Intermittant & Extended Fasting and OCD

Fasting may seem counter-intuitive considering the prevailing health guidelines. Fasting put simply means not eating and we do it every night while we sleep. If you are someone who wishes to benefit from fasting and have OCD, I have some advice and some pointers that may assist in your experience and achieve your goals easier. That said, fasting is simple, but not “easy.”

There are several things I suggest you do before fasting:

• Learn about fasting. Read “The Obesity Code” and “The Complete Guide to Fasting” by Dr. Jason Fung. This should help you understand what you are getting into and the benefits it confers.
• First attempt to go on a ketogenic diet as many of the benefits are the same. It is also easier to go “hungry” on a ketogenic diet because ketones tend to suppress hunger. You become more ketotic while fasted.
• Determine how long the fast will be.
• Start with intermittent fasting before doing prolonged fasts. This will work no different than an exposure exercise. Once you realize that ignoring the hunger impulse and its passing isn’t actually related to one’s immediate metabolic demands, it becomes easier to understand hunger and not interpret it as a trigger.
• Talk to your PCP and Psychiatrist to make sure you are in good enough health to fast. Fasting a is a context-dependent therapeutic measure. If you are relatively thin extended fasts may not be good because you are at higher risk for complications due to malnutrition or refeeding syndrome.
• Do not do this if you have suffered from anorexia or bulimia unless under the direct supervision of a doctor, preferably in an inpatient setting.
• Do not attempt to fast if pregnant or lactating
• Do not attempt to fast if you are diabetic without having your doctors input. Medicines may need to be altered in order to prevent hypoglycemia. Metformin and/or insulin may lower an already low blood sugar level while fasting. It won’t feel good and could be dangerous.
• Try to keep good sleep hygiene (use your bed for sleeping and sex only, not lie awake and stare at the ceiling; try to maintain the same time to go to bed and when you get up, get sunshine in the morning) and maintain a relaxation protocol (meditation, massage, yoga, walking, reading, watching comedies etc…).

While all the precautions are important, fasting is a relatively safe and effective protocol.

What to do while fasting:

• Keep busy. This has to be the most important piece of advice I can give someone with OCD. Your brain will make you think you are doing something dangerous even though it is not. I have gone days without feeling hungry and it is weird at first.
• Hunger will be your companion, but only temporarily. Try to put hunger in perspective. A lot of our hunger has to deal with classical conditioning, not unlike Pavlov’s dogs. The same tools used in CBT may be helpful here. The point is to not reassure yourself and create an OCD loop. By now you should already know the effects and side effects of fasting.
• Stay hydrated and mineralized (salt and potassium are your best friends). You will have to supplement salt since you will initially drop a ton of water weight (I’ve dropped almost 5-7lbs in water alone.)
• Weigh yourself once a day and only once a day. You may want to check your progress, but this only encourages neuroticism. You can only lose ~0.53lbs a day without food anything more is lost as water weight so stay hydrated and stay mineralized. Please note I said this twice! If you feel like crap it’s because of not enough minerals and water.
• Aim for 2 liters-ish of water. It will help you feel full and try to add some minerals to your water. I use Trace Minerals Research’s “ConcenTrace Trace Mineral Drops” and by the same company “40,000 Volts Electrolyte Concentrate” in my water. Please note I said this thrice! This will solve 90% of complaints about fasting.
• Dr. Fung recommends unsweetened tea or unsweetened black coffee and some bone broth. Use the bone broth if you must, just add salt and a splash of vinegar and it tastes pretty good; ideally stay under 200kCals worth or about 4 cups. This is to get you through rough patches. I use it to sometimes help me sleep since hunger can rear its head and make it difficult for me to fall asleep.
• Don’t let the perfect be the enemy of the good. While a water fast is most the traditional form of fasting, using unsweetened tea, black coffee or broth will only help. It is unknown if these components interfere with autophagy. mTor is sensitive to protein intake.
• Fasting increases cortisol levels and can interrupt sleep, especially on day 1. If having trouble sleeping, review your medications with your doctor. It can be acceptable to use tryptophan or 5-HTP at night to help with sleep, but only with the OK of your doctor. Tryptophan and 5-HTP can interact with serotonergic medications (like SSRIs) which can lead to serotonin syndrome which is a medical emergency. I happen to be on a very low dose of medication which permits me to use the aforementioned supplements. Please note, some have experienced great sleep too, so don’t necessarily expect it, but just file it away as a possibility. Supplementing with magnesium is also used and is safe, just remember that too much of it works as a laxative. Magnesium oil can be a good way to get magnesium in your system transdermally.
• If you crave salt, consume salt 0.25tsp at a time.
• You can stop at any time, for any reason and “return to normal” pretty quickly, making the safety factor pretty high. Depending on how long the fast is, break your fast slowly and carefully to avoid diarrhea or upset stomach. During fasts, your guts are on a vacation. You may actually still poo even though you haven’t eaten anything which is sometimes weird.

While all the precautions are important, fasting is a relatively safe and effective protocol.

So why fast?

• Weight Loss – you really can’t get better than a no-calorie diet. It is low in fat, protein & carbs. It’s a convenient and powerful tool for weight loss. and it doesn’t slow down your basal metabolic rate (at least in the first 3 days).
• Increased HGH levels which are great to put on muscle and lean mass.
• It can reverse type II diabetes.
• You can experience some interesting effects like mild euphoria, serenity, and focus that isn’t really common for those of us OCD people who are on medications.
• Autophagy. It turns out that fasting can eliminate senescent cells (good for nothing cells) from our bodies reducing the risk of metabolically based cancers. Dr. Thomas Seyfriend recommends a 1-week water fast as a preventative measure against some cancers.
• It is a great exposure exercise. Learning that hunger isn’t going to kill you or not sleeping for a night isn’t going to ruin your day allows one to “practice” in real time coping with some stress. The ketones tend to stabilize mood which makes coping with stress easier. Of course, suicidal ideation or hallucinations are not common and should cue you to stop.