title: Incorporation of fasting therapy in an integrative medicine ward: evaluation of outcome, safety, and effects on lifestyle adherence in a large prospective cohort study.
abstract: OBJECTIVE
  The aim of this study was to implement fasting therapy in an inpatient integrative medicine ward and to evaluate safety, acceptance, and effects on health-related outcomes and lifestyle adherence.
  
  
  METHODS
  This was a prospective observational study with consecutive inpatients over 3 [corrected] years. Inclusion and exclusion criteria for fasting therapy were checked by treating physicians and recommendations given. After receiving full information patients decided whether they would participate in fasting. Outcomes were assessed on admission, at discharge, and 3 and 6 months after discharge.
  
  
  METHODS
  The study took place in an integrative medicine department of an academic teaching hospital.
  
  
  METHODS
  Subjects were newly admitted inpatients with chronic internal diseases and chronic pain syndromes, with lengths of hospital stay of >3 days.
  
  
  METHODS
  All patients received intensive integrative treatments including Mind/Body Medicine, acupuncture, nutritional/lifestyle education, and hydrotherapy. Fasting patients participated in a 7-day juice fast (intake <350 kcal/day) with accompanying bowel cleansing, 2 prefasting relief days, and 3 days with stepwise reintroduction of food.
  
  
  METHODS
  Outcomes were assessed based on rate of participation in fasting, severity of main complaint, quality of life (QOL, MOS 36-Item Short-Form Health Survey), safety, lifestyle adherence to recommendations given (relaxation, diet, exercise).
  
  
  RESULTS
  Of 2121 patients with complete discharge questionnaires, 952 patients participated in fasting, 873 had a normocaloric vegetarian diet, and 296 patients had other diets and were excluded. Response rates were 71% and 56% at 3- and 6-month follow-up. The main disease-related complaint at discharge was significantly greater improved in fasters versus nonfasters (p < 0.01). Patient QOL increased significantly and comparably from baseline to discharge in both groups. Fasting was well tolerated and no serious fasting-related adverse effects were reported. In all, 743 (78%) of fasting patients reported improvement of their health through fasting. Descriptors of lifestyle adherence showed higher levels of related activities in the 3 and 6 months of follow-up.
  
  
  CONCLUSIONS
  Fasting can safely and successfully be implemented in an inpatient integrative medicine concept and is perceived as a health-promoting method by the majority of patients. Potential effects on disease-related complaints and lifestyle adherence should be further evaluated in randomized trials.
authors.affiliation: Department of Integrative and Internal Medicine V, Kliniken Essen-Mitte, and Complementary and Integrative Medicine of the Alfred Krupp von Bohlen und Halbach Foundation, University Duisburg-Essen, Essen, Germany. andreas.michalsen@uni-essen.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Michalsen
authors.forename: Barbara
authors.initials: B
authors.lastname: Hoffmann
authors.forename: Susanne
authors.initials: S
authors.lastname: Moebus
authors.forename: Markus
authors.initials: M
authors.lastname: Bäcker
authors.forename: Jost
authors.initials: J
authors.lastname: Langhorst
authors.forename: Gustav J
authors.initials: GJ
authors.lastname: Dobos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000628:therapy*; D015331:Cohort Studies; D004035:Diet Therapy / Q000379:methods*; D005215:Fasting; D005260:Female; D006304:Health Status; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011446:Prospective Studies; D012449:Safety; D011795:Surveys and Questionnaires; D013997:Time Factors