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The symptomatology of fasting forms a most interesting study, which can be fully appreciated only by the man or woman who studies it at first hand, by carefully observing fasting individuals, and by personally fasting. The following studies of the fasting patient will, however, give the reader a good working knowledge of this vital part of the subject.
Under his discussion of "Subjective Impressions" arising during the fast, Benedict says, "It is commonly believed that the withdrawal of food for one or two meals results in dizziness, a feeling of faintness, and at times, in pains in and about the epigastrium." This is not only the common belief, it is also the professional belief. Physicians, even physiologists who should know better, attribute any discomfort that may follow the missing of food, to the lack of food. Benedict shows that, while in some cases some discomfort was noticed, in the majority of cases, no such symptoms were observed. On the contrary, unusual vigor and strength were observed. He says: "The fast of Merlatti, which was said to have continued 50 days, was characterized by extreme discomfort, pain, and sensations of coldness. During the 30-day fast of Jacques, the only marked discomfort noticed was a slight attack of gout which appeared on the sixteenth day. In the numerous fasts of Succi, no marked discomfort was observed. In fact, during his fast at Florence his cheerfulness and apparent good health were the subject of much comment. It should be stated, however, that both Jacques and Succi took small amounts of narcotics from time to time throughout their fasts, though, as Prausnitz has pointed out, this may have been as much to stimulate a popular interest in the concoctions as to dull the sense of any possible pain, except possibly during the early days of the fast. Celli experienced considerable discomfort during the first one and one-half days of his fast, but this suddenly ceased after a movement of the bowels. * * * The records of the subjective impressions of J. A. in the experiments in the Stockholm Laboratory, show that on the first day of the fast he noticed no dizziness. On the second day, while his general condition was good, he observed unusual weakness following a slight muscular exertion. On the third day he was not in a little discomfort when climbing on a short ladder inside the respiration chamber. On the fourth day, the pain in the stomach disappeared and no dizziness was noticed in the experiment on the ladder. On the fifth day the general condition was excellent, and there was no pain or discomfort in the stomach. His strength, too, was greater although he noticed that if he arose suddenly from bed there appeared to be black spots before his eyes. * * * In Prausnitz's opinion, the feeling of discomfort attending hunger is, in many instances, a purely physical condition. * * * It seems, therefore, that from the experiments made in this laboratory, the conclusion can properly be drawn that fasting, per se, produces no marked symptoms of pain or weakness, at least during the first days of inanition."
Two factors must be taken into account in our consideration of this conclusion that fasting produces no marked symptoms of pain or weakness during the first few days of abstinence. One of these is that Benedict's tests were made upon comparatively well individuals and these do not develop pains when fasting; the other is that he says "fasting per se," does not produce symptoms of pain or weakness in the first few days of fasting. Pain or weakness or both may, and often do, arise in the beginning of a fast due to a variety of causes, but not to the fast. That they are not produced by the fast is obvious from the fact that they cease while the fast is still in progress. These will be accounted for as we proceed.
The pulse varies greatly during a fast. It may run up to 120 or even higher, or it may drop as low as 40, per minute. Indeed, Mr. Macfadden records a case in his practice in which the pulse went down as low as 20 and was so feeble it could scarcely be felt. It is the usual thing to have the pulse rate increase at the beginning of the fast and then, after a day or two, to drop. In chronic cases that are confined to bed during the fast, the pulse usually, after its temporary rise, drops to 48, or 40, where it may remain for a day or two days and then mounts up again to 60. After a few days it will settle at 60 and remain there until eating and activity are resumed. It is, of course, understood that the pulse is subject to all the variations, while fasting, as at other times of life, and that where there is "disease" of the heart, or nervous troubles, it will often vary greatly from the above standard. Where stimulants are employed during a fast, these occasion more heart activity than if taken when one is eating.
Discussing what, to the uninitiated, are alarming heart symptoms which may arise during a fast, Mr. Carrington says: "I may here remark, however, that such extreme variations invariably denote some profound physiological change taking place at the time--a crisis, in fact. The fact that hitherto weak hearts are actually strengthened and cured by fasting proves conclusively that any such unusual symptoms, observed during this period, denote a beneficial reparative process, and not any harmful or dangerous decrease or acceleration, due to lack of perfect control by the cardiac nerve."--Vitality, Fasting and Nutrition, p. 464.
