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Current Pain and Headache Reports

, Volume 14, Issue 2, pp 80–87 | Cite as

Prolonged Fasting as a Method of Mood Enhancement in Chronic Pain Syndromes: A Review of Clinical Evidence and Mechanisms

  • Andreas MichalsenEmail author
Article

Abstract

Periods of deliberate fasting with restriction to intake of solid food are practiced worldwide, mostly based on a traditional, cultural, or religious background. Recent evidence from clinical trials shows that medically supervised modified fasting (200–500 kcal nutritional intake/day) with periods from 7 to 21 days is efficacious in the treatment of rheumatic diseases and chronic pain syndromes. Here, fasting is frequently accompanied by increased alertness and mood enhancement. The beneficial claims of fasting are supported by experimental research, which has found fasting to be associated with increased brain availability of serotonin, endogenous opioids, and endocannabinoids. Fasting-induced neuroendocrine activation and mild cellular stress response with increased production of neurotrophic factors may also contribute to the mood enhancement of fasting. Fasting treatments may be useful as an adjunctive therapeutic approach in chronic pain patients. The mood-enhancing and pain-relieving effect of therapeutic fasting should be further evaluated in randomized clinical trials.

Keywords

Caloric restriction Diet Fasting Mood Pain 

Notes

Disclosure

No potential conflicts of interest relevant to this article were reported.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Wang T, Hung CC, Randall DJ: The comparative physiology of food deprivation: from feast to famine. Annu Rev Physiol 2006, 68:223–251.CrossRefPubMedGoogle Scholar
  2. 2.
    Lützner H: Fasten. Bindlach: Gondrom Verlag; 2002.Google Scholar
  3. 3.
    Fahrner H: Fasten als Therapie. Stuttgart: Hippokrates; 1991.Google Scholar
  4. 4.
    Buchinger A: Fasting. In Clinician’s Complete Reference to Complementary and Alternative Medicine. Edited by Nowey DW. St. Louis: Mosby; 2000.Google Scholar
  5. 5.
    Owen OE, Smalley KJ, D’Alessio DA, et al.: Protein, fat, and carbohydrate requirements during starvation: anaplerosis and cataplerosis. Am J Clin Nutr 1998, 68:12–34.PubMedGoogle Scholar
  6. 6.
    Varady KA, Hellerstein MK: Alternate-day fasting and chronic disease prevention: a review of human and animal trials. Am J Clin Nutr 2007, 86:7–13.PubMedGoogle Scholar
  7. 7.
    • Varady KA, Bhutani S, Church EC, Klempel MC: Short-term modified alternate-day fasting: a novel dietary strategy for weight loss and cardioprotection in obese adults. Am J Clin Nutr 2009, 90:1138–1143. This review summarizes metabolic and cardioprotective effects of calorie restriction.CrossRefPubMedGoogle Scholar
  8. 8.
    Lützner H: Fasten/Fastentherapie. In Naturheilverfahren und Unkonventionelle Medizinische Richtungen. Edited by Bühring M, Kemper FH. Berlin: Springer; 1998:1–26.Google Scholar
  9. 9.
    Exton MS: Infection-induced anorexia: active host defence strategy. Appetite 1997, 29:369–383.CrossRefPubMedGoogle Scholar
  10. 10.
    Shelton H: The Hygienic System. Fasting and Sun Bathing. San Antonio, TX: Dr. Shelton’s Health School; 1963.Google Scholar
  11. 11.
    • Johnstone AM: Fasting: the ultimate diet? Obes Rev 2007, 8:211–222. This review gives an overview of clinical and physiological effects of fasting used for weight loss in obese patients. CrossRefPubMedGoogle Scholar
  12. 12.
    Michalsen A, Hoffmann B, Moebus S, et al.: Incorporation of fasting therapy in an integrative medicine ward: evaluation of outcome, safety, and effects on lifestyle adherence in a large prospective cohort study. J Altern Complement Med 2005, 11:601–607. (Published erratum appears in J Altern Complement Med 2005, 11:1121.)CrossRefPubMedGoogle Scholar
