Water Fast Coaching and Nutritional Therapy

Introduction: disclaimer

I’d like to begin by stressing that anyone suffering from a serious addiction should consult with their doctor before contemplating an extended water fast – and especially so when (1) treatment for that addiction involves prescription drugs or when (2) the addiction itself relates to prescription drugs. As much as it has been a privilege for me to accompany numerous clients through their fasting journey to a positive outcome with regard to their particular addiction, it is equally true that fasting can also cause damage when practised inappropriately. And to be clear, fasting is completely inappropriate for some people, given their particular case and health history, such as those suffering from an active eating disorder.

In order to minimise the risks, I would always advise fasting under the supervision of both a doctor as well as a fasting expert who intimately understands the interrelationship between fasting and addictions. As such, this article is intended for educational purposes only.

The physical and emotional/psychological elements of addiction

The NHS (National Health Service, UK) defines addiction as:

not having control over doing, taking or using something to the point where it could be harmful to you. Addiction is most commonly associated with gambling, drugs, alcohol and smoking, but it’s possible to be addicted to just about anything…[1]

Included among these would also be the common dietary addictions which so many people can relate to, including addictions to sugar, salt and caffeine. Excessive consumption of these items can certainly lead to harm, specifically insulin resistance and diabetes (sugar), high blood pressure (salt) and overstimulation of the adrenals and sympathetic nervous system (caffeine).

When fasting, it can be useful to approach the issue of addiction from two perspectives: physical addiction and emotional/psychological addiction.

On a physical level, addictive substances cause changes to your biochemistry which induce your body to demand more of the given substance in order to sustain homeostasis – that is, the stability of your metabolism.

On an emotional/psychological level, addictive substances manipulate the way you feel about and relate to a given type of food, drink or drug, so that you want more of it. More than just simple desire, you actually need more of the addictive substance in order to sustain your mood or ‘emotional homeostasis‘.

Because the physical and emotional elements of addiction are so closely intertwined, it’s easy to confuse the two. And because of the way they interact with one another, it’s also easy to end up in a downward spiral. For instance, that chocolate bar (literal or figurative) elicits biochemical physical changes in the brain as dopamine and other hormones are released. This makes you feel good emotionally. As the effects wear off, you crave more – and grab for another bar, thereby repeating or perhaps even intensifying the cycle in a positive feedback loop.

In the next section, these two perspectives are applied to the context of fasting, in exploring how fasting impacts on some specific addictions

The potential benefits of water fasting

In the same way that it is not fully understood how certain pharmacological drugs exert their medicinal effect, the same applies to many aspects of fasting. In my experience working with clients, however, I have observed clinically that fasting can reduce the dependence on certain addictive substances. Below, I have chosen three examples of addictive substances and how fasting can help.

Refined sugar:

It may come as a surprise to learn that scientists cannot agree whether sugar technically meets the strict clinical criteria to officially declare it an addictive substance. However, there is no doubt that – similarly to addictive drugs – sugar causes the release of opioids and dopamine in the brain, and in animal studies has been shown to cause ‘dependency’, as exhibited through behaviours of bingeing, withdrawal and cravings.[2]

Over the years, many clients have come to me with the specific goal of resolving their sugar ‘addiction’. Regardless of their previous degree of attraction to sugary foods, most clients declare that by the end of a week of fasting they no longer have cravings for refined sugars. The timescale tends to be remarkably reliable. For anyone who hasn’t completed a 7-day fast themselves, this may understandably seem incomprehensible, if not miraculous!

The interesting point, however, is that it isn’t the sweet taste per se which no longer interests most of my clients, but specifically the uncontrolled attraction to refined sugars. In contrast, the idea of natural sugars from fresh, succulent fruits typically does remain attractive to them, albeit in greater moderation. On longer fasts, even this tends to gradually evolve into a preference for vegetables over fruit: that is, food items which consist primarily of complex carbohydrates rather than simple sugars. In short, attraction to any form of sweet taste can eventually disappear, with a substantial minority of my clients actually feeling repulsed by the idea of any sweet foods at the end of their fast, especially in the case of extended 14-40 day fasts.

Approached from the perspective of physical and emotional/psychological addiction, these clinical results would seem to imply that a week may be long enough to clear the physical addiction to refined sugars, given that most clients experience a neutral or negative bodily (physical) sensation at the thought of eating high-sugar foods such as chocolate, cake or ice cream by the end of their fast. Many clients who self-declare as ‘sugar addicts’ can also refeed after a 7-day fast with no cravings towards refined sugars, finding themselves content instead with a lower intake of healthier natural sugars from fresh and/or dried fruits afterwards. I witness time and again how rewarding this can be for the given client – and understandably so!

On another level, however, remains the question of what happens to the underlying emotional/psychological addiction to a given substance. Unfortunately, I have observed on numerous occasions that acute and/or chronic stress situations can trigger a relapse, with clients running to the convenience store to ‘self-medicate’ on candy bars or similar items. Of course, this can then initiate an entirely new cycle of physical addiction, elicited through consuming the refined sugar itself. Being mindful of this danger in advance can be an important component of a successful post-fasting strategy.

Of course, sometimes it isn’t a latent emotional/psychological addiction which triggers a relapse. In the case of refined sugar, it can simply be a social situation in which baked goods are ‘unavoidable’. The fact of the matter is that refined sugar is commonly present in a multitude of settings in everyday life – and that it is often just a matter of time before we end up consuming it.

The good news is that many clients report that when a new cycle of dependency to refined sugars establishes itself, it is often less severe than before the fast. I’ve experienced this myself through personal fasting practice. As a poor, young student in Vienna I became ‘hooked’ on a daily 100g intake of cheap but extremely good-quality chocolate. I’ll be honest. It lasted for years – until I did my first 7-day water fast. I experienced all the changes described above, including an eventual return to daily chocolate bars. However, the interesting thing was that now I could ‘get my fix’ with only 70-80g a day instead. With subsequent 7-day fasts, this trend of a gradually decreasing ‘fix’ continued until eventually – as much as I still love chocolate 🙂 – I no longer need the daily fix at all. I won’t lie, though: the entire process took a few years from beginning to end.

Extrapolating from this, it is extremely important to understand that repeated shorter fasts (eg 7 days) can be much more effective than aiming for a ‘hole in one’ with a single multi-week fast. Many clients mistakenly believe, for instance, that a single 40-day fast will resolve all their addictions. Given the continued likelihood of exposure after a fast to something as addictive as sugar, however, it makes much more sense to think of a ‘2 step forward, 1 step backwards’ approach instead.

This approach also yields a more drawn-out overall timescale. As much as it would be wonderful to simply wave a magic wand to solve our problems, the psychological reality is unfortunately more complicated than this. As described in my own case above, a more extended period of time is often necessary to allow a softening of the deep-seated habits and behaviours which reinforce the emotional/psychological addiction to sugar – even though the actual cravings for sugar may be resolved with each successive 7-day fast.

Beyond this, it is also extremely important not to aim for a fast which feels emotionally/psychologically too long, for this can actually reinforce the particular emotional addiction. For example, numerous clients first come to me reporting that, after having fasted alone, their diet actually felt more out of control than before. Forcing out a fast which feels emotionally/psychologically too long is also potentially dangerous, as discussed below (The potential risks of fasting with addictions).

Smoking:

Unlike sugar, there is complete medical consensus that the active drug in tobacco – nicotine – is highly addictive. Given the powerful dopamine rush it causes within 20 seconds of inhalation, the Centre for Addiction and Mental Health (Canada’s largest mental health teaching hospital) even compares it to opioids and cocaine.[3] The Centers for Disease Control and Prevention (CDC, USA) goes on to note that, despite the fact that each year half of all smokers try to quit permanently, only 6 percent actually succeed.[4]

Although hardly any of my clients fast with the primary aim of giving up smoking, I do work with some clients who also happen to be smokers. Of this minority cohort, a further minority need to undertake a fast which feels too long for complete abstinence. In such cases, I sometimes suggest beginning the fast without even trying to give up smoking. This isn’t an ideal solution by any means, but sometimes, on balance, it is nevertheless the best solution – and also one which, as a side benefit, may lead to giving up smoking permanently, as described in greater detail below.

I have observed a very interesting trend with this cohort over the years, with two distinguishing patterns. First, similar to the situation regarding sugar (see above), the number of cigarettes required in order to get a daily ‘fix’ of nicotine tends to decrease through the first few days of the fast. Depending on the degree of addiction and the length of the fast, this can sometimes lead to quitting completely during the fast with no relapse afterwards. Second, such clients tend to become increasingly sensitive to their own cigarette smoke through the course of the fast. Most commonly, this leads to coughing when trying to light up, until the actual experience of smoking becomes so unpleasant that the given client actually prefers not to smoke at all – which can then lead to long-term quitting. The timescale for this varies during the fast, usually ranging from 2-3 days up to about 2 weeks.

Similar to the situation regarding sugar, acute and/or chronic stress after the fast can retrigger old behaviors and the emotional/psychological addiction to smoking. Interestingly, however, many clients do resist the temptation to return to smoking. In my experience, some of these ex-smokers are fully successful even over the long term, while, for others, the old addictive behaviour instead evolves, finding another mode of expression. In place of cigarettes, sugary foods frequently become the object of addiction – and it is perhaps no coincidence that both sugar and nicotine elicit a similar release of dopamine in the brain.

SSRIs and psych meds:

Although SSRIs such as Zoloft and Prozac are not usually classified as addictive substances, various other categories of psych meds do cause clinical addiction, such as benzodiazipines (eg. Xanax, Valium, Ativan), prescription stimulants (eg. Adderall, Vyvanse), and so-called Z-drugs (eg. Ambien). Even though SSRIs, SRNIs and most other antidepressants may not qualify technically as addictive substances, I have worked with numerous clients who previously, in everyday life, have been unable to get off their antidepressants due to debilitating withdrawal symptoms, both physical and psychological. In other words, for all intensive purposes they are nevertheless ‘hooked’.

As noted in the Introduction, anybody aiming to come off their (psych) meds while fasting should work together both with their prescribing clinician as well as a fasting expert who understands whether it is even possible to fast while on the given medication. This is a safety issue. Period. The mental health organisation MIND notes that coming off benzodiazipines too suddenly can cause withdrawal symptoms including confusion, psychosis, seizures, tremors and hallucinations,[5] and a recent study in the Journal of the American Medical Association (2023) found that coming off benzodiazipines too quickly could be fatal.[6] Even in the case of technically non-addictive SSRIs, it is essential to agree on a withdrawal schedule with your doctor, whether or not you are fasting.

Especially in the case of SSRIs, I have worked with numerous clients who in everyday life had previously struggled to reduce their medication and who subsequently succeeded during their fast. This is certainly not a guarantee of success. And unlike the situation regarding sugar and smoking, I observe no predictable timeframe for success beyond the fact that extended fasts tend to be necessary: possibly 21 days or even longer, depending on the individual case. Unfortunately, though, some clients are simply not psychologically predisposed to undertake such a long fast. (The risk of overstepping a client’s psychological limits is also why daily monitoring during the given fast is essential.) And, finally, some clients are not in a position psychologically to fast at all.

In short, despite the potential benefits of reducing a clinical dependence on psych meds, it is crucial to proceed carefully to minimise the chance of a negative outcome. As the saying goes: primum non nocere (first, do no harm).

The potential risks of fasting with addictions

Many of the risks of fasting with addictions have already been covered in passing in the paragraphs above. Here, they are categorised in their own right.

Dysregulated eating

In my experience as a water fasting coach, probably the most common problem is the risk of triggering or intensifying dysregulated eating habits. As mentioned above, the addiction to nicotine can easily morph into overeating (as many ex-smokers note in general, regardless of whether they have fasted or not). In the case of clients who have weaned themselves off psych meds during a fast, a subsequently greater attraction to eating often arises. And even within the context of food-related addictions, some clients who resolve their sugar addiction through a 7-day fast likewise report a general tendency towards overeating afterwards – even if it manifests through consuming large volumes of healthy, low-calorie foods such as salads.

Many of my clients acknowledge and understand the fact that, regardless of the particular object of addiction, they suffer from an underlying pattern of addictive behaviour in general. For them, fasting can initially shift the focus of that behaviour away from toxic substances such as nicotine and alcohol towards food. Although, at this point, the underlying behavioral patterns may still remain, I would nevertheless argue that this constitutes a step forward – in that they have eliminated exposure to a toxic drug.

Moving forward from here, it is important to continue working on old habits and behavioral patterns: so many of which can drive emotional/psychological addiction. This can take place through a multitude of different therapies, including 12-step programs and/or therapeutic fasting. Again, though, I would reiterate that, despite the potential benefit, there is nevertheless a danger of reinforcing addictive behavior when fasting is conducted inappropriately, as discussed below.

Reinforcement of emotional/psychological addictions

For most people, eating is one of the great comforts of life. So if any addictive behaviour exists at all towards food and eating, then taking away that food for too long during a fast can risk a backlash afterwards, with the given addictive behaviour becoming reinforced. In my experience, it is thus a fine line between (1) maximising the possibility of reducing physical addiction and (2) triggering the risk of intensified underlying emotional/psychological addictions afterwards.

As described above, a certain length of time is often necessary to resolve physical addictions (eg. usually about a week for refined sugar) – and yet if that length of time exceeds what feels manageable emotionally/psychologically in terms of giving up food and eating in general, it can actually lead to a negative outcome through increased addictive behaviour afterwards. This can happen in one of two ways: either towards food or towards the original addiction. For example, several years ago I had a client who had planned on doing a 30-day fast in order to get off his antidepressant: something he had not been able to succeed at in everyday life due to the withdrawal symptoms. During the fast he successfully followed an agreed withdrawal schedule and came off his meds completely. However, at around the 21-day mark his thoughts began to obsess increasingly around food, which then, in turn, started to impact negatively on his mood and state of mind. This risked a return to the depression and anxiety he had suffered from in the first place. Rather than provoke a backlash towards his subsequent relationship with food or a negative outcome regarding his long-term mental health, I called off the fast at this point: precisely because (1) he had already achieved his goal and (2) the emotional/psychological risks of continuing were, in my view, too great.

It is not only a fine line between maximising benefits and incurring risks. It is also a largely invisible line – and also the reason why it is absolutely essential that clients with addictions seek expert advice both before as well as during their fasts. For example, when such clients come to me with gland plans for a 40-day fast, I often spend much of the consultation trying to talk them down to a shorter fast, precisely because of the reasons discussed here.

Blood pressure issues

Beyond a certain invisible length of fasting time, most clients start to feel a rising level of tension inside them. There are many possible reasons, including the desire to get back to ‘normal’ life, an impatience with low fasting energy levels or sleep patterns, or simply an increasing intolerance to the abstinence from food. Beyond a certain point – and this varies considerably from client to client – this tension can start to impact negatively on the sympathetic nervous system: your so-called ‘fight or flight’ response. Not only do many clients report this qualitatively, but it in certain cases it can also be measured quantitatively: through a mildly elevated blood pressure, relative to earlier in the fast.

The most common physiological response during a fast is towards decreased blood pressure. This has been clearly demonstrated through studies investigating both intermittent fasting[7] as well as extended therapeutic water fasts.[8] So when the opposite occurs it is important to treat this is a potential red flag and safety issue. Electrolyte imbalance is a potential cause for increasing blood pressure during a fast,[9] but over the years only a single client of mine has ever confirmed this through bloodwork. Rather, in the rare instances when I have observed increasing blood pressure, it has correlated with clients’ self-reported feelings of tension and impatience with continuing the fast.

Again, we return to the issue of finding the right length of fast: one which is long enough, and yet not so long that it starts to trigger complications or diminishing returns. In this respect, most clients need help both before the fast in establishing an appropriate initial goal, as well as remaining sensitive to their emotional/psychological state during the fast itself.

Increased symptoms

I regularly observe that clients fasting with addictions tend to suffer from increased overall symptomatology during their fasts. This may be related to a confluence of both (1) the withdrawal symptoms elicited through coming off an addictive substance as well as (2) the normal ‘detox symptoms’ (or, more technically, ‘adverse events’) which have been documented to accompany extended fasts.[10] These symptoms can include increased fatigue, nausea, headache and body aches: all of which are known to present in both cases.

When strong symptoms present, it is clearly important to know how to manage these symptoms for the sake of maximum client comfort. More importantly, it is also crucial to able to distinguish normal (if unpleasant) symptoms from those elicited through a developing safety issue. Most clients simply don’t have the experience to do so alone. I have worked with numerous clients who have previously ended up in hospital when following a fasting protocol alone or under inappropriate supervision. In short, the importance of this issue cannot be overestimated.

Final thoughts: a summary

Clearly, fasting with addictions or fasting in order to address addictions has potential benefits as well as potential risks. It is also important to recognise that, while some elements of addiction – particularly the physical element – can respond well, the deeper behavioral patterns which drive emotional/psychological addiction can often be more stubborn. In order to ensure maximum safety and minimise the risk of negative outcomes, anyone suffering from a serious addiction should seek expert advice before considering a fast and work with both their doctor as well as a fasting expert during their fast.

Please feel free to share your thoughts or questions in comments section below!

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[1] https://www.nhs.uk/live-well/addiction-support/addiction-what-is-it/

[2] Avena NM, Rada P, Hoebel BG. Evidence for sugar addiction: behavioral and neurochemical effects of intermittent, excessive sugar intake. Neurosci Biobehav Rev. 2008;32(1):20-39. doi: 10.1016/j.neubiorev.2007.04.019. Epub 2007 May 18. PMID: 17617461; PMCID: PMC2235907

[3] https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/nicotine-dependence

[4] Centers for Disease Control and Prevention (CDC). Quitting smoking among adults—United States, 2001-2010. MMWR Morb Mortal Wkly Rep. 2011;60(44):1513-1519

[5] https://www.mind.org.uk/information-support/drugs-and-treatments/sleeping-pills-and-minor-tranquillisers/withdrawal-effects-of-benzodiazepines/

[6] Maust DT, Petzold K, Strominger J, Kim HM, Bohnert ASB. Benzodiazepine Discontinuation and Mortality Among Patients Receiving Long-Term Benzodiazepine Therapy. JAMA Netw Open. 2023;6(12):e2348557. doi:10.1001/jamanetworkopen.2023.48557

[7] Wang W, Wei R, Pan Q, Guo L. Beneficial effect of time-restricted eating on blood pressure: a systematic meta-analysis and meta-regression analysis. Nutr Metab (Lond). 2022 Nov 8;19(1):77. doi: 10.1186/s12986-022-00711-2. PMID: 36348493; PMCID: PMC9644535

[8] Goldhamer AC, Lisle DJ, Sultana P, Anderson SV, Parpia B, Hughes B, Campbell TC. Medically supervised water-only fasting in the treatment of borderline hypertension. J Altern Complement Med. 2002 Oct;8(5):643-50. doi: 10.1089/107555302320825165. PMID: 12470446

[9] Ellison DH, Terker AS. Why Your Mother Was Right: How Potassium Intake Reduces Blood Pressure. Trans Am Clin Climatol Assoc. 2015;126:46-55. PMID: 26330658; PMCID: PMC4530669

[10] Finnell JS, Saul BC, Goldhamer AC, Myers TR. Is fasting safe? A chart review of adverse events during medically supervised, water-only fasting. BMC Complement Altern Med. 2018 Feb 20;18(1):67. doi: 10.1186/s12906-018-2136-6. PMID: 29458369; PMCID: PMC5819235

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