner guidance in this direction. However, in this instance, the relatives and the patient should be well acquainted with the risks involved, and the physician conscious of his risk of censure by his medical peers.

The Time of the Fast

The time of the fast should be a very special time. Many of our Meadowlark guests have told us that it was the most significant event in their lives to that time. To begin with it is a time of tearing down the old and the onset of building a new body temple. What better words to occupy the mind at the beginning of the fast than the words of that well known physician-poet, Oliver Wendell Holmes in “The Chambered Nautilus”:

It should be a space in one’s life for reorientation and self assessment. It only makes common sense that in this age when the internal and external environments are filled to overflowing with synthetic imitations of the stuff that evolution took a few million years to design, the body and mind need to have periods for an all-important time of cleansing.

The state of mind and its activities can be most significant for the faster. For some it can be a time of self-discovery, a time to stop playing a role and to begin living the real person. Thus, it can be a time for releasing the ego and discovering the Transpersonal Self. In this frame of reference, the late psychiatrist, Roberto Assagioli,l3 speaks of starting to LIVE rather than just to exist. Because these crises in personal development will frequently be met during the fast, it is essential that the person guiding the fast recognize them in their full significance.

Assagioli describes the stages of the unfoldment of the True Self:

1) Crises preceding the spiritual awakening;

2) Crises caused by the spiritual awakening;

3) Reactions due to the spiritual awakening;

4) Phases of the process of transmutation.(l2)

If these important signs along the road of life are not recognized, a great injustice can be done the person involved. In the process of unfoldment, there may be midnight emergencies as the dying ego manifests itself through a dream or through the frightening experience of the so called dark night of the soul. It is then that an understanding nurse should be available, one who is thoroughly trained in the process of the fast; and a psychologist or physician trained in and familiar with the areas of transpersonal experience.

For these reasons, and others, the special event of the fast should not be carried on in the usual setting of home or business if anything of lasting value is to be anticipated, other than perhaps temporarily taking off a few pounds of body weight. The setting should be a place of natural beauty, removed from newspapers, radio, television, phone calls, visitors (even including contact with the immediate family). If at all possible, the spot should be self-chosen rather than decided upon, a-priori, solely by a physician, friend or family member. Since the fast can be a time of real enrichment of one’s inner life, preparation can well lead to some research ahead of time into books that would have meaning for the coming events. Especially significant can be biographies of men and women who have been a source of inspiration or religious writings that have a place in structuring and bringing significance to life.

The importance of the timing of the fast is beautifully illustrated in these words in the Aquarian Gospel of Jesus Christ:

The Fasting Process

A careful history and physical examination should precede the fast for any person other than one in optimal health, and in that case an office visit is recommended with the guiding physician assessing the desirability of the fast. This is particularly true when any fast is expected to last more than two or three days. Included in the preparation should be blood tests for uric acid, blood sugar, creatinine, cholesterol, total protein and some evaluation of liver function. An electrocardiogram should be considered.

To better explain the fasting process, we will divide it into four stages that also reflect those set down by Dr. Cott, who made a study of the format used in the Russian model, to which reference was made. Stage 1 is a time of general excitation of the involuntary nervous system, lasting one to three days; Stage 2, a time of inhibition, continuing from day two or three to the end of the first week and sometimes even into the second week; Stage 3, a time of gradual recovery, which most festers do not go beyond during their initial experience; Stage 4, full recovery.

It is most interesting to note the close parallel of the stages of fasting to the stages resulting during the healing process accompanying administration of homeopathic remedies. In fact, it can be very beneficial to use the two therapeutic modalities concurrently.

From the physiological point of view, during Stage 1 the general excitation is manifest through the increased electrical activity observed with the electroencephalogram, while the blood picture reveals a mobilization of the healing agents as seen in the increased number of white blood cells being poured into the general circulation. Stage 2 is heralded by increasing evidence of acidosis, the presence of hypoglycemia and a psychomotor depression. There is generally a loss of appetite, and the tongue is likely to become coated. Gradually the excitation gives way and is superseded by inhibition.

