Reverse IC with Water Fasting

Water fasting for reversing Interstitial Cystitis (IC) symptoms?  Say it isn’t so! As one study suggests: “In rodents, intermittent or periodic fasting protects against diabetes, cancers, heart disease and neurodegeneration, while in humans it helps reduce obesity, hypertension, asthma and rheumatoid arthritis.” 

Can it help overcome the pain associated with IC and is it right for you? Fasting seems to be the latest health trend, with intermittent fasting, alternate-day fasting, and water fasts are becoming quickly popular in the wellness arena. Water fasts have been used for centuries and have been done in a number of different ways and for varying lengths of time, usually five to 40 days.

What is a water fast?

In a true water fast, you are limited to drinking only water and no food for the duration of the fast. Interestingly, modern science has found a variety of verifiable positive effects of fasting that has on human health.  However, there are some downsides to fasting as well, so it is important to review both the positive and negative to determine if fasting is right for you.

Benefits of Water Fasting for IC

1. Autophagy. My number one favorite benefit is the process of autophagy.  The term ‘autophagy’, derived from the Greek meaning ‘eating of self’, was first coined by Christian de Duve over 40 years ago (Glick, Barth, & Macleod, 2010). Autophagy is your body’s normal, natural process for recycling unnecessary or dysfunctional components. The body reprograms itself, clearing out old cells or damaged cells and replacing them with new ones (Cheng et al., 2014). This means that fasting can encourage your body’s natural healing mechanisms to actively destroy and recycle damaged tissues, which may have a positive effect on several serious conditions.  This can often lead to improved immunity and reduction in autoimmune symptoms. The idea is the body gets rid of damaged autoimmune cells and replaces them with healthy new ones. This could come handy since IC is characterized by recurrent inflammation and destruction of bladder tissue without obvious cause, that some speculate could be a broken immune system response.
2. Improved digestive health. Research suggests that fasting can improve digestive health, allowing good bacteria to flourish, resulting in an overall improvement in metabolism, weight, and many other cardiometabolic conditions.  Fasting is also a great break for your gut, which is often helpful if you have food intolerances and allergies. The elimination of food antigens can also reduce inflammation that is often associated with chronic pain and immune dysfunction. This is because water fasting can upregulate a T cell response, called T-regulatory cells, that are involved in oral tolerance of food. In fact, eating foods that your body is intolerant to can make your immune system work too hard and make your more susceptible to infections. Therefore, giving your gut a break can actually enhance immunity and reduce inflammation, a crucial symptom of IC. (Make sure you follow up the fast with a healthy diet and probiotics)
3. Improved markers of metabolic syndrome. Water fasting can improve aspects of metabolic syndrome: abdominal fat, inflammation and blood pressure are reduced. Insulin sensitivity is increased, and the functional capacities of the nervous, neuromuscular and cardiovascular systems are improved (Longo & Panda, 2016).  Fasting results in a lowering of the hormones insulin and leptin levels and an elevation of adiponectin and ghrelin levels. By increasing insulin and leptin sensitivity, you can suppress inflammation and stimulate autophagy. Fasting can reverse all the major abnormalities of metabolic syndrome such as reduced body fat, blood pressure and glucose metabolism (Longo & Mattson, 2014).
4. Slowed aging. There are biomarkers that are associated with reduced aging when you water fast. These include changes in the levels of signals in your body, such as IGF-1, IGFBP1, glucose, and insulin. Fasting for 3 or more days causes a 30% or more decrease in circulating insulin and glucose, as well as rapid decline in the levels of insulin-like growth factor 1 (IGF-1), the major growth factor in mammals. Together with insulin, reducing growth factor is associated with decreased aging and cancer (Longo & Mattson, 2014).  It could also slow down the aging of your immune system so that you are less susceptible to infections.
5. Reduction in oxidative stress. Oxidative stress is a condition where too much oxygen can wreak havoc in your cells. It’s complicated, but the bottom line is that oxidative stress is an indication that you are out of balance on a cellular level. This condition can cause excessive fatigue, brain fog, muscle and joint pain, wrinkles, gray hair, poor eyesight, headaches and sensitivity to noise, and a decreased immune system.  And a decreased immune system makes you more at risk of getting even more infections.

