World's Longest Medically Documented Repeated Fasting History in a 92 Years Old Man Who Fasted 21 Days Yearly for 45 Years: A Case Report

Abstract

Case presentation:

Scientific documentation on lifelong repeated cycles of long-term fasting doesn't exist. We report the case of a 92-year-old man who fasted 3 weeks yearly for 45 years.

Results:

Body weight and clinical parameters showed cyclic variations, returning to baseline after food reintroduction. Biological age analysis indicated that the patient was 5.9 years younger than his chronological age. Mental and physical health tests documented the absence of frailty, that the patient could function independently, had excellent cognitive functions, and a good mobility.

Conclusion:

It can be reasonably assumed that this subject have had protective effects from his yearly fasting.

Introduction

Fasting is not the absence of eating; it serves a repair and regeneration function. The benefits of intermittent fasting have been documented in many animal and human studies. ¹ However, research on long-term fasting in nonobese humans has only recently been conducted. ² In the 1970s and 1980s, several studies on zero-calorie diets for the treatment of morbid obesity with fasting periods lasting several weeks or even months were published. ^3,4 The longest published fasting reported in 1973 lasted 382 days. ⁵

There have been numerous publications on long-term fasting in free-living animals, such as hibernating mammals and migratory birds, demonstrating their astonishing abilities to tolerate fasting. ⁶ Many wild animals fast yearly often for decades. Publications on rural populations in Gambia undergoing restricted eating during monsoon periods revealed a cyclical pattern of overall weight changes following seasonal rhythms. ⁷ Additionally, fasting practices are well-known in theological literature, with examples including the yearly fasting periods like Lent in Christianity and Ramadan in Islam. However, to our knowledge, there are no publications documenting repeated long-term fasting.

In Germany, fasting has been recognized for its therapeutic effects beyond weight loss, although it is not widely acknowledged in mainstream medicine. Recent studies showed benefits of fasting such as an increase in total antioxidant capacity, ⁸ positive changes in the gut microbiome, ⁹ normalization of blood pressure even in medicated subjects, ¹⁰ health improvements in rheumatic diseases, ¹¹ and chronic pain. ¹² Health effects of fasting have been, at least in part, attributed to the inactivation of mammalian target of rapamycin by nutrient deprivation which triggers mechanisms to cope with nutritional stress, ¹³ including DNA repair, ¹⁴ autophagy, ¹⁵ and oxidative stress defense. ⁸ Since these mechanisms are known to be hallmarks of aging, fasting is increasingly used as a nonpharmacological strategy to promote healthy aging.

The metabolism of wild animals and humans is programmed to operate on circadian and circannual rhythms, which are natural cycles that occur in our bodies over 24-h and every year. ^16,17 These rhythms programmed in our hypothalamus dictate when we feel hungry, when we feel sleepy, and when our metabolism is most active or inactive. ¹⁶ Emerging scientific evidence suggest that we can optimize our health by reintroducing these natural cycles. ^18,19

We report the case of a 92-year-old man who yearly fasted 3 weeks during 45 years (Supplementary Data S3). This is to our knowledge the world's longest medically documented repeated fasting observation. Body weight and clinical evolution were documented from 1970 to 2022. Current cardiometabolic, physical, and mental health status as well as the epigenetic biological age of this patient were reported at his last visit.

Case Description

The patient has been fasting since 1970, starting at the age of 40. Altogether, he fasted 46 times, on average 21 days a year. He started to fast without any specific medical reason, more as a personal challenge. However, upon experiencing an improvement in his physical and emotional well-being, he decided to repeat this 3-week fast periodically. Under medical supervision, he carried out a fasting cure every spring and a calorie reduction diet (800 kcal) in autumn, both of 21 days. The fasting program was according to the Buchinger fasting program, as described in peer-reviewed guidelines. ²⁰ This included a total calorie intake of around 250 kcal/d (250 mL organic fresh fruit juice at noon and 250 mL vegetable soup in the evening, 20 g of honey). The fasting was accompanied by moderate physical activity. He fasted for the last time in spring 2015 at the age of 85 on his own decision because he noticed that the transition from eating to fasting was getting more difficult. Nevertheless, he continued to come twice a year for a 21-day stay on a calorie restriction diet of 800 kcal.

The patient was born in 1930. He had no health problems except an operation for hernia in 2005 and a kidney stone previous to his first fasting experience. He smoked around 10 cigarettes per day and drank moderately alcohol. He had no particular symptoms during his fasts, apart from a mild headache at the beginning of his first fast. He never developed gallbladder stones or sarcopenia from the first time he fasted in 1970. He felt increasingly well physically and emotionally during and after each stay. He lost in average 6.9 kg per fasting period. He progressively regained weight until baseline after every intervention. The cyclic variations in body weights are shown in Figure 1. Only a period of occupational stress caused a change in the baseline body weight (Fig. 1).

FIG. 1.