During the first few days, usually all of Stage 1 and the beginning of Stage 2, the patient is pretty much occupied with cleaning the gastrointestinal tract. This includes the liver, which is relieved of the responsibility of having to handle its usual daily load of imitation foods that have much to do with chronic degenerative diseases. At the same time, the cleansing releases much of the body’s innate energies formerly concerned with handling this metabolic load, thus allowing the body a chance to restore natural health and bring about a state of homeostasis. During this period, the cleansing process is very evident in marked signs of toxicity, the return of former physical symptoms, and a marked dulling of mental processes, and not infrequently an overwhelming sense of fatigue and the need to rest. Stage 3, then, is one of normalization with its accompanying feeling of well being, usually far surpassing the state pre-existing the fast.

Weight loss during the early days of the fast can be dramatic, especially in women who have a water retention problem. Sometimes the loss can be as much as four to seven pounds in a single day, and 10 to 20 pounds in a week is not unusual. By the end of the first week, however, this will have leveled off to an average of three-fourths of a pound a day, and there will be days of no loss, and perhaps even days of gain. This need not be viewed with alarm. Factors reflected in the fluid retention may have been too liberal use of salt in the diet, the use of birth control pills, the use of tobacco, the overuse in the diet of refined carbohydrates, or in some cases certain foods may be associated with the problem. When foods are suspected, they may be evaluated by presumptive testing following the fast, as described by Phillpot. Pyridoxine (Vitamin B6) and Vitamin C also may be helpful in dealing with this problem. (Very frequently at this time there will surface an unresolved emotional problem and the need to release long dried up tears. Often we have observed this interrelationship. Many times there has been observed a marked diuresis following a counseling session that produced a flood of tears.)

As is common knowledge, the hypothalmic portion of the brain and the closely related posterior pituitary have a major role in controlling water balance. In several patients where there was further evidence of such a deficiency, therapeutic use of posterior pituitary in minimal dosage was of real value. There will be a rapid increase in weight following the fast in these patients if they early bring the refined carbohydrates into their diets and if they do not adequately avoid sources of salt. Closely paralleling large losses of fluid in the early fast will be symptom-producing losses of potassium and occasionally sodium. The latter loss peaks on about the fourth day, while the former loss is evident and rapid during the first few days and gradually may taper off between the tenth and fourteenth days. The most common symptoms related to these losses include weakness, postural hypotension, diarrhea, nausea, vomiting, vertigo and leg cramps. All will be greatly ameliorated by a potassium supplement.(15)

It is well to bear in mind that the early days of the fast also are marked by an acidic condition of the body with the release into the urine of considerable acetone, which can be monitored very easily by test papers available at any pharmacy and used in the control of diabetes. As the fast progresses, another reliable indicator of the body’s return toward homeostasis is the use of pH testpapers on the saliva, checked morning and night due to the body’s circadian rhythms. Ideally one would like to see the papers register pH values between 6.4 and 6.8.(16)

The breakdown of toxic tissue products during the fast will frequently be reflected in blood chemistry values, which can be rechecked during its course. To be expected is an early rise in uric acid due to the breakdown of tissue nucleoproteins. In this connection there will be on rare occasions an attack of gout. However, this is, in our opinion, no excuse for the use of antiurogesic drugs during the course of a fast. Should gout make its appearance, it could much more safely be managed with homeopathic remedies or herbs.

Fatalities during the fast have been reported in the medical literature when drugs were used, when tests were made requiring intravenous administration of chemicals, and when alcohol or tobacco were used.(17) Patients desirous of getting off drugs, alcohol, tobacco should always do so only under close medical supervision. During the course of the fast there will frequently be an elevation of the enzymes associated with liver function, reflecting the increased involvement of that organ in the detoxification. These will gradually return to normal as the fast continues into Stages 2 and 3. There will frequently be evidences of the added stress on the kidneys but in this instance, too, there will be gradual improvement as reflected in the blood urea values. More often these may be late manifestations after the fast if the patient stays on the new diet and keeps away from the use of drugs and foods containing additives. There will also be a return toward normal levels of elevated cholesterol and triglycerides. These later findings will be enhanced by the coincident use of a good program of aerobic exercise.

