THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINEVolume 8, Number 5, 2002, pp. 643–650© Mary Ann Liebert, Inc.

Medically Supervised Water-Only Fasting in theTreatment of Borderline Hypertension

ALAN C. GOLDHAMER, D.C.,

DOUGLAS J. LISLE, Ph.D.,

PETER SULTANA, M.D.,

SCOTT V. ANDERSON, M.D.,

BANOO PARPIA, Ph.D.,

BARRY HUGHES,

and T. COLIN CAMPBELL, Ph.D.

ABSTRACTBackground:

Hypertension-related diseases are the leading causes of morbidity and mortal-ity in industrially developed societies. Surprisingly, 68% of all mortality attributed to high bloodpressure (BP) occurs with systolic BP between 120 and 140 mm Hg and diastolic BP below90 mm Hg. Dietary and lifestyle modifications are effective in the treatment of borderline hy-pertension. One such lifestyle intervention is the use of medically supervised water-only fastingas a safe and effective means of normalizing BP and initiating health-promoting behavioralchanges.

Methods:

Sixty-eight (68) consecutive patients with borderline hypertension with systolic BPin excess of 119 mm Hg and diastolic BP less than 91 mm Hg were treated in an inpatient set-ting under medical supervision. The treatment program consisted of a short prefasting period(approximately 1–2 days on average) during which food consumption was limited to fruits andvegetables followed by medically supervised water-only fasting (approximately 13.6 days on av-erage). Fasting was followed by a refeeding period (approximately 6.0 days on average). Therefeeding program consisted of a low-fat, low-sodium, plant-based, vegan diet.

Results:

Approximately 82% of the subjects achieved BP at or below 120/80 mm Hg by theend of the treatment program. The mean BP reduction was 20/7 mm Hg, with the greatest de-crease being observed for subjects with the highest baseline BP. A linear regression of BP decreaseagainst baseline BP showed that the estimated BP below which no further decrease would be ex-pected was 96.0/67.0 mm Hg at the end of the fast and 99.2/67.3 mm Hg at the end of refeed-ing. These levels are in agreement with other estimates of the BP below which stroke events areeliminated, thus suggesting that these levels could be regarded as the “ideal” BP values.

Conclusion:

Medically supervised water-only fasting appears to be a safe and effective meansof normalizing BP and may assist in motivating health-promoting diet and lifestyle changes.

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INTRODUCTION

ypertension-related diseases are the mostcommon causes of morbidity and mortal-ity within industrially advanced societies(Stamler et al., 1993). Each year in the UnitedStates there are 500,000 victims of stroke. Hy-pertension is a major causal factor in these in-

TrueNorth Health Center, Rohnert Park, CA.

Cornell University, Ithaca, NY.

Paracelsian, Inc., Ithaca, NY.

cidents, one third of which are fatal (Taylor etal., 1996). Hypertension also is thought to bethe most readily preventable and controllablefactor in congestive heart failure, a disease in-volved in more than 400,000 deaths and2,000,000 coronary events each year in theUnited States (Kannel et al., 1994).Given the magnitude of the causal roleplayed by hypertension in these diseaseprocesses, it is not surprising that many treat-ment alternatives have received considerableresearch attention (Kaplan, 1998a) (Table 1).Surprisingly, the vast majority of individuals(68%) who die as a result of the pathologicchanges associated with elevated blood pres-sure (BP) do so with systolic blood pressure of120–140 mm Hg and diastolic pressure below90 mm Hg. These ranges are below the thresh-old generally established for medical treatment(Joint National Committee on Detection, Eval-uation, and Treatment of High Blood Pressure,1997).According to the sixth report of the Joint Na-tional Committee on Detection, Evaluation andTreatment of High Blood Pressure (Joint Na-tional Committee on Detection, Evaluation,and Treatment of High Blood Pressure, 1997),hypertension is diagnosed when the systolic BPexceeds 140 mm Hg and/or the diastolic BP ex-ceeds 90 mm Hg. Alternatively, hypertensionis sometimes defined as the level of blood pres-sure elevation at which drug treatment is jus-tifiable (Kaplan, 1998b). Under this seconddefinition, a patient is diagnosed with hyper-tension when the effects of treatment are likelyto be less destructive than the elevated BP.With currently available drug treatments, thissituation is considered to be present when theaverage of multiple reliable readings amongpatients without concomitant risk factors ortarget organ damage exceeds 160 mm Hg sys-tolic BP and/or 95–100 mm Hg diastolic BP(Hoes, 1995; Joint National Committee on De-tection, Evaluation, and Treatment of HighBlood Pressure, 1997; Sever et al., 1993).Both of these criteria, however, leave mil-lions of people either medically unattended(i.e., below 160/95 mm Hg) and/or unin-formed (i.e., below 140/90 but still at elevatedrisk) of the seriousness of their condition. Drugtreatment below 160/95 mm Hg is usually notadvocated, and is rarely indicated below140/90 mm Hg (Kaplan, 1998c). Yet, a patientwith a BP of 136/88 mm Hg, for example, is atapproximately five times greater risk of strokethan a patient with a BP of 110/70 mm Hg(Stamler et al., 1993).A meta-analysis of nine prospective studiesalso found no evidence of a threshold level atwhich lower levels of BP were not associatedwith lower risks of stroke and congestive heartdisease (CHD) (MacMahon et al., 1990). A pos-itive linear association between BP and mor-tality was demonstrated, with an approximate

