There have been an increasing number of topics recently regarding 'extended fasting' in different forms, e.g. multiple day water fasts, long term juicing fasts etc. While these have proved to be interesting conversations some concerns have been raised about the possible harmful effects of these topics on the young, impressionable and those who have eating disorders.
Now, while we all value freedom of speech I'm sure everyone here can also understand that we live in a time when everyone seems to be very quick to call their lawyers. It's a society of blame, sad state of affairs though this may be. Unfortunately this has the knock-on effect that as forum staff we have to be careful not to be seen as endorsing or encouraging behaviours which could be considered dangerous or harmful without proper medical supervision - not only for the potential legal implications of course but also for the health & wellbeing of our members.
The 5:2 method in itself seems to be medically safe and is endorsed by various medical types including of course the good Doctor Mosley himself who popularised it. This forum was set up primarily to discuss his methods and, to a degree, variations thereof. Being that in his method he suggests 'up to 500/600 calories', that the days preferably be non-consecutive and that one should fast for no more than a day at a time, it is open to some adaptation as 'up to...' suggests that 0 calories is just as acceptable (indeed, he has confirmed this on the official site and via twitter), consecutive days are okay (but many fasters may find it easiest to split the days up) and the calories can be used for whichever meals/snacks the faster finds easiest. So, in its basic form there is already a lot of variation. Then of course there are the options of 4:3 and ADF, also acceptable and seemingly effective methods.
Those who have read The Fast Diet book or seen the original Horizon documentary will know that Dr Mosley did also partake in longer fast, several days in a row on minimal calories. This was done with medical supervision, and while I'm sure most of us wouldn't keel over or suffer serious ill effect from doing similar this is where things do start to get a bit difficult for we staffers.
We don't want to nanny you, we don't want to have to overly limit the discussions here. This may be a 5:2 board, but other similar methods (The Fast Diet, 5:2, ADF, 4:3, The Two Day Diet etc) have always been welcome here and recently more members seem to be trying fast days on fewer than 500 calories (such as water fasts), for various reasons. Two single days a week on 0-500 calories seems to be acceptable within the 'rules' of 5:2, even two consecutive days for those who find they can handle it. But where should we draw a line, if any?
It's only natural for discussions on forums to branch out, stray off topic, veer into new ground - just as indeed it seems quite natural for us to experiment with our fasts and what works for us. Some of us like to try and push our limits, I understand that. At most forums topic development and veering into new subjects generally isn't too much a problem, except in terms of keeping forums tidy! However, here we have a forum which centres around issues of health. This isn't a forum about videogames or a TV show, what is discussed here has potentially more real life implications and therefore free speech may have to bow down to a sense of responsibility.
That's not in any way meant to suggest that things haven't been discussed in a responsible way mind you. No-one's pointing any fingers here, this is just an issue which has arisen and needs to be tackled before anything gets out of hand. Nipped in the bud so to speak (or perhaps trained up a trellis).
It's clear that there are strong feelings on this subject and there have been multiple messages & posts regarding the extended fasting discussions. We do need to decide on an official forum policy about these discussions so that staff can be consistent in any actions needed such as locking or removing inappropriate topics/posts.
Of course, we are a community and I prefer to consult with as many members as possible before making any big decisions like this!
So, what we forum staff need to know from you is how you feel about the discussion of extended fasting.
For the sake of a quick consensus I've added a poll and would appreciate your votes. Naturally you may also post a reply with a more in depth response if you wish and I'll do my best to keep up with everything and take it all into consideration when the mods & I discuss the responses to aid our decision.
We've already decided that a notice needs to be added to posts about extended fasting, to link to the forum policy (which should cover our backs sufficiently for now!) and to show that a member of staff has seen and noted the topic's content. This is what we've made:
So, without further ado, these are the poll options we present to you!
Fasting discussion should be limited to:
By voting in this poll you agree that you have read the first post of the topic in full and understand the issue at hand.
1. 5:2, 4:3, ADF, 36-hour liquid, 'Two Day Diet' etc. No discussion of longer fasts.
2a. As in (1), plus up to 4 days liquid fasting (no notice added by staff). No discussion of longer fasts.
2b. As in (2a), but with notice added by staff.
3a. As in (1), plus up to 10 days liquid fasting (no notice added by staff)
3b. As in (1), plus up to 10 days liquid fasting (subject to notice added by staff)
4a. No limits on length of fasting discussion, but notice to be added to fasts over 36 hours
4b. No limits on length of fasting discussion, but notice to be added to fasts over 4 days
4c. No limits on length of fasting discussion, but notice to be added to fasts over 10 days
5. Create a new forum for Extended Fasting discussion (see below for more details)
6. I am happy with whatever the forum staff feel is in the best interest of the community
Caroline has kindly done a bit of research on PubMed for us and found the following information:
I looked on PubMed for information about refeeding syndrome which is the biggest risk with longer fasts. A very recent (this year) review of the literature ( http://www.ncbi.nlm.nih.gov/pubmed/23315514 ) identified risk factors for developing refeeding syndrome:Poor nutritional intake for more than 10 days, weight loss >15% prior to recruitment and low-serum magnesium level at baseline predicted the refeeding syndrome with a sensitivity of 66.7%: specificity was >80% apart from weight loss of >15% which was 59.1%.
Dominic has pointed out the following quotes from Dr Mosley in the book:
Dr Michael Mosley in 'The Fast Diet' wrote: I don't think it is necessary or particularly desirable to do a prolonged fast before embarking on the Fast Diet. While there are few known risks involved in fasting for less than 24 hours, the same is not true of prolonged fasts. I decided to start with a four-day fast because I knew I was in safe hands...
[Dr] Valter [Longo] thinks that the majority of people with a BMI over 25 would benefit from fasting, but he also thinks that if you plan to do it for more than a day it should be done in a proper centre. As he put it, 'a prolonged fast is an extreme intervention. If it's done well, it can be very powerful in your favour. If it's done improperly, it can be very powerful against you.'...
I did the four-day fast... mainly because I was curious. I would not recommend it as a weight-loss regime because it is completely unsustainable. Unless they combine it with a vigorous exercise regime, people who go on prolonged fasts lose muscle as well as fat. Then, when they stop, as they must eventually do, the risk is they will pile the weight right back on.
Based on the above the current opinion of forum staff is that option 2a, 2b or 4a would be our preference.
Another option we have discussed is the possibility of setting up a specific forum for Extended Fasting discussion, which would be viewable only to registered members (thus reducing slightly the issue of casual young visitors reading the contents). This forum would have its own set of rules & clear warnings. I think of this as like a concerned parent preferring for their teenager to drink/have sex at home - they may not condone it but would prefer it to be done in a safe environment! But perhaps adding this forum would make these discussions seem more acceptable/appealing. It would however save mods the trouble of adding warnings to topics as they could just be moved to the new forum, and would only need to add warning to individual posts elsewhere if they veered into extended fasting. I don't know if I like the idea of a forum full of this sort of talk though, it's not the essence of what this site was set up for.
Note that the above primarily applies to users discussing their own extended fasting experiences. I welcome any thoughts you may have regarding how acceptable it is to discuss existing studies of longer term fasts, for example the chap who fasted (under medical supervision) for a whole year and suchlike.
It's a tricky one isn't it? What are your thoughts?
TL;DR: No, this is important, please take the time to read it! ;P