The Fast at Meadowlark

Let us now turn attention to the actual program for the groups of festers as carried on at the Meadowlark rehabilitation center. An average group of festers might include an arthritic seeking to reduce the amount of medication; two with obesity problems who in the past have not been able to keep their weights down; another guest with migraine headaches; a guest with lupus erythematosis keen on getting off cortisone, and another guest wishing the spiritual benefits of a fasting experience. At the initial meeting the guests are asked to share individually their reasons for wanting to fast and are made to see the seriousness of the discipline and the need of the involvement of their whole person in the process. They are also informed that the discipline is going to be strictly adhered to.

Each faster is then instructed by the nurse as to the measurements that will be recorded daily, most of which the faster will take for himself and record on special forms. These records include a.m. temperature, pulse twice daily for evidence of ecological factors related to illness, blood pressure, water intake and urine output during Stages 1 and 2 for evidence of water retention, check of urine for ketones and Vitamin C level, and twice daily salivary pH readings.

Vitamin C supplementation is routinely carried on throughout the fast to aid in the detoxification program. If a water fast is carried on longer than a week, a general vitamin supplement is added to the regime. If diuresis seems to be incomplete, diuretic herb teas are frequently suggested. These might consist of goldenrod, chamomile, watercress, parsley or rose hips.

When the fast is merely for reducing and physical evaluation and there is no evidence of disease, the fastener’s progress could be watched on the basis of weekly office visits with interim phone calls.

Concerning the role of exercise, opinions vary all the way from those who advise bed rest to those who make a great point of long periods daily of walking, cycling or swimming. It would seem that a middle of the road policy is generally applicable, with individual variations to suit the particular faster. For those who are most toxic and are not troubled with excess weight, initially, much rest best suits their condition, to be followed by a program of gradually increasing exercise as tolerated. In general it is probably wiser not to include jogging, other forms of strenuous exercise and certainly no competitive exercise, yet fastens are frequently surprised by the physical strength they find as they move into Stage 2 and by the ease with which they can endure long periods of sustained exercise.

Concerning the use of enemas, colonies, or of their avoidance, opinions are very controversial. Once again we have taken a middle of the road position, starting the fast with an initial purge, using phospho-soda, and following on the next three days with self-administered enemas, unless diarrhea occurs or the stool becomes clear. Further enemas are not regularly employed unless there would seem to be discomfort due to the collection of feces.

It is important to keep dental plates in the mouth, biting on them to keep the gums in condition or there may be such shrinkage that by the end of the fast the plates no longer fit.

Personal hygiene is particularly important during the fast, for there may be considerable body odor due to the detoxification taking place. A shower is suggested for each morning. Water temperatures should not be extreme because too long in hot water can be ennervating. To follow a shower with a good body brushing is a good procedure. Cosmetics and deodorants should be avoided during the fast, for they tend to drive the impurities back into the system. An absorbent material or cornstarch under the arms could, however, be used in addition to frequent cleansing. The coated tongue can be brushed and thus cleansed, which will partially alleviate frequent bad taste in the mouth.

In the case of the water fast, spring water from a known good source is preferable; but if this is not possible, distilled water is the second choice, if appropriate minerals are added to approximate a natural source of water. Approximately 70 ml. of water or other liquid per kilogram of body weight should be drunk daily, with the occasional substitution of herb teas if desired.

In as much as we like to see our fasters learn to flow with life, we never tell them ahead of time how long they will be fasting. Instead we encourage them to get in touch with their INNER KNOWER and allow that to be their guide, with suitable comments or suggestions from us when appropriate. This is a day to day decision and not preordained.

In the instance of juice fasts, the juices should be prepared daily as nearly as possible to their time of use, in any case not more than a day before. Preferably, juice is produced with a pressure-type juicer, rather than a centrifugal type. Grapefruit or apple are the usual juices we employ for the start of the day, changing to vegetable juices for the rest of the day. Orange juice is avoided because of its high sugar content and due to the fact that many people have the problem of hypoglycemia. The usual amount of juices for the day is one liter to be divided into four glasses frequently diluted and sipped throughout the day rather than to be drunk solely at meal times. For specific suggestions as to variations on juices see the books of Paavo Airola and those from the Bircher-Benner Clinic, available through health food stores. Favorites among our group have been a mix of carrot and celery juice and Bieler broth.(18) The latter has the advantage especially for people who have multiple allergies or maladaptive reactions to certain foods, for zucchini is very rarely a culprit. Bear in mind also that the green leaves of vegetables restore a favorable acid-alkaline balance after the combustion of foods more rapidly than anything else, so that a plain juice from green leaves has a unique place in the fasting purification process. Supermarket vegetables, if used, should be washed thoroughly to remove any vestiges of pesticide sprays. Organically grown vegetables are preferred.