  13. 13.
    Hartel U, Volger E: Inanspruchnahme und Akzeptanz klassischer Naturheilverfahren und alternativer Heilmethoden in Deutschland—Ergebnisse einer reprasentativen Bevolkerungsstudie. Forsch Komplementarmed Klass Naturheilkd 2004, 11:327–334.CrossRefPubMedGoogle Scholar
  14. 14.
    Stange R, Amhof R, Moebus S: Complementary and alternative medicine: attitudes and patterns of use by German physicians in a national survey. J Altern Complement Med 2008, 14:1255–1261.CrossRefPubMedGoogle Scholar
  15. 15.
    Wilhelmi de Toledo F: Fasten/Fastentherapie: physiologie des fastens. In Fasten/Fastentherapie: Physiologie des Fastens. Edited by Springer LoseblattSammlung. Berlin; 1998.Google Scholar
  16. 16.
    Müller H, de Toledo FW, Resch KL: Fasting followed by vegetarian diet in patients with rheumatoid arthritis: a systematic review. Scand J Rheumatol 2000, 30:1–10.Google Scholar
  17. 17.
    Kjeldsen-Kragh J, Haugen M, Borchgrevink CF, et al.: Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet 1991, 338:899–902.CrossRefPubMedGoogle Scholar
  18. 18.
    Michalsen A, Riegert M, Lüdtke R, et al.: Mediterranean diet or extended fasting’s influence on changing the intestinal microflora, immunoglobulin A secretion and clinical outcome in patients with rheumatoid arthritis and fibromyalgia: an observational study. BMC Complement Altern Med 2005, 5:22.CrossRefPubMedGoogle Scholar
  19. 19.
    Lipecki R: Klinische Studie zur Effizienz einer kombinierten Heilfastenbehandlung als Migränetherapie. Inaugural Dissertation 1990, Universität Würzburg:1–53.Google Scholar
  20. 20.
    Hargraves WA, Hentall ID: Analgesic effects of dietary caloric restriction in adult mice. Pain 2005, 114:455–461.CrossRefPubMedGoogle Scholar
  21. 21.
    de los Santos-Arteaga M, Sierra-Dominguez SA, Fontanella GH, et al.: Analgesia induced by dietary restriction is mediated by the kappa-opioid system. J Neurosci 2003, 23:11120–11126.PubMedGoogle Scholar
  22. 22.
    Müller H, Wilhelmi de Toledo F, Schuck P, Resch KL. Blutdrucksenkung durch Fasten bei adipösen und nichtadipösen Hypertonikern. Perfusion 2001, 14:108–112.Google Scholar
  23. 23.
    Goldhamer AC, Lisle DJ, Sultana P, et al.: Medically supervised water-only fasting in the treatment of borderline hypertension. J Altern Complement Med 2002, 8:643–650.CrossRefPubMedGoogle Scholar
  24. 24.
    Horne BD, May HT, Anderson JL, et al.: Usefulness of routine periodic fasting to lower risk of coronary artery disease in patients undergoing coronary angiography. Am J Cardiol 2008, 102:814–819.CrossRefPubMedGoogle Scholar
  25. 25.
    Michalsen A, Weidenhammer W, Melchart D, et al. Short-term therapeutic fasting in the treatment of chronic pain and fatigue syndromes: well-being and side effects with and without mineral supplements [in German]. Forsch Komplementarmed Klass Naturheilkd 2002, 9:221–227.CrossRefPubMedGoogle Scholar
  26. 26.
    Peper E, Rogner J, Hettwer H: Stationäres Heilfasten. Prä-/Post-Befragung zum körperlichen und emotionalen Befinden sowie erlebten Veränderungen. Präv.-Rehab 1996, 8:129–136.Google Scholar
  27. 27.
    •• Michalsen A, Kuhlmann MK, Lüdtke R, et al.: Prolonged fasting in patients with chronic pain syndromes leads to late mood-enhancement not related to weight loss and fasting-induced leptin depletion. Nutr Neurosci 2006, 9:195–200. This report describes the mood-enhancing effect of extended fasting as observed in a controlled study in patients with chronic pain syndromes. CrossRefPubMedGoogle Scholar