Mr. Macfadden records the case of a man whose heart beat fell to twenty and was so faint it could scarcely be felt, after three weeks of fasting. It quickly rose after the patient took some nourishment. (Natural Cure for Rupture--p.p. 36-37). Abnormally slow pulse is seen in rare cases of extreme debility, especially in those who have for weeks, months or years prior to the fast, been in the habit of taking stimulants. A complete withdrawal of the stimulants results in a great slowing up of the habitually excited activities of the body. Mr. Carrington says that some of these cases die, although I have not seen it. He says: "The long-deferred crisis is at hand. Either the patient will recover the expended powers, and live; or, if wasted to such an extent that recovery is impossible, will die, during the fast. This is the most frequent, if not the only cause of death that occurs during cases of protracted fasting, when death occurs before the return of natural hunger. Such cases never die from starvation; it is a physiological impossibility for them to die during a fast before the return of natural hunger--unless the vital powers have previously been so wasted as to render their recuperation impossible--death being due to this failure; and it will thus be seen that the real cause of death is, again, previous mal-treatment--death occurring in spite of, and not on account of, the fast. Had the fast been instigated, in such cases, at an earlier period, the vital powers might have been sufficiently strong to have withstood the shock--recuperation instead of failure would have resulted; i.e., instead of death."--Vitality, Fasting and Nutrition.
A very rapid pulse is seen in exercise, excitement, nervous shock, and gas pressure, etc. Exertion may increase the pulse rate more in the faster than in the regular eater. As there is nothing essentially abnormal about this and the pulse rate soon settles back to its regular fasting level, there need be no concern over it.
Let us not forget, in considering the unusual cases, that the vast majority of patients will not experience any of these inconveniences during a fast. Abnormally high or low pulse rates during a fast are exceptions and not the rule and do not denote any danger from the fast in itself. They should cause no alarm, so far as fasting, per se, is concerned. As a rule, the heart beat is steady, forceful and in keeping with the activities of the body.
While in acute disease it is usual to have temperature and pulse rate rise and fall together, in fasting and chronic disease this is not always so. For example, in many cases of heart disease or in goitre, the heart may be beating at an enormous rate and temperature remain normal or fall below normal. In fasting, on the other hand, the pulse rate may fall very low and temperature remain normal. Or, if the fasting patient becomes active, his pulse rate may rise to 110 or 120 a minute and his temperature remain normal.
The first day of fasting is seldom accompanied with any noticeable change in the usual demand for food. On the second day there is usually a big demand for food. By the third day this has greatly abated or entirely disappeared. From the disappearance of appetite onward, for many days, the body ceases to call for food, until a time arrives when food must be had. During this period it is not uncommon for a repugnance to food to be present. Nausea and efforts at vomiting may develop at the very thought, smell or sight of food. But a time comes when natural hunger returns, when it is very necessary to avoid over-eating.
Sinclair says, "I was very hungry the first day--the unwholesome, ravening sort of hunger that all dyspeptics know." Such "hunger" soon ceases and fasting becomes easy. There is no desire for food. He also tells us:
"I recollect reading a diverting account of the fast cure" "in which the victim was portrayed as haunted by the ghosts of beefsteaks and turkeys. But the person who is taking the fast knows nothing of these troubles, nor would there be much profit in fasting if he did. The fast is not an ordeal; it is a rest; and I have known people to lose interest in food as completely as if they had never tasted any in their lives."
Large numbers of individuals go on a fast and never experience any desire for food from the start. Indeed, many of them have no desire for food before going on the fast. Levanzin, who fasted several times in his life, says he never felt hungry on the first day of his fasts. The demand for food during the first two days of fasting has been over-emphasized by many writers on the subject. Much of the supposed demand for food experienced during this time is not that at all, but the "craving" for the accustomed stimulants. John Smith says: "The more stimulating the food, the sooner does the demand for it return."--Fruits and Farinicea, p. 175.
Fasting patients sometimes complain of being hungry, when the experienced practitioner knows that they are not. Occasionally one complains of hunger through the whole length of the fast. These sensations are due to irritative conditions or to the mind.
