Goldman, David

ABSTRACTIntroductionConventional weight‐loss strategies often result in inadequate fat loss, poor sustainability, and unintended lean mass loss. Prolonged water‐only fasting followed by dietary change may offer an effective alternative, but its impact on body composition remains underexplored.MethodsThis secondary analysis utilized dual‐energy X‐ray absorptiometry (DXA) to assess changes in fat‐free mass (FFM), fat mass (FM), and bone mineral content (BMC) in adults [median (IQR) age: 62 (15) years with overweight or obesity. Participants underwent a median (IQR) of 14 (6) days of water‐only fasting, followed by 6 (3) days of food reintroduction with a whole‐plant‐food diet and a subsequent maintenance period of 45 (5) days. Study visits occurred at baseline and at the end of each period.ResultsAt end of fasting, FFM accounted for 74% of total BW lost during fasting. However, at the follow‐up visit, the median (IQR) percentage change in total BW, FFM, FM, and visceral adipose tissue (VAT) mass from baseline was −8.2 (5.2), −4.4 (5.6), −14.7 (8.9), −15.8 (12.8) %, respectively. At follow‐up, FM loss accounted for 67% of the total BW lost. BMC remained unchanged across all study visits.ConclusionsThis protocol produced sustained FM loss, specifically VAT mass, and FFM recovery, suggesting it may support effective weight management.

(1) Background: Chronic inflammation and insulin resistance are associated with cardiometabolic diseases, such as cardiovascular disease, type 2 diabetes mellitus, and non-alcoholic fatty liver disease. Therapeutic water-only fasting and whole-plant-food refeeding was previously shown to improve markers of cardiometabolic risk and may be an effective preventative treatment but sustained outcomes are unknown. We conducted a single-arm, open-label, observational study with a six-week post-treatment follow-up visit to assess the effects of water-only fasting and refeeding on markers of cardiometabolic risk. (2) Methods: Patients who had voluntarily elected and were approved to complete a water-only fast were recruited from a single-center residential medical facility. The primary endpoint was to describe changes to Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) scores between the end-of-refeed visit and the six-week follow-up visit. Additionally, we report on changes in anthropometric measures, blood lipids, high-sensitivity C-reactive protein (hsCRP), and fatty liver index (FLI). Observations were made at baseline, end-of-fast (EOF), end-of-refeed (EOR), and six-week follow-up (FU). (3) Results: The study enrolled 40 overweight/obese non-diabetic participants, of which 33 completed the full study protocol. Median fasting, refeeding, and follow-up lengths were 14, 6, and 45 days, respectively. At the FU visit, body weight (BW), body mass index (BMI), abdominal circumference (AC), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), low-density lipoprotein (LDL), hsCRP, and FLI were significantly decreased from baseline. Triglycerides (TG) and HOMA-IR scores, which had increased at EOR, returned to baseline values at the FU visit. (4) Conclusion: Water-only fasting and whole-plant-food refeeding demonstrate potential for long-term improvements in markers of cardiovascular risk including BW, BMI, AC, SBP, DBP, blood lipids, FLI, and hsCRP.