The first week of the fast is in every way the hardest, for gradually one after another the symptoms of detoxification become manifest. These are generally related to health problems of the past and make their appearance in reverse order of the time of life when they were originally present. This follows the same law that will be observed when using homeopathic medications. One of the most frequently recurring symptoms is the withdrawal headache of the coffee addict. Other commonly encountered symptoms include extreme fatigue, dizziness, nausea, vomiting, palpitations, nasal mucous, visual disturbances, muscle pains and cramps, diarrhea, flatus, irregularities of the heart and increased body odor. (The latter should never be handled by the use of deodorants as this will block the pores of the skin and drive the toxins back into the body.) Symptoms can be greatly ameliorated by the use of the potassium supplement to which reference has already been made. Nausea can often be handled by the addition of lemon juice to the faster’s water, or by the use of homeopathic Nux vomica or Ipecac. If vomiting continues for more than a day, it may on rare occasions be necessary to give intravenous fluids. When there is intolerance to ascorbic acid (Vitamin C), magnesium oxide or bicarbonate of soda may be given along with it. Inasmuch as magnesium deficiency is reported at times, it has been our custom to give magnesium oxide in equal parts with the bicarbonate and ascorbic acid. If, however, this is followed by diarrhea, the amount of magnesium oxide should be decreased. When there is considerable evidence of toxicity, that is to say the liver has a large load of work ahead, to help the individual get back into a state of health the liver flush has frequently been used, as recommended by Harold Stone, the father of polarity therapy. It consists of a mixture of olive oil, lemon and grapefruit juice, and garlic.

Although at Meadowlark we have ample evidence that the psychological benefits of the fast, the attunement to the inner life, are equal in value to the improvement in outward health, I have found scant information in the literature reviewed on the use of psychotherapy in conjunction with the fast. Nor is there scarcely a mention of the bonus of transpersonal experiences which are often accompaniments of the group process that I will describe. I will mention one study done by Wine and Crumpton (l9) that does make a few good points. In their work they divided 37 men into three groups. In group one were placed the men who had a negative attitude in their hospital surroundings, became irritable, demanding and spent much time making accusations. In the second group were those judged as not being successful in life; as might be expected, neither were they particularly successful in fasting. The third group worked together as a unit sharing each others’ problems. This was the one group that truly profited from the experience, gaining insights into their reasons for overeating, the realization of how superficial their lives had been and the discovery of their need to find a new way of life.

At Meadowlark we have the advantage of a setting of great natural beauty in the mountain-girded valley of Hemet, California, which is truly a space apart from the noisy structured life of a large city or hospital setting. This is no doubt a factor in making our group therapy more effective than the study just mentioned. There is also the advantage that our group makes no distinction as to who is included; thus those with poor self esteem have the support of the others. The addition of dream analysis not only helps one to discover the real person but it also frequently takes an individual who has never visited the realm into the dormant area of transpersonal reality. Too, our program takes the faster through exercise programming, biofeedback, psychosynthesis, various types of group encounter, and art therapy, often relating to dream experiences (as related in the chapter on dreams). Lastly but by no means least, much stress is placed upon the keeping of a personal journal.

Certainly one of the greatest benefits of the fast is the mental clarity that accompanies it, and another is the opportunity to discover the value of daily meditation. The group experience always adds to every aspect, for it gives support to each member; and the sharing, loving concern between members and staff frequently strengthens the faster’s personal image.