Dr. Guelpa in his book, Auto-intoxication and Dis-intoxication, says that food taken into the stomach serves to absorb and neutralize the toxic material in the stomach and intestine and thus relieves the sinking, empty, gnawing, etc., sensations which are caused by active auto-intoxication, but mistaken for hunger. Major Austin points out that drinking a large glass of saline purge "causes the disappearance of hunger instead of increasing it" and thinks this is due to the cleansing of the alimentary tract of toxins. Of course, the disappearance of hunger after taking a purge may be accounted for in another way, but I would remind my readers that these toxic symptoms are not hunger sensations.
These "hunger sensations" may be relieved in such a variety of ways--lavage, water drinking, heat applied to the upper part of the abdomen, abdominal massage, etc.--or will pass away in a short time without anything being done to relieve them, that only the inexperienced and uninformed can think of them as representing a physiological demand for food.
A patient informs me that he was very hungry during the night and could not sleep. Upon being questioned he says the hunger has passed away--a sure indication that it was not real hunger.
Pashutin says: "Some of the experiments which we will have an opportunity to speak about below led to the conclusion that this desire for food and water is great only at the earliest stage of inanition. Manassein, however, mentioned that the animals also at the last period of starvation manifested great thirst." Again, quoting from Albitzky, he says, "At the later days of starvation * * * only violent force by means of a cage or chain holds the animal from undertaking to hunt for something edible."
In fasting steers, as in man, the so-called "hunger feeling" ceases after the second day. This feeling is believed to be caused by the physical contraction of the alimentary tract in adjusting itself to the diminished bulk of its contents. We do not accept this explanation of hunger. These animal experiences coincide exactly with human experiences in fasting. The so-called "hunger contractions" of the stomach increase in vigor in both man and animals during a fast, but do not give rise to hunger. Dr. Trall observed that vegetarians can "bear fasting for a time much better than the flesh eater; and they usually suffer but little in comparison with those who enjoy a mixed diet, from craving sensations of the stomach, on the approach of the dinner or supper hour. To this rule I have never known an exception."
Dr. Oswald says: "In my experiments on the operation of the fasting-cure, I have noticed the curious fact that for the first day or two the clamors of the stomach are restricted to certain hours, and can be induced to waive a disregarded claim."
Appetite is often accompanied with various feelings of discomfort, even actual pain. There may be a general feeling of weakness, or there may be mental depression. Frequent complaints of gnawing in the stomach, an "all gone" sensation in the stomach, rumblings in the abdomen, actual abdominal pain, nausea, headache, weakness and other morbid sensations accompanying appetite are made by Mr. Average Citizen. Indeed, I meet many who refer to distress in the stomach as hunger.
These symptoms are identical with those experienced by the drug addict who is deprived of his accustomed drug. The symptoms of drug addiction are usually more intense. Food drunkenness (gluttony) produces its symptoms and these symptoms are mistaken for hunger. The symptoms are temporarily relieved by eating, just as a cup of coffee temporarily relieves the coffee-induced headache, and this leads to the idea that food was needed.
Such symptoms pass away if their owner will refrain from eating for a few days. Indeed, in many cases, they will pass away within an hour after the accustomed meal time has passed if no food is eaten.
True hunger is accompanied by no symptoms. In true hunger one is not aware that he has a stomach. There is no headache, or other discomfort. There is merely a consciousness of a need for food, which, like thirst, registers itself in the mouth and throat.
Dr. Claunch thus differentiates between appetite and hunger: "The difference between true hunger and false craving may be determined as follows: When hungry and comfortable it is true hunger. When 'hungry' and uncomfortable it is false craving.
"When a sick person misses a customary meal, he gets weak before he gets hungry. When a healthy person misses a customary meal he gets hungry before he gets weak."
These are interesting studies during a fast. The tongue becomes heavily coated in almost every instance (I have seen five or six exceptions) and remains so throughout the fast, gradually clearing up, beginning at the edges and the point, until, when hunger returns, it is clean.
The breath becomes very foul and remains so during most of the fast, gradually becoming less so as the work of purification proceeds, until, with the return of hunger, it is sweet and clean. The more foul is a man's body, the more foul will be his breath and the more heavily coated his tongue.
