Contraindications to Long-Term Fasting

Abstract

<h3>To the Editor:—</h3> The recent communication, "Prolonged Starvation as Treatment for Severe Obesity," by Drenick et al (<i>JAMA</i><b>187</b>:100 [Jan 11] 1964) and your editorial in the same issue emphasize some of the hazards of starvation treatment. It appears that the protein catabolism which occurs in starvation can be safely handled by patients with normal kidneys, but a recent unfortunate experience with a patient whom I saw in consultation indicates that this is not the case when there is kidney disease: The patient was an 18-year-old boy who weighed 365 lb (166 kg) and had mild hypertension. He showed no clinical signs of renal disease, and routine urinalyses were normal. He was placed on a complete fast and lost 40 lb (18 kg) in 14 days, but toward the end of this period went abruptly into a stage of vomiting and then coma. He was found to have a