GOLDHAMER ET AL.644

ABLE

1.R

ESULTS OF

REVIOUS

TUDIES

EPORTING

LOOD

RESSURE

EDUCTIONS

SSOCIATED WITH

ARIOUS

NTERVENTIONS

TRATEGIES

SystolicDiastolic(mm Hg)(mm Hg)Source

Body weight loss



1.6



1.3Staessen et al. (1989

)

Sodium restriction



16.0



9.0MacGregor et al. (1989

)Vegetarian/high-fiber diet



2.8



1.1Appel et al. (1997

)Alcohol intake



4.8



3.3Puddey et al. (1992

)Exercise



6.50



6.5Arroll and Beaglehole (1992

)

Combination of low-fat, low-



17.0



13.0McDougall et al. (1995

)salt, vegan diet, and exerciseEffects of standard



12.0



6.0Kaplan (1998

)antihypertensivedrug treatment

Blood pressure reduction per kilogram of body weight loss.

Sodium intake reduced from 200 mmol/d to 50 mmol/d.

Reduction of alcohol intake from 440 mL to 66 mL/wk.

Average of 3 weekly events of aerobic activity.

Meta-analysis of studies.

1% increase in mortality from all causes foreach 1 mm Hg increase in systolic BP (Hyper-tension, Detection, and Follow-Up Program,1979). MacMahon et al. (1990) further pointedout that at essentially any level down to at least70 mm Hg, a diastolic BP increment that is per-sistently 5 mm higher is associated with at leasta 34% increase in stroke incidence and a 21%increase in CHD risk.Although medication may have a net posi-tive benefit for certain patients with signifi-cantly elevated BP, the more relevant messageis disquieting: most people who die of coronaryartery disease, congestive heart failure, orstroke do not have BP in ranges sufficiently el-evated to warrant drug treatment (Kaplan,1998d). Given the current limitations of drugtreatment, the exploration of alternative, non-invasive methods of BP control should besought.There exists an impressive body of scientificliterature indicating substantial effects of con-servative health promoting interventions on BPcontrol (Hoes, 1995; Joint National Committeeon Detection, Evaluation, and Treatment ofHigh Blood Pressure, 1997; Kaplan, 1998a;Sever et al., 1993). These interventions includeregular aerobic exercise, bodyweight reduc-tion, smoking cessation, increased dietary fiberintake, alcoholic beverage restriction, con-sumption of a vegan-vegetarian diet, andsodium intake restriction. The advantages ofthese interventions are threefold. First, thereare virtually no iatrogenic effects. Second, thedegree of BP reduction is in some cases greaterthan the average reduction of 12/6 mm Hgcommonly obtained by drug therapies (Kaplan,1998e). Third, not only are these approachestypically devoid of iatrogenic effects, but eachis associated with known comprehensivehealth benefits.While the modification of a single lifestylevariable might not result in BP reductions com-parable to those expected with medication, theuse of multiple modifications undertakensimultaneously has much greater promise(Table 1). This paper reports the results of suchan effort, wherein multiple lifestyle variableswere controlled in an inpatient environment.Suspension of smoking and alcoholic beverageuse, body weight loss, sodium restriction, anddietary modifications were simultaneously ap-plied in a short-term inpatient experience thatalso included a period of medically supervisedwater-only fasting.The purpose of this investigation was totest the effects on BP of water-only fasting to-gether with multiple lifestyle modifications ina medically supervised controlled environ-ment. The study allowed for the eliminationof smoking and alcoholic beverage use, andrestriction of sodium intake. The water-onlyfast also facilitated body weight reduction.After the fasting process was completed, alow-fat, low-sodium, vegan diet was pro-vided. It was our expectation that the reduc-tion in BP obtainable with this safe noninva-sive approach would exceed the resultstypically demonstrated by any single lifestylemodification used independently.

METHODS

Patients included 68 self-referred adults, con-secutively admitted for inpatient care for thetreatment of a variety of health concerns overa period of 3 years (1997–1999). Presentationwith a baseline systolic BP of 120–140 mm Hgand a diastolic BP of less than 91 mm Hg wasrequired for inclusion. Baseline measures weretaken the first morning after patient arrival atthe facility. Initial mean BP levels were 129/78mm Hg (Table 2). All patients who met thesespecific inclusion criteria during this 3-year pe-riod were included in the study.BP measurements were made by staff doctorsutilizing standard recommended procedures(Baum, 1987). A single BP measurement wastaken daily at morning rounds between 7:30

and 9:00

with a portable BaumanometerMercury Syphgmomanometer (Copiague, NY),with the patients in the supine position. Pulseand BP were measured using the same arm,recording Karotokof sounds 1 and 5.For at least 2 full days prior to (or in somecases after) their arrival at the clinic, patientswere instructed to eat a diet consisting exclu-sively of fresh raw fruits and vegetables andsteamed vegetables. Once this transition dietprogram and examination procedures werecompleted, and informed consent was ob-

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