Membership in a Meadowlark fasters’ group is something that is taken very seriously, assuredly a factor in its success. To enter it is the guest-patient’s decision rather than the physician’s. No one is accepted for the group who is to be in residence for less than two weeks, and it is made very clear at the start that fasting is a discipline, that certain rules will be strictly adhered to. For instance, daily attendance at group meetings promptly at 7 a.m. is required, and sampling of food from the refrigerator is absolutely forbidden. Violation of either rule is grounds for asking the guest to drop out of the group. There are other, less rigid rules. To those who cannot meet the requirements, and it happens that some guests do ask for a less strenuous regime after a few days’ sampling, it is suggested that another, more appropriate time will come when they will feel more emotionally fulfilled and able to undergo the necessary discipline. This strictness has a salutatory effect on those who do succeed, for the accomplishment seems even greater.

Coming Off the Fast

The length of the fast has already been discussed, so we will turn directly to the plan of withdrawal from the fasting state. As a rule of thumb, approximately the same length of time should be given to the withdrawal phase as was spent on the fast. It should be remembered that at the end of the fast, the amount of digestive juices available is limited and the stomach may have considerably shrunk. Thus the initial feedings should be in small amounts at frequent intervals. Breaking this rule and gorging after a fast as some occasionally do, or eating highly refined or spiced foods, can have serious consequences, such as severe abdominal pain, diarrhea and vomiting. Deaths have even been reported from such impulsive behavior.

The longer the fast, the more care is needed in its method of termination. The usual procedure is to break it with fruit or vegetable juices. Meadowlark’s routine is one glass of fruit juice for breakfast and two to three of vegetables juices during the remainder of the day. In the case of fasts that have continued longer than a week, the juices should at first be diluted. These are sipped at intervals throughout the day and not gulped down as a substitute for a meal. The juices used have already been described under the discussion of the juice fast. The water intake should also be kept up so that a total daily fluid intake should average thirty milliliters per kilogram (one ounce per two pounds of body weight.) For a one-week fast, I would suggest two to three days of juice; for two weeks, double this. However, in case of obesity, one can stay considerably longer on the juice if it is so desired. From juices the next step is the introduction of a breakfast of fruits or Muesli,(20) and the other two meals of vegetables, largely raw or very lightly cooked. If there is a suspected reaction to foods, this is the time for presumptive food testing as already described. Lastly we would add dairy products and wheat, carefully noting any possible change in pulse rate or other symptoms that might suggest a reaction to either.’

If chronic illnesses are evident, such as arthritis, malignant states, ulcerative colitis, asthma, cardiovascular diseases, it is very advisable to stay permanently away from red meats such as pork, beef and lamb and consider the vegetarian way of life. If this is too difficult after a period of really good progress in overcoming the signs of the previous disease, it might be permissible to add fish, shell fish and chicken. There are several reasons for the use of vegetable proteins rather than animal that have already been discussed in the chapter on nutrition. It is also of interest to note how many people lose their appetite for meat on completion of the fast. Another benefit is that the appetite can once again discriminate between foods that are health building and those that destroy the body. The latter are very likely to leave a bad taste in the mouth that may persist for as long as several days. The so called junk foods destroy this discriminative sense and induce cravings for sugar, salt and other harmful foods.

The Significance of the Fast

Returns from a follow-up letter Meadowlark sent to fasters who were in a position to evaluate their fasts after a period of three or more years, reveal these remarks:

“was able to eliminate most of my migraine problems” . . .

“for at least six months there has been no evidence of hypoglycemia” . . .

“exhaustion gone, no depression” . . .

“the sustained weight loss was certainly helpful” (10 pounds lost on 11-days’ water fast still sustained). . .

“malabsorption problem is lessened” . . .

“It cleared my excess mucous problem” . . .

“able to stay off prednisone” . . .

“blood pressure now normal.”

Most of the fasting guests have noted that they have made permanent changes for the better in their diets with a greater feeling of health and well being; this usually means far less use of meats, refined foods and a greater consumption of vegetables in particular. The majority have kept on a regular, increased use of exercise as a part of their ways of life. Several have made a practice of finding time for daily meditation.

In conclusion may I share the comments of a housewife/psychologist who captures the meaning of her fast through reviewing her personal journal and sharing it with us:

Notes:

1. Cadbury, Henry 1., George Fox’s Book of Miracles, pp. 33, Cambridge University Press ’48
   
2. Stechschulte, D. and Dunn, M.; Starvation and Heart Failure, J. of Kansas Medical Society, Nov. ’65 pp.5OO Suzuki et al.; Fasting Therapy for Psychosomatic Diseases with special reference to its indications and therapeutic mechanism; Tohuku J. Experimental Medicine, 118 Suppl. 245, 1976.
   