Changes in body weight in a patient who fasted 21 days yearly for 45 years. The patient alternated between Buchinger Wilhelmi fasting (3 weeks at 250 kcal per day, in red) with calorie restriction periods (3 weeks at 800 kcal per day, in black). Period of occupational stress (arrow) had an influence on the baseline of body weight.

Standard laboratory parameters were measured at the beginning of each stay. On a few occasions, the examinations were also conducted at the end of the stay, such as for lipid levels (Fig. 2). They revealed cyclic variations in blood cholesterol and triglyceride concentrations which dropped during long-term fasting and returned to baseline levels, in the normal ranges, when the patient reintroduced the food. The baseline levels did not increase which suggested that long-term fasting had a protective effect preventing the age-related increase in cholesterol and triglyceride concentrations. The complete blood analysis at the beginning and the end of his last long-term fast at the age of 85 years is shown (Table 1). They revealed a good metabolic health. Repeated long-term fasting in this case did not cause any metabolic change of concern in between each fasting or calorie restriction. In the course of his life, he changed his nutrition toward organic food, home cooked, but was not a vegetarian and continued drinking half a liter beer per day. He stopped smoking with no relapse after his first fast.

FIG. 2.

Changes in lipid metabolism during the last 15 years the patient regularly fasted. The patient alternated between Buchinger Wilhelmi fasting (3 weeks at 250 kcal per day, in red) with calorie restriction periods (3 weeks at 800 kcal per day, in black). Dotted lines represent the periods during which the patient was not in the clinic. The x-axis labels are indicative and do not represent a continuous period of time.

Table 1.

Blood Analysis Showing the Effects of a 21-Day Long Fast on the Health of the Patient

Parameter	Normal range	Unit	Baseline	End of fasting
Sedimentation	12.0–25.0	mm/h	10/18	16/30
Leukocytes	4.0–11.0	Tsd/μL	6.6	6.5
Erythrocytes	4.5–5.8	Mio/μL	4.7	4.38
% hypochrome erythrocytes	<5.0	%	0.2	0.2
Hemoglobin	14.0–18.0	g/dL	13.9	13.7
Hematocrit	42.0–52.0	%	43	40
MCV	82.0–99.0	fL	91	92
MCH	27.0–33.0	pg	30	31
MCHC	31.0–37.0	g/dL	33	34
Thrombocytes	140.0–440.0	Tsd/μL	313	299
GOT (AST)	5.0–17.0	U/L	23	16
GPT (ALT)	5.0–23.0	U/L	22	19
GGT	5.0–35.0	U/L	19	15
Alkaline phosphatase	50.0–190.0	U/L	76	58
Vitamin D	20–70	μg/L	42	53
Uric acid	3.4–7.0	mg/dL	7	7.3
Urea	10.0–50.0	mg/dL	27.4	38.3
Creatinine	0.70–1.30	mg/dL	1.06	0.88
INR	0.9–1.2		1.03	1.01
Quick	70–130	%	95	99
Total cholesterol	80.0–200.0	mg/dL	206	182
Triglycerides	40.0–175.0	mg/dL	127	102
HDL cholesterol	35.0–120.0	mg/dL	54	53
LDL cholesterol	0.0–150.0	mg/dL	128	107
LDL/HDL	<4.0		2.4	2.0
Sodium	135–147	mmol/L	140	141
Potassium	3.60–5.20	mmol/L	4.4	4.7
Calcium	2.20–2.60	mmol/L	2.55	2.46
Magnesium	1.6–2.5	mg/dL	0.9	0.9
TSH basal	0.27–4.20	ulU/mL	1.2	0.9
PTT	25–37	sec	31	30
Glucose	55.0–110.0	mg/dL	94	87
HbA1c	4.2–5.7	%	5.1	5.1
CRP	0.0–5.00	mg/L	0.5	0.19

This fasting cure was the last one of a series of annual repetitions of Buchinger Wilhelmi fasting (3 weeks at 250 kcal per day, in red) and calorie restriction periods (3 weeks at 800 kcal per day, in black). The patient was 85 at the time when this blood test was done.

ALT, alanine transaminase; AST, aspartate transaminase; CRP, C-reactive protein; GGT, gamma-glutamyl transpeptidase; GPT, glutamate-pyruvate transaminase; GOT, glutamate-oxaloacetate transaminase; HbA1c, glycated hemoglobin; HDL, high-density lipoprotein; INR, international normalized ratio; LDL, low-density lipoprotein; MCH, mean corpuscular hemoglobin; MCHC, mean corpuscular hemoglobin concentration; MCV, mean corpuscular volume; PTT, partial thromboplastin time; TSH, thyroid stimulating hormone.

During his last stay in 2022, an extensive panel of examinations was performed. The patient had primary hypertension and a mild hypertensive cardiac hypertrophy. He had aortic, tricuspid, and pulmonary regurgitation grade I. The patient also had had bradycardia and sinus node dysfunction, which lead to the implantation of a dual chamber pacemaker in November 2019. Some degree of aortic sclerosis and some calcified carotid bulb plaques on both sides without significant stenosis was also reported. Altogether, he had no limitation in any of his everyday life actions. A bladder diverticulum (2.1 cm) was found. Slowly growing PSA values were reported in August 2008, corresponding to a tolerated increase of 13% per year. Since he is asymptomatic, these values were under observation (Supplementary Data S1). The biological age determined using DNA methylation analysis that indicated that the patient was 5.9 years younger than his chronological age.

The physical examination revealed once a shoulder impingement syndrome, which disappeared with regular physiotherapy and self-performed gymnastics. The patient undertook a series of frailty tests during his last visit. The frail scale score was 0, documenting the absence of frailty. Barthel Index for Activities of Daily Living of 100/100 indicated that the patient could function totally independently. Mini Mental Status Test indicated excellent cognitive functions (score of 30/30). The score at the Geriatric Depression Scale was 0, indicating the absence of depression. The mobility examined by a physiotherapist using the JANDA method and the Tinetti performance-oriented mobility assessment scale, all obtained the maximal scores (Supplementary Data S2).

Discussion

Here, we have provided the most comprehensive description of lifelong cycles of long-term fasting. The patient was not frail and had excellent cognitive functions, and a good mobility after having fasted yearly 3 weeks during 45 years. It cannot be full ascertained that this good metabolic and physical health can be attributed to fasting, since healthy longevity can be subjected to both genetic, environmental, and lifestyle influences. ²¹ The adoption of a healthy lifestyle is also likely to have contributed to the good health of this patient. Fasting followed by vegetarian diet has been shown to help patients with rheumatoid arthritis. ^22,23 Overall, maintaining a balanced diet, engaging in consistent physical activity, limiting alcohol intake, and refraining from smoking can potentially extend the lifespan of women by up to 14 years and men by up to 12 years. ²⁴ Further studies will have to be conducted with large groups of individuals having done fasting interventions at different frequencies.

The patient's biological age was 5.9 years younger than his chronological age prompts questions about the possible rejuvenating effects of fasting. The epigenetic biological age is known to be sensitive to lifestyle intervention, ²⁵ and fasting is known to act on mechanisms which are known to be hallmarks of aging by activating DNA repair mechanisms, ¹⁴ stem cell regeneration, ²⁶ autophagy, ²⁷ or antioxidant defences. ²⁸

Recent scientific studies on fasting have been mostly focusing on understanding the optimal duration of fasting periods, neglecting the importance of their frequency. The role of frequency is emerging as a key topic for compliance and therapeutic efficacy in some studies on intermittent fasting ²⁹ or fasting mimicking diets. ³⁰ Regular fasting cycles might work better than single therapies because our bodies can adapt to them biologically. Our metabolism can be trained to handle transitions from eating to fasting, as shown by studies on blood cells that get habituated to nutrient availability changes. ³¹ Athletes who have been switching their metabolism to fat burning during intense exercise regularly also have a higher metabolic flexibility and an enhanced ability to oxidize fat. ³²

The variations in body weight of the patient resembled the natural variations in body weight of fasting animals like emperor penguins. ³³ A tendency of people losing weight rapidly to regain it and increase their weight over the baseline value when they stop dieting, referred to as weight cycling, is a major source of anxiety in people dieting. In this patient, it was more the reflection of a physiological weight cycling of animals and humans living in natural environment without any pathological consequence since it returned to baseline.

Conclusion

We concluded that this 92-year-old man in exceptional mental and physical health seemed to have had protective effects from his yearly practice of long-term fasting in a medical setting. This one case doesn't allow to draw conclusions on the aging, preventing benefits of long-term fasting in general. Nevertheless, it corroborates the assumption that like animals, humans were evolutionary adapting to seasonal food shortage to fast periodically and have still conserved this ability of long-term fasting.

Patient Perspective

“I came first fasting at Buchinger Wilhelmi after I found by chance an article in an ancient magazine. When I was here for the first time, the cure suited me very well compared to what I assumed. And the improvement are probably the deciding factor for my coming back regularly. I wasn't very overweight, that wasn't the main reason for coming here. First of all, the adventure, the good success of losing weight at Buchinger, going away, and increasing vitality. I haven't really had any side effects at all. I think at the beginning, I had a tiny bit of a headache. I have never had any problems with fasting. Switching to the fasting mode at 85 took a little longer and was also a little more uncomfortable and I said to myself you'll come twice a year to do the 800 kcal diet. I get by just fine with the 800 calories. I'm basically not hungry. In between my stays, I did not deprive myself and indulged in the foods I desired while maintaining a balanced diet. Despite my age, I am physically healthy and attribute it to the repeated fasting, which has always brought me great pleasure. I eagerly look forward to my upcoming visits. I have fasted for 45 years. 45! Once a year: loyal like the migratory birds, always in spring.”