  28. 28.
    Michalsen A, Schlegel F, Rodenbeck A, et al.: Effects of short-term modified fasting on sleep patterns and daytime vigilance in non-obese subjects: results of a pilot study. Ann Nutr Metab 2003, 47:194–200.CrossRefPubMedGoogle Scholar
  29. 29.
    Michalsen A, Frey UH, Merse S, et al.: Hunger and mood during extended fasting are dependent on the GNB3 C825T polymorphism. Ann Nutr Metab 2009, 54:184–188.CrossRefPubMedGoogle Scholar
  30. 30.
    Schwartz MW, Seeley RJ: Seminars in medicine of the Beth Israel Deaconess Medical Center. Neuroendocrine responses to starvation and weight loss. N Engl J Med 1997, 336:1802–1811.CrossRefPubMedGoogle Scholar
  31. 31.
    Palmblad J, Levi L, Burger A, et al.: Effects of total energy withdrawal (fasting) on the levels of growth hormone, thyrotropin, cortisol, adrenaline, noradrenaline, T4, T3 and rT3 in healthy males. Acta Med Scand 1977, 201:15–22.PubMedGoogle Scholar
  32. 32.
    Michalsen A, Schneider S, Rodenbeck A, et al.: The short-term effects of fasting on the neuroendocrine system in patients with chronic pain syndromes. Nutr Neurosci 2003, 6:11–18.CrossRefPubMedGoogle Scholar
  33. 33.
    Bergendahl M, Evans WS, Pastor C, et al.: Short-term fasting suppresses leptin and (conversely) activates disorderly growth hormone secretion in midluteal phase women: a clinical research center study. J Clin Endocrinol Metab 1999, 84:883–894.CrossRefPubMedGoogle Scholar
  34. 34.
    Ahima RS, Prabakaran D, Mantzoros C, et al.: Role of leptin in the neuroendocrine response to fasting. Nature 1996, 382:250–252.CrossRefPubMedGoogle Scholar
  35. 35.
    Silva JP, von Meyenn F, Howell J, et al.: Regulation of adaptive behavior during fasting by hypothalamic Foxa2. Nature 2009, 462:646–650.CrossRefPubMedGoogle Scholar
  36. 36.
    Göhler L, Hahnemann T, Michael N, et al.: Reduction of plasma catecholamines in humans during clinically controlled severe underfeeding. Prev Med 2000, 30:95–102.CrossRefPubMedGoogle Scholar
  37. 37.
    Spark RF, Arky RA, Boulter PR, et al.: Renin, aldosterone and glucagon in the natriuresis of fasting. N Engl J Med 1975, 292:1335–1340.PubMedCrossRefGoogle Scholar
  38. 38.
    Maoz E, Shamiss A, Peleg E, et al.: The role of atrial natriuretic peptide in natriuresis of fasting. J Hypertens 1992, 10:1041–1044.CrossRefPubMedGoogle Scholar
  39. 39.
    Horowitz JF, Coppack SW, Paramore D, et al.: Effects of short-term fasting on lipid kinetics in lean and obese woman. Am J Physiol 1999, 276:E278–E284.PubMedGoogle Scholar
  40. 40.
    • Ahima RS, Lazar MA: Adipokines and the peripheral and neural control of energy balance. Mol Endocrinol 2008, 22:1023–1031. This report describes the role of leptin and adipokines in the regulation of nutritional energy balance. CrossRefPubMedGoogle Scholar
  41. 41.
    Tichomirowa MA, Keck ME, Schneider HJ, et al.: Endocrine disturbances in depression. J Endocrinol Invest 2005, 28:89–99.PubMedGoogle Scholar
  42. 42.
    Fulton S, Woodside B, Shizgal P: Modulation of brain reward circuitry by leptin. Science 2000, 287:125–128. (Published erratum appears in Science 2000, 287:1931.)CrossRefPubMedGoogle Scholar
  43. 43.
    Schweiger U, Broocks A, Tuschl RJ, Pirke KM: Serotonin turnover in rat brain during semistarvation with high-protein and high-carbohydrate diets. J Neural Transm 1989, 77:131–139.CrossRefPubMedGoogle Scholar
  44. 44.
    Curzon G, Joseph MH, Knott PJ: Effects of immobilization and food deprivation on rat brain tryptophan metabolism. J Neurochem 1972, 19:1967–1974.CrossRefPubMedGoogle Scholar
  45. 45.
    Huether G, Zhou D, Schmidt S, et al.: Long-term food restriction down-regulates the density of serotonin transporters in the rat frontal cortex. Biol Psychiatry 1997, 41:1174–1180.CrossRefPubMedGoogle Scholar