Risks of Water Fasting

1. Dehydration.  Although it sounds strange, a water fast could make you dehydrated. This is because roughly 20 to 30% of your daily water intake comes from the foods you eat. Symptoms of dehydration include dizziness, nausea, headaches, constipation, low blood pressure and low productivity. To avoid dehydration, you will need to drink a lot more water than you are used to drinking.
2. Loss of electrolytes. During a water fast, you may lose electrolytes, which are needed for your heart to function. This can lead to abnormal heartbeats and can potentially be dangerous in susceptible individuals.  Drink electrolyte water to prevent this from occurring if you decide to water fast.
3. Low blood sugar. Some people have reactive hypoglycemia and may find it difficult to fast.  This is because they are not efficient at using fat for energy, and may struggle to transition to ketosis. What is ketosis?  Ketosis is actually a normal metabolic process in your body that occurs when your body does not have enough glucose (sugar) for energy, so it burns up stored fat for energy instead (McIntosh, 2017).  Ketones are produced as a by-product of this process, which can be measured on home test strips or finger prick tests. Once you can achieve ketosis, the fast gets much easier. It is recommended that you initially do a shorter fast, or experiment with a period of intermittent fasting before trying to do a prolonged water only fast.
4. Orthstatic hypotension. This occurs when you get dizzy when you stand up suddenly.  It is common when water fasting, but it can also be dangerous. The dizziness and risk of fainting could lead to an accident.
5. Sudden death. Although it is rare, there is a chance of sudden death during a water fast.  Granted these people did have pre-existing heart conditions, but it is still worth mentioning, particularly in the context of a prolonged water fast over 72 hours.
6. Extreme hunger. Face it, hunger is uncomfortable.  Although most hunger subsides after 3 days, the first few days can be unbearable, especially if you are surrounded by food.  It is best to stay away from any sources of temptation during your fast so that makes it less intolerable.

IC & My Fasting Experience

What provoked me to do a water fast? I had persistent symptoms of urinary inflammation and pain, typical IC.  Pain during urination, pain during intercourse and overall heightened sensitivity (mostly in my urethra). I also had digestive issues, gas, severe bloating, maldigestion and was prone to frequent UTIs.

I have experimented with both a 4.5 and a 7.5-day water fast. I did two 4.5 day fasts and one 7.5 days fast. Hands down, I will never do a fast longer than 4 days again!  The 4 days were the most therapeutic for my body. It reduced my inflammation substantially and got me out of IC pain. It was also relatively easy to return back to eating normal foods again.  

The first time I fasted was the hardest transitioning to ketosis (this is when your body switches from burning calories to burning fat cells instead and you do not feel that hungry anymore). It took me 3 days to achieve ketosis and I even passed out on day 3 due to orthstatic hypotension. I was very weak the entire fast and was very glad to break it.

The 7.5 day fast for me was not as eventful.  I was better prepared to go into the fast and was able to achieve ketosis much quicker and had fewer problems overall. However, this one stressed my adrenals and my gut and it took me a long time to get it back to normal. I had indigestion for 8 days, diarrhea, knee and joint pain and even got a UTI after the fast!  Luckily, I was able to resolve it rather quickly, but it taught me a lesson: prolonged water fasting is not for everyone.

Overall, I think the second fast was harder on my body because I have done several fasts in the past few months prior and it may have been too soon for me.  There is a period of refeeding that is very important in the context of fasting, it is very important for stem cell proliferation of the immune cells. Therefore, it is possible I did not give my body enough time to rebuild new cells after the fast, and perhaps my immune system suffered as a result (Longo, 2018)

A word of advice: If you decide to fast, hire a health coach or nutritionist to help prepare you for your fast.  You need have been following a comprehensive elimination diet full of good quality foods for a period of time before you fast to mitigate any negative side effects that could occur during or after the fast.  You will also want them to run preliminary blood work on you to make sure you are healthy enough to fast. This will also help them guide you as to the duration of a fast that would be suitable for you.

References:

• Cheng, C. W., Adams, G. B., Perin, L., Wei, M., Zhou, X., Lam, B. S., . . . Longo, V. D. (2014). Prolonged fasting reduces IGF-1/PKA to promote hematopoietic-stem-cell-based regeneration and reverse immunosuppression. Cell Stem Cell, 14(6), 810-823. doi:10.1016/j.stem.2014.04.014
• Glick, D., Barth, S., & Macleod, K. F. (2010). Autophagy: cellular and molecular mechanisms. J Pathol, 221(1), 3-12. doi:10.1002/path.2697
• Longo, V. (2018). Dr. Valter Longo on Resetting Autoimmunity and Rejuvinating Systems with Prolonged Fasting and the FMD. Retrieved (2018, July 19) from https://www.youtube.com/watch?v=evGFWRXEzz8&t=3361s
• Longo, V. D., & Mattson, M. P. (2014). Fasting: molecular mechanisms and clinical applications. Cell Metab, 19(2), 181-192. doi:10.1016/j.cmet.2013.12.008
• Longo, V. D., & Panda, S. (2016). Fasting, Circadian Rhythms, and Time-Restricted Feeding in Healthy Lifespan. Cell Metab, 23(6), 1048-1059. doi:10.1016/j.cmet.2016.06.001
• Mandal, A. (n.d.) What is Autophagy?  Retrieved (2018, July 5) from https://www.news-medical.net/health/What-is-Autophagy.aspx