When we observe body temperature during a fast, we are presented with a paradoxical series of phenomena which prove both interesting and highly instructive. For example, temperature tends to remain normal in most cases of fasters suffering with chronic disease, to fall in acute disease and to rise in those patients who have sub-normal temperature. Benedict points out that during the fast, for a period of seven days at least, there is an occasional tendency for it to increase as the fast progresses.
Temperature does not rise as high in fever patients who are not fed as it does in the same patients when fed. Invariably, the temperature falls to normal as the fast progresses. Indeed, in acute "disease," where there is high temperature, the fever subsides somewhat as soon as eating is discontinued and seldom rises high thereafter.
In rare cases of chronic disease there is sub-normal temperature. This is most likely to be observed in the morning before the patient has become active. It is striking evidence of the value of the fast that in these patients, as the fast nears its natural termination, the temperature rises to normal and remains there. In those chronic sufferers whose temperature is habitually below normal, it will surely but slowly rise until it reaches normal by the time the fast naturally ends. "Thus," says Carrington, "supposing the patient's temperature to be 93.8° at the commencement of the fast, it will gradually rise until about 98.4° is reached--though the fast may have extended over forty or more days. . . . Time after time, in case after case, I have watched this gradual rise in the bodily temperature of the patient, and in every case the temperature has not failed to rise as the fast progressed. At first, it is true, the temperature sometimes tends to fall, but let the fast be persisted in, and a return or rise to normal will occur in every case."
Carrington records several cases where temperature was subnormal while eating, but gradually returned to normal while fasting. In some of these, premature eating resulted in an immediate drop in temperature. One case he records had a temperature below 94° F. before the fast. At the end of a thirty-four days fast the temperature had nearly reached the normal standard.
A. Rabagliatti, M.A., M.D., F.R.C.S., Edinburgh, made this same discovery, and says of it, "In point of fact, I raised the temperature of a man who was, besides thin, emaciated, and attenuated by constant vomiting, lasting for seven years, from 96° F. to 98.4° F. by advising him to fast for thirty-five days. On the 28th day his temperature had risen to normal, and remained so."--Air, Food and Exercise, p. 261.
Low temperature is often the result of too much food, or lowered vitality due to habitual over-eating The case just quoted from Dr. Rabagliatti was, as he remarks, "dying on the plan of frequent feeding." He lost 13 pounds during the fast and gained health although he had been sick and taking a "highly nourishing diet" for seven years. Carrington noted a few instances of long fasts where the temperature dropped a degree or two immediately upon resuming eating.
Dr. Hazzard records a case in which body temperature was constantly at ninety-four degrees at the beginning of the fast. No change in temperature was noted until the twentieth day, when it increased nearly a degree, it reached ninety-seven degrees ten days later and remained at this standard thereafter. She also says that in a few subjects the temperature was so low that it could not be determined on a clinical thermometer, but "invariably normal individual average was reached before the end of the treatment."
Experiments upon starving animals show that the temperature remains normal through the fasting period and then begins to fall rapidly for from 2 to 6 days before death supervenes.
It is the rule, in chronic troubles, for the temperature to remain normal. Dr. Eales' temperature remained normal throughout his fast. Dr. Tanner's temperature dropped at the end of his fast, although he survived. This drop in temperature, both in man and in animals, undoubtedly marks the exhaustion of the body's reserve resources and the beginning of actual starvation.
I have had but one such case in my own experience, the sudden drop occurring on the 36th day of the fast. I broke the fast immediately and kept the patient warm with heat applied externally. He made a quick recovery and suffered no ill effects.
Carrington thinks that the fact that temperature falls to normal when above it and rises to normal when below it and that it reaches the normal point, in either case, just as the fast is completed and ready to be broken, is further proof that "fasting is a natural process, counselled by nature, with landmarks clearly defined, and but waiting to be recognized by man." This, it seems to me, is the only logical conclusion that can be drawn from the facts.
Despite the fact that the faster maintains normal temperature on a fast, or even has a slight rise in temperature, there is commonly a feeling of chilliness in a moderate temperature in which he ordinarily feels comfortable. This feeling of chilliness may be experienced, even when the bodily temperature is above normal, that is, when there is slight fever. We attribute this feeling of chilliness in individuals of normal or above normal temperature to decreased cutaneous circulation. Let a man strip nude in a cold room and remain there until he feels warm. Then let him walk nude into a warm room. Immediately, shivering results and he will feel cold.
