The recent student-led protests have given us much food for thought. While I was thinking of a topic for this newsletter, in the midst of the protests, fasting is what came to mind.
The long and rigorous fasts observed by Sonam Wangchuk and one of the student leaders reflected the seriousness of their demands. Fasting became a silent and powerful tool to convey a message. Gandhiji fasted at several points during the Independence movement to put forth his message. Buddha, too, referred to fasting as a disciplinary practice and a practical aid to meditation.
Fasting has been embedded in many cultures and civilisations. Be it the Navratri fasts, Ramzan fasts or the Karva Chauth fast, many of us are familiar with these traditions and the unique fasting protocols associated with them.
But, let’s take a moment to explore the significance of fasting in the medical setting.
Fasting in the Medical Context
Fasting for medical reasons is an established modality, with roots that can be traced back to ancient times. Here, I am not referring to fasting before medical investigations such as a CT scan or MRI.
Ayurvedic texts have described fasting as a treatment for digestive diseases, fevers and metabolic problems. It was recommended as a way to stimulate digestion and eliminate toxins. Similar approaches appeared in Egyptian, Chinese and Middle Eastern traditions, where food was withheld to treat infections and digestive issues. Therapeutic fasting was also advocated in ancient Greece, with the aim of giving the body a chance to heal during illness by abstaining from food.
Interestingly, physicians in ancient times also noticed a connection between fasting and epilepsy. Doctors treating patients with epilepsy observed that those who ate sparingly experienced fewer seizures. They did not understand why this happened, but the observation was recorded in medical texts, though it remained underutilised as a treatment strategy.
It was in the 1920s at the Mayo Clinic that Dr. Wilder and his team formalised this fasting-based strategy without complete abstinence from food, through what came to be known as the ketogenic diet. The ketogenic diet became a standard treatment for epilepsy in the 1920s and 1930s, with a success rate of 50-90 per cent in reducing seizures in children.
This successful phase of ketogenic diet therapy was followed by the development of anti-seizure medications in the 1930s and 1940s, such as phenytoin. The ease and novelty of medication pushed ketogenic diet therapy into the background, and it was almost forgotten for nearly 50 years, from the 1940s to the 1990s. Drugs became the dominant treatment option, until drug-resistant epilepsy began to emerge as a major challenge.
The Story of Charlie and the Keto Diet
In this context, the story of Charlie and the setting up of The Charlie Foundation is both moving and significant in medical history. It is the story of a family’s desperation, an ancient therapy, and the determination to resurrect a forgotten medical treatment.
Charlie, the son of Hollywood filmmaker Jim Abrahams, was only 11 months old when he began experiencing severe and frequent seizures, which only worsened with time. Multiple drugs, combinations of medications, and even brain surgery at some of the best centres in the United States failed to bring relief.
In desperation, Jim Abrahams began researching independently and came across the ketogenic diet in a library book. References to the success of this diet existed, but none of the doctors had mentioned it, as it had fallen out of mainstream medical practice with the advent of anti-seizure drugs.
When Charlie was put on the ketogenic diet under Dr Freeman, one of the few physicians who continued to practice it, extraordinary results were seen. The seizures stopped almost immediately. What surgery and medication could not achieve, diet did. Charlie went on to live a normal and healthy life, and was eventually taken off the prescribed diet after remaining seizure-free for several years.
Overwhelmed by gratitude, yet outraged by how dietary therapy had been ignored, Charlie’s father set up The Charlie Foundation for Ketogenic Therapies. This foundation helped renew scientific interest in the ketogenic diet. He also produced and directed the film …First Do No Harm, which played a major role in increasing public and medical awareness of ketogenic diets as a treatment option.
These efforts proved to be a catalyst. Today, there are more than 7,500 studies supporting ketogenic diets for drug-resistant epilepsy, especially in children. More and more variations of the classical ketogenic diet have been developed, validated and successfully implemented. Whether it is LGIT (Low Glycaemic Index Therapy), MAD (Modified Atkins Diet) or the MCT diet, these protocols are widely used at centres treating children with epilepsy.
The quest to develop more practical dietary protocols continues. Researchers are now working on versions that are easier to follow, such as the “Simplified MAD”, where foods do not need to be weighed and can instead be measured using metric spoons.
Fasting-based Therapies
Fasting-based therapies are now being explored for other neurological conditions as well, including Alzheimer’s disease, autism and brain tumours.
Beyond neurological conditions, fasting protocols have also gained enormous popularity for weight reduction. Intermittent fasting, in its many formats, became widely practised and remains a much-discussed dietary approach. I have written earlier about intermittent fasting, along with its benefits and limitations.
The purpose of writing this article is to highlight the power of diet in the treatment of disease. Very often, diet can be as effective as the most expensive drugs, if not better. There is no strong diet lobby to support it in the way that the pharmaceutical industry supports medicines, which is why diet rarely gets the spotlight it deserves.
Through this article, I also hope to highlight the value of careful empirical observations and detailed history-taking. These can lead to a better understanding of underlying mechanisms and treatments, which can later be validated through technology and scientific testing. Time spent listening to patients can never be futile.
It is also fascinating that fasting-based protocols can be developed without complete abstinence from food. It may sound unbelievable, but it is being done. The mechanism behind this is the production of a metabolic state called ketosis, which is what happens when the body fasts. Ketosis occurs when the body begins to burn fat instead of glucose, which is its usual fuel in the fed state.
The ketones produced during this process reduce neuronal excitability in the brain and help stabilise electrical activity in neurons, thereby lowering seizure frequency and intensity.
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Fasting is not merely an act of abstinence. It has been a political tool, a spiritual practice, a cultural tradition and, importantly, a therapeutic strategy. Its history reminds us that sometimes the simplest interventions, when understood deeply and applied carefully, can hold extraordinary power.
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Ms. Neelanjana Singh, Nutrition Consultant & Author |