   Duncan, Garfield—In fasting 1300 patients, Allan Cott reports his success with the treatment of hypertension, impaired pulmonary function, chronic heart disease and psoriasis
   
3. Cott, Allan; Fasting; the Ultimate Diet, Bantam Books ’75
   
4. Shelton, Herbert; The Hygenic System, Fasting and Sunbathing Vol. III Dr. Shelton’s Health School, San Antonio, Tex. 1934 revised 1963
   
5. Knutson, K.E. and Selinus, R.; Fasting in Ethiopia; An Anthropological and Nutritional Study; Am. J. Clinical Nutrition 23 (7) July ’70.
   
6. Gandhi, M.K.; Gandhi’s Autobiography, the Story of My Experiments with Truth; Public Affairs Press; Washington, D.C. ’48 7. Coca, Arthur F., The Pulse Test; Arco Publ. Co. N.Y.
   
7. Randolph, Philpott and Mandell; various papers delivered to groups interested in Medical Ecology. Also see Dickey, Lawrence; Medical Ecology; Thoms, Springfield ’76
   
8. Bircher, Ruth, Ralph, Alfred and von Brasch; Eating Your Way to Health, A Penguin Handbook; Baltimore ’72
   
9. Luce, Gay Gaer; Body Time, Pantheon Books ’71
   National Institute of Mental Health, Chevy Chase, Md., ’70; Biological Rhythms in Psychiatry and Medicine ’70; Tompkins and Bird; The Secret Life of Plants; Harper and Row Publ. ’72
   
10. Sakr, Ahmad; Fasting in Islam; Am. Diabetic Ass’n. Vol. 67, July ’75.
    
11. Boyd, Doug: Rolling Thunder; Random House, N.Y. ’74
    
12. Theosophical Research Center, London: Some Unrecognized Factors in Medicine; Theosophical Press, Wheaton, Ill. ’39.
    
13. Assagioli, Roberto: Psychosynthesis; Hobbs, Dorman Co. N.Y. ’65.
    
14. Levi: The Aquarian Gospel of Jesus the Christ; Leo Dowling, publisher, Los Angeles, 1908.
    
15. Potassium supplement: Sodium bicarbonate 2 parts Potassium chloride or citrate 1 part Citric acid 2 parts.
    
16. PH indicator papers – obtainable through Micro Essential Lab. Brooklyn, N.Y. specify range 6-8.
    
17. Spencer: Lancet ’68 Mount: Lancet July 6, 1944 Sakr, Ahmad (see note #10)
    
18. Bieler Broth: Equal amounts of green beans, celery and zucchini are placed in a saucepan with a small amount of parsley. Water is added. Cook on low heat for ten minutes until vegetables are just tender. This is blended till of a creamy consistency and then served.
    
19. Wine, D.B., Crumpton, E: Group Psychotherapy with 27 Starving Men, Psychiatry Digest 29 (7): 17-20, July ’68.
    
20. Muesli: Note 8 above

Symptoms


Anorexia nervosa and bulimia seem like opposite conditions, but they share these common traits:

• Fear of overeating and gaining weight
  
• Depression
  
• Low self-esteem, poor body image
  
• Self-destructive outlook, self-punishment for some imaginary wrong
  
• Disturbed family relationships
  
• Increased rate of illness due to low weight, frequent weight gain/loss and/or poor nutrition
  
• Abnormal preoccupation with food and feeling out of control
  

• Are mostly female, and/or preteen, teenage or college age
  
• Tend to place too much emphasis on body image and perfection
  
• May feel the need to be perfect to gain parental attention.
  
• Have marked physical effects loss of head hair, slowed heart rate, low blood pressure, absence of menstrual periods
  
• Tend to experience extreme depression more than bulimics
  
• Develop osteoporosis in later life due to lack of calcium and decreased production of estrogen, if menstruation stops. Excessive exercise can contribute to this as well.
  