  46. 46.
    Mattson MP: Energy intake, meal frequency, and health: a neurobiological perspective. Annu Rev Nutr 2005, 25:237–260.CrossRefPubMedGoogle Scholar
  47. 47.
    Goggi J, Pullar IA, Carney SL, Bradford HF: Modulation of neurotransmitter release induced by brain-derived neurotrophic factor in rat brain striatal slices in vitro. Brain Res 2002, 941:34–42.CrossRefPubMedGoogle Scholar
  48. 48.
    Rumajogee P, Madeira A, Vergé D, et al.: Up-regulation of the neuronal serotoninergic phenotype in vitro: BDNF and cAMP share Trk B-dependent mechanisms. J Neurochem 2002, 83:1525–1528.CrossRefPubMedGoogle Scholar
  49. 49.
    Komaki G, Tamai H, Sumioki H, et al.: Plasma beta-endorphin during fasting in man. Horm Res 1990, 33:239–243.CrossRefPubMedGoogle Scholar
  50. 50.
    Molina PE, Hashiguchi Y, Meijerink WJ, et al.: Modulation of endogenous opiate production: effect of fasting. Biochem Biophys Res Commun 1995, 207:312–317.CrossRefPubMedGoogle Scholar
  51. 51.
    Hanus L, Avraham Y, Ben-Shushan D, et al.: Short-term fasting and prolonged semistarvation have opposite effects on 2-AG levels in mouse brain. Brain Res 2003, 983:144–151.CrossRefPubMedGoogle Scholar
  52. 52.
    Mattson MP, Wan R: Beneficial effects of intermittent fasting and caloric restriction on the cardiovascular and cerebrovascular systems. J Nutr Biochem 2005, 16:129–137.CrossRefPubMedGoogle Scholar
  53. 53.
    Mattson MP, Chan SL, Duan W: Modification of brain aging and neurodegenerative disorders by genes, diet, and behavior. Physiol Rev 2002, 82:637–672.PubMedGoogle Scholar
  54. 54.
    • Maalouf MA, Rho JM, Mattson MP: The neuroprotective properties of calorie restriction, the ketogenic diet, and ketone bodies. Brain Res Rev 2009, 59:293–315. This review gives an overview of the potential neuroprotective effects of calorie restriction, fasting, and ketone bodies. CrossRefPubMedGoogle Scholar
  55. 55.
    •• Fontán-Lozano A, López-Lluch G, Delgado-Garcîa JM, et al.: Molecular bases of caloric restriction regulation of neuronal synaptic plasticity. Mol Neurobiol 2008, 38:167–177. This review discusses the effects of fasting and calorie restriction on brain function and cellular/synaptic processes underlying analgesia and cognitive function. CrossRefPubMedGoogle Scholar
  56. 56.
    • Taylor BK, Abhyankar SS, Vo NT, et al.: Neuropeptide Y acts at Y1 receptors in the rostral ventral medulla to inhibit neuropathic pain. Pain 2007, 131:83–95. This report illustrates how neuropeptide Y, which is also modified by fasting, is involved in the spinal transmission of pain. CrossRefPubMedGoogle Scholar
  57. 57.
    Ito N, Yabe T, Gamo Y, et al.: I.c.v. administration of orexin-A induces an antidepressive-like effect through hippocampal cell proliferation. Neuroscience 2008, 157:720–732.CrossRefPubMedGoogle Scholar
  58. 58.
    • Mehta LH, Roth GS: Caloric restriction and longevity: the science and the ascetic experience. Ann N Y Acad Sci 2009, 1172:28–33. This review discusses the ascetic background of fasting tradition and implications for current research on the effects of caloric restriction. CrossRefPubMedGoogle Scholar
  59. 59.
    Wilhelmi de Toledo F, Buchinger A, Burggrabe H, et al.: Guidelines of fasting therapy. Forsch Komplementarmed 2002, 189–199.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Immanuel Hospital Berlin, Department of Internal and Complementary Medicine; and the Institute of Social Medicine, Epidemiology and Health EconomicsCharité-University Medical CentreBerlinGermany

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