During a visit at the local library I stumbled upon a book on fasting (written in Romanian). I do most of my reading on my tablet, for convenience. Trying to locate the book on Amazon Kindle returned an empty query. To my surprise, the book was not available/translated to English. It was only available in French. So, I bought the book – the physical copy.
I’m not sorry about the investment I made. Many concepts and ideas from this book are also detailed in my book Periodic Fasting. This is great because when some of my fellow Romanians will ask me to translate my book, I could simply guide them to book of Lestrade, which is already available in Romanian.
Furthermore, Thierry Lestrade obtained first-person access to research and experiments conducted by Russian scientists and doctors with regards to therapeutic fasting. Much of this research will be lost in the archives of Russian institutes as they have not (and most likely will not) been translated into other languages, unless we can do something about it.
In this entry I will describe the five stages of prolonged water fasting, as it has been widely used in the practice of Dr. Yuri Nikolayev, the Director of the Fasting Clinic of The Moscow Institute of Psychiatry for many years.
He claimed to have successfully treated more than 7,000 patients (as of 1972) suffering from neuro-psychiatric conditions by using therapeutic fasting. The average duration of a fast would be 30 days. He probably oversaw the experience of more than 10,000 patients because in 1972 he was only at the heights of his career.
Dr. Yuri Nikolayev (1905 – 1998) was first exposed to the practice of fasting in his early childhood. Whenever he or his brother Lev would get sick, their mother treated them with 2-3 days of fasting. His father, Serghei Nikolayev, was a polyglot. He wrote, edited, and translated to and from several languages. In 1913 he got his hands on Upton Sinclair’s book The Fasting Cure. There was a frequent exchange of letters between Serghei and the American author.
Long story short, these letters together with Sinclair’s book would have a profound influence on young Yuri’s personal experience with fasting as well as the implementation of therapeutic fasting in his medical practice.
The Five Stages of Fasting – Dr. Yuri Nikolayev
I will start with an article from Los Angeles Times, published Apr. 3, 1972. Written by Murray Seeger, the article was titled Soviet Cure-All: Eat Nothing for 30 Days. You can read it in its entirety here (it’s paid access).
MOSCOW—Vladimir Leshkovtsev had the flu and was sore all over. The doctors he saw told him he had infectious metabolic polyarthritis. The doctors treated Vladimir for six weeks but he felt no better. He decided to be his own doctor and to follow a radical course of treatment he had only heard about. 
Hearing about the successful stories of therapeutic fasting that Dr. Nikolayev used with his patients, Vladimir decided to give it a try. He ate nothing, but drank plenty of water, for 45 days. He was relieved of his arthritis. Bonus: he lost 44 pounds and has not seen a doctor for the last 10 years since his fast ended.
“Leshkovtsev was in great danger of becoming an invalid,” Dr. Yuri Nikolayev of the Moscow Research Institute of Psychiatry observed. “The experiment conducted by him is one of the most successful cases of healing.” 
For maintenance, Vladimir would continue fasting 8-10 days every year.
Other soviet doctors reported to have treated various pathologic conditions with fasting, ranging from: metabolic disorders, gallstones, hypertension, asthma, tumors, hypochondria (!) and several others. These are anecdotal claims. We cannot know their validity.
Dr. Nikolayev cautioned that the hunger treatment should be administered only under carefully controlled conditions. The patient and his relatives must approve the procedure and the patient is thoroughly examined before the treatment starts. 
Each fast supervised by Dr. Nikolayev usually undergoes through five major stages…
- Food Deprivation – Eating Cessation – The First 2-3 Days
During this first initial stage, the patient is being given a solution of MgSO4 (magnesium sulfate, otherwise known as Epsom salt) to trigger complete bowel discharge. It does not specify how much of it, but from what I’ve seen on the internets, folks dilute 1 tbsp into a glass of water to obtain the desired laxative-like effects. The bitter after-taste is usually masked with a sip of juice. For this purpose, I’d go for lemon water.
In the initial phase, the patient is at risk of being disturbed by any reference to food, whether it’s visual, olfactory, or even a mere discussion about food. Any perception of food triggers salivary effects, sometimes even stomach cramps. Sleep is reduced and superficial, patients are irritable and may exert exacerbation of their symptoms. Weight loss is between 800 grams to 1 kg per day, blood pressure remains stable, while the cardiac rhythm may be easily intensified and irregular. 
This initial increased weight loss may be due to glycogen depletion and water loss.
- Acidosis Phase
Between the third and fifth days of fasting, food stops causing any stimulation to the patient. There are occasional headaches, sensations of dizziness – especially with the sudden change of body position (i.e. waking up or going from sitting to standing) -, nausea, and a generalized feeling of weakness. I assume this happens as the body is learning to rely on its on adipose tissue as the primary source of fuel.
The tongue is usually coated with a white thin layer. Blood sugar may decrease to 65% of its initial level. The feeling of nausea is due to the increased blood acidity. In reality, as the body adapts to the lack of food intake it starts burning its own fat, and the incomplete oxidation may result in products that increase acidity. 
I suspect this is the case for folks entering a fast from a higher carbohydrate diet background, a situation in which the body is not accustomed to predominantly using fat – but glucose – for energy.
Not surprising, these Russian doctors stress on increasing water intake, as well as on exercising !! three hours a day. Say what?! This would be considered recklessness compared to your conventional ‘rest, stay calm and peaceful’ fasting advice.