• May have severe damage to heart and vital organs due to an excessive loss of weight and to a mineral imbalance from vomiting and/or poor nutrition
  

Bulimia Sufferers:

• Can be overweight, underweight, or normal weight
  
• Are mostly female and older teen or young adult
  
• Binge eat and then vomit (purge) and/or take laxatives or water pills (diuretics) to “undo” the binge
  
• Have severe health problems that come from the binge-purge cycle of eating. These include stomach lining damage, irregular heartbeat, kidney damage from low potassium levels, and damage to tooth enamel from vomiting.
  
• Repress anger because they can’t express emotions in an assertive way. They fear upsetting important people in their lives.
  

There is no one cause for these eating disorders. There are many factors. They include:

• A possible genetic link
  
• Metabolic and biochemical problems or abnormalities
  
• Pressure from society to be thin
  
• Personal or family pressures
  
• Fear of entering puberty or becoming sexually active
  

• Medical diagnosis and care the earlier, the better
  
• Psychotherapy individual, family, and/or group
  
• Behavior therapy
  
• Medication antidepressant medicine is sometimes used.
  
• Medical nutrition therapy
  
• Support group participation
  
• Outpatient treatment programs
  
• Hospitalization if your weight loss makes you 25% or more below normal weight and/or has affected vital functions
  

Questions to Ask

Have you lost a significant amount of weight by dieting and exercising on purpose (not due to any known illness) and do you have any of these problems? An intense fear of gaining weight or of getting fat You see yourself as fat even though you are at normal weight or are underweight. You continue to diet and exercise excessively even though you have reached your weight goal.
Are you aware that your eating pattern is not normal and are you afraid that you will not be able to stop binge eating? Are you depressed after binging on food?
Do you have a combination of these problems along with abnormal eating habits? Irregular heartbeat Slow pulse, low blood pressure Rapid tooth decay Low body temperature, cold hands and feet Thin hair (or hair loss) on the head, babylike hair on the body (lanugo) Dry skin, fingernails that split, peel, or crack Problems with digestion, bloating, constipation Three or more missed periods (in a row), delayed onset of menstruation, infertility Periods of depression and lethargy, euphoria and/or hyperactivity Tiredness, weakness, muscle cramps, tremors Lack of concentration
Do you do one or both of the following? Hoard food Leave the table right after meals to “go to the bathroom” to induce vomiting and/or spend long periods of time in the bathroom from taking laxatives and/or water pills
Do you have recurrent episodes when you eat a large amount of food at a very fast pace and do at least 3 of the following? Eat high-calorie, easily eaten foods during a binge Binge eat with no one watching Stop the binge eating when you get stomach pain, go to sleep, interact socially, or induce vomiting Attempt to lose weight over and over with severe diets, self-induced vomiting, and/or laxatives or water pills Have weight changes of more than 10 pounds due to binging and fasting
If you have answered NO to all of the above questions you are probably not suffering from anorexia nervosa and/or bulimia. If you are not sure, though, see a counselor for a professional assessment.

{Note: Eating disorders are too complex and physically harmful to be treated with self-care alone. Experts agree that experienced professionals should treat people who have eating disorders. See “Places to Get Information & Help” under “Eating Disorders” on page 375.}

Prevention


The following tips may help prevent an eating disorder:

• Accept yourself and your body. You don’t need to be or look like anyone else. Spend time with people who accept you as you are, not people who focus on “thinness.”
  
• Eat nutritious foods. Focus on complex carbohydrates (whole grains, beans, etc.), fresh fruits and vegetables, low-fat dairy foods, and low-fat meats.
  
• Eat at regular times during the day. Don’t skip meals. If you do, you are more likely to binge when you eat.
  
• Avoid white flour, sugar, and “junk” foods high in calories, fat, and sugar such as cakes, cookies and pastries. Bulimics tend to binge on junk food. The more they eat, the more they want.
  
• Get regular moderate exercise. If you find that you are exercising excessively, make an effort to get involved in nonexercise activities with friends and family.
  
• Find success in things that you do. Your work, hobbies, and volunteer activities will promote self-esteem.
  
• Learn as much as you can about eating disorders from books and organizations that deal with them.
  
• Parents who want to help daughters avoid eating disorders should promote a balance between their daughters’ competing needs for both independence and family involvement.