It is well-known that heavy eaters are always complaining of the heat. They may be said to be constantly "feverish." Carrington suggests that the feeling of chilliness may be, in part, due to the absence of this feverishness. He suggests, also, that what is now regarded as normal temperature is a degree too high. The faster, the person on a fruit diet, the moderate eater, comfortable in summer, is likely to feel cold to the touch of the heavy eater.
Carrington records the case of a man whose temperature, by thermometric reading, was regularly, while eating, 2° F. below normal, yet he never felt chilly; but who on the twenty-third day of his fast, his temperature having risen to 97.8° F. (only .6° below normal), felt cold. He gives it as his opinion that the feeling of chilliness in this instance was due, in part at least, to decreased peripheral circulation--an anemia of the skin. But he also thinks that sharpened senses which, as we have seen, are rendered more acute in every instance of fasting, possess a keener perception to changes in body temperature.
We experience a sense of chilliness only when blood has been withdrawn from the skin; when, in other words, there is anemia of the skin, and we may actually be so chilly as to shiver on the hottest summer day. We may feel chilly while the thermometer shows our bodily temperature to be normal or slightly above normal. Geo. S. Keith, M.D., LL.D., records a case of a patient in which, he says: "The great peculiarity in the case was a chilliness coming on when he took anything like a meal."--Fads of An Old Physician, p. 168. This is somewhat a reversal of the chilliness seen in fasting, but it shows that the sensation of chilliness is not due to fasting, per se.
As pointed out before, whatever the explanation of the feeling of chilliness, it has nothing to do with the actual temperature of the body, which may actually be above normal. Susanna W. Dodds says of it: "In this cold paroxysm there is a rise in temperature (which the fever thermometer will detect) sometime before the chilling stage begins."--The Liver and Kidneys, p. 44.
In many cases, particularly of overfed individuals, we have what is called "famine fever" when a fast is entered upon. It is a slight elevation of temperature which may last from one to several days. I agree with Carrington that "it is, as in the case of all other diseases, a curative crisis, and should be regarded as a favorable sign, in consequence." Dr. Rabagliatti also regarded it as curative and added: "If we cannot fast without fever, it is because we have been previously improperly fed."
It is the usual thing for the fasting person to sleep no more than three to four hours out of each twenty-four hours, and this frequently causes worry. Three general causes for this sleeplessness are recognized: (1) It may be due to general nervous tension. The faster cannot sufficiently relax. (2) Sleeplessness is often due to a deficient circulation. The feet become cold and the faster finds it difficult to maintain warmth. A hot water bottle or jug placed at the feet will usually remedy this. (3) The fasting person does not require the usual amount of sleep. In a general sense, the amount of sleep one requires is proportioned to the quality and quantity of one's food. If you are comfortable and relaxed, you may be quite certain that you will sleep as much as you require.
In his narrative, from which I have previously quoted, Mark Twain records the case of one man who went without sleep for twenty-one days at a stretch, noticing during this period of fasting, no desire for sleep and no ill effects from not sleeping. Horace Fletcher frequently pointed out that when he ate less food he required less sleep. The sleeplessness and sluggishness that follow a heavy meal are well-known to everyone. If we are to be mentally alert, we must eat lightly or not at all. Such facts would seem to indicate that the digestion of large quantities of food is an exhausting process.
The faster who does not sleep is likely to fret and fuss about how long the nights are, but he does not feel the loss of sleep. It is true, of course, that all fasters who complain of not sleeping, like all other patients who declare that they never closed their eyes all night, sleep much more than they think they do. I have visited the rooms of fasters who complained of not sleeping and found them fast asleep, only to have them tell me the following day that they "never slept a wink all night."
A few patients sleep more while fasting than when eating. Insomnia victims are especially likely to do this. Fasting is perhaps the quickest and most satisfactory means of remedying insomnia, although there are cases in which it requires six to ten days to secure the sleep. Sinclair says, of his first fast: "I slept well throughout the fast."
I cared for one young man who slept sixteen hours out of twenty-four almost every day of a thirty days fast. Another man, an asthmatic, slept almost day and night for days during and following the fast. But asthma cases, like insomnia cases, having lost much sleep, usually sleep much as soon as fasting brings relief from the dyspnea so that they can sleep.