Their rationale for such an active routine is that it helps the body to breathe, ventilate, and sweat, all of which helps it activate organs engaged in eliminating toxins from the body (skin, kidneys, bowels, liver, etc). They also used daily enemas for this purpose.
- Compensation and Balance
During the fourth and seventh day, the body suddenly regains balance and the overall status of the patient is radically altered. With the feeling of weakness gone, the patient feels strong and motivated, his mood is improved. After the tenth day, weight loss stabilizes at 200g/day, the white tongue coating clears and the tongue regains its pinkish color. Patients who are catatonic experience a decrease of this state and their negative feelings begin to disappear. For those with auditory hallucinations, the inner voices tend to lose intensity. 
I’d like to emphasize that this simplistic picture is characteristic of that moment in time, the 60s and the 70s. Every human being is unique. While there may be many general aspects shared between us and while we are 99% identical from a genetic standpoint, the 1% is what makes us different. This difference can and will most likely results in different responses to therapeutic fasting.
So, I’d suggest you take these reports with the adequate grain of salt that they deserve.
- Breaking the Fast – Reinitiating Eating
After a few more days, the patient passes the crises and gains a feeling of euphoria. The patient’s symptoms begin to disappear and he feels very good, until the stored energy source is consumed. This occurs after about 30 days, the doctor said. By that time, the patient’s tongue is clean, his skin color is a healthy pink, bad breath disappears and he develops a “wolf’s appetite.” 
I think that the duration of a fast depends on the amount of bodyfat the patient has. We know from medical literature of fasts extending to 382 days. The ‘rule’ is that the fast should be ended, when bodyfat becomes depleted (usually around 3%). This coincides with the wolf appetite mentioned by the doctor.
Hunger is the least of problems during prolonged water fasting. It goes away after glycogen is depleted and your body starts to efficiently burn fat. Hunger, the real one, comes back when your bodyfat is very low and energy cannot be efficiently drawn from fat; this is when muscle catabolism starts increasing. This is the point of no return – the point where the prolongation of fasting turns from safe to life-threatening.
However, the body has its own mechanisms to prevent this to occur. This is when NPY (neuropeptide Y) secretion increases significantly, allowing the subject to develop real ravenous hunger. And as I’ve said it so many times, folks complain about starvation when they have not eaten for a couple of hours. That’s not real hunger. The real one happens when bodyfat is extremely low.
Now, let’s see how Dr. Nikolayev recommends reinitiating alimentation:
Food is reintroduced gradually. First, he is given diluted fruit juices, then whole juices and grated fruit mixed with yogurt. These are followed by cooked vegetables and boiled cereals. Near the 40th day, normal eating is resumed. The doctor said the hunger treatment gives the entire nervous system and the brain a rest. The body is cleaned of poisons and the tissues and glands renovated. 
This is the general approach to refeeding. It’s the strategy that has been followed by many clinics of therapeutic fasting. However, I’d assume that to optimize nutrient intake, it may be better to replace fruit juices with vegetable juices. Vegetables are more nutritious than fruits. Further on, I’d focus on the consumption of cooked vegetables and yoghurt. I wouldn’t consume cereals. Water intake should be emphasized as well.
- Normal Alimentation
The fourth to the sixth day of realimentation (after breaking the fast) is when the appetite of the patient may be significantly increased. This is when, at his request, he may be provided with more fruits, bread, and plenty of vegetables. The patient may start consuming meat after the 7th day – however, this should be avoided as much as possible…
If the fasting cure was successful, the pathologic disorders of the patient have gone. Their blood pressure and the glucose levels stabilize at their initial values. The greedy appetite and the increased mood usually last for 2-3 weeks after which they resume to normal. 
To note that Dr. Nikolayev was a vegetarian; hence his recommendations centered on low meat consumption.
From these reports we also find out of patients with poor response to therapeutic fasting. Once again, we are all different. What works for me may not work for you. Complications may appear predominantly during the acidosis phase. Complications such as nausea and dizziness may be counteracted by drinking alkaline water (rich in bicarbonate). If nausea persists for more than 3 days, fasting should be interrupted.
Complications may also appear during the realimentation phase. They are mostly due to excessive food intake. We know of historical therapeutic fasting reports (found in the medical literature) when patients died of complications in the realimentation phase (see more here).
There are cases when cycles of fasting may have to be implemented – such as with severe pathologic conditions. A second cure, as per Dr. Nikolayev, may be even more efficient and it may require fewer days of fasting because the body is now familiar with this intervention. He suggests a window of at least 6 months between these cures.
In conclusion, I have to remind you one more time to please take these reports as pragmatically as possible and please understand that they reflect the reality and the level of knowledge of the times they have been written.
While therapeutic fasting may be a very powerful tool in the repertoire for optimizing wellbeing, it should be implemented with the most caution possible and under medical supervision. Which brings me to my:
Disclaimer: None of the content on this website should be taken as medical advice. It should not be used as a substitute for professional medical care or treatment. I am not a doctor and I don’t play one on the Internet either; if you decide to implement any strategy, protocol, or therapy discussed on the website, you do it on your own risk and you should do it under the supervision of a qualified physician/authority.
Thoughts and comments below.
- Lestrade, T. (2015). Postul Negru. Ed. Philobia. (Romanian Version).
1.1. Lestrade, T. (2015). Le Jeune, Une Novelle Therapie. (French Version).
- Cott, A. (1974). Controlled fasting treatment for schizophrenia. Journal of Orthomolecular Psychiatry, 3(4.1974).
- Seeger, M. (1972). Soviet Cure-All: Eat Nothing for 30 Days. Retrieved from LA Times.