If you were an avid newspaper reader in 1966, you might have seen a strange little story from United Press International. Under the headline “Stout Scot Peels Off 293 Pounds,” it told the story of 26-year-old Angus Barbieri eating breakfast. In his case, it was literally a broken fast, one that had begun more than a year before.

“Apart from feeling a wee bit weak, I feel no ill effects,” he told a reporter.

The doctor who supervised Barbieri’s 382-day fast published a case report in 1973, describing not only his 276-pound weight loss—from 456 to 180 pounds—but also the many vitamins and minerals they used to keep him alive, and the fact his patient went “37 to 48 days between stools.”

(So you've never gone that much trouble going #2—but if you're feeling constipated, learn How to Make Yourself Poop.)

Reading the study today, it’s hard to decide which is more appalling: the doctor’s conclusion that “starvation therapy can be completely successful, as in the present instance”; his expression of gratitude to Barbieri for his “cheerful cooperation and steadfast application to the task in attaining a normal physique”; or the paragraph describing “five fatalities coinciding with the treatment of obesity by total starvation.”

“I don’t think you could ethically publish a study like that today,” says Krista Varady, Ph.D., an associate professor at the University of Illinois-Chicago and author of The Every-Other-Day Diet, who has studied fasting for the past decade.

Varady says that a starvation study would violate the Declaration of Helsinki, which established guidelines for human experimentation with an emphasis on the welfare of the subject.

Although Barbieri’s doctor, William K. Stewart, clearly thought he was doing his patient a service by helping him attain that “normal physique,” no modern-day university would overlook the obvious risk of open-ended starvation.

But that doesn’t mean there aren’t good reasons to consider fasting for both weight loss and long-term health.

Life in the Fast Lane

You may think, as I did when I read the study, that “the treatment of obesity by total starvation” would by definition be considered so horrible and barbaric that no doctor would ever consider it. But according to “Fasting: The History, Pathophysiology, and Complications,” a study published in 1982, fasting and starving are the same thing, medically.

The only difference is semantic. When someone fasts, we assume he’s doing it voluntarily.

Throughout history, fasting was mostly a religious practice, and still is for Muslims during Ramadan. For weight loss, though, the story probably begins with Bernarr Macfadden in the early 20th century.

Macfadden was an influential health and fitness guru who was often far ahead of his time. He advocated strength training for both men and women, condemned white bread for its empty calories, and argued that tobacco caused both lung cancer and heart disease.

But when he was wrong, he was spectacularly, insanely wrong.

He rejected the germ theory of disease, for example, and opposed vaccinating children. Here’s an actual quote, recounted in Weakness Is a Crime: The Life of Bernarr Macfadden, by Robert Ernst: “Medicine has had its day. It belongs to the ignorance of the distant past.”

When it came to fasting, Macfadden had a firm belief, based first on observations of farm animals and later on a lifetime of self-experiments, that fasting helped the body heal itself.

Macfadden was never confused about whether to starve a fever or cold. He believed in fasting for any reason, or no reason at all.

We now know he was right on many counts. Today fasting is considered a mild form of stress that can ramp up the process of autophagy—the cells scrubbing themselves of metabolic waste. It also helps generate a hormone called BDNF, for brain derived neurotrophic factor, which is crucial for the survival of brain cells.

And it obviously has a benefit for weight loss. If you eat less often, you’ll probably end up eating less food. (Learn The Real Truth about Fasting for Weight Loss.)

Varady’s studies use alternate-day fasting, or ADF. Subjects eat about 25 percent of the amount of food they would need to maintain their weight on “fast” days, and anything they want on “feed” days.

“Our research shows that people only eat about 110 percent of their energy needs on their feed day,” she says. “They don’t binge, and that’s why they lose weight.”

They average a daily calorie deficit of about 25 to 35 percent over time, Varady says. For an average overweight guy, that’s probably 500 to 750 calories less per day than he’s used to.

Which leads to the next logical question: Is there any benefit to achieving that deficit by fasting, versus eating less food on a daily basis?

Less Is Less

In his terrific new book, Spring Chicken: Stay Young Forever (or Die Trying), Bill Gifford recounts the story of Luigi Cornaro, a wealthy 16th-century Italian who, in his late 30s, began to suffer what we now know as type 2 diabetes.

“His doctors immediately pinpointed the cause of his distress in his ‘intemperate’ lifestyle,” Gifford writes.

Cornaro eventually restricted himself to a single daily bowl of soup—just 12 ounces—with a little bread, washed down with three glasses of wine. He went on to live a full and surprisingly healthy life, culminating with the publication, in 1558, of what Gifford describes as the world’s first bestselling diet book.

He was 81 at the time, and revised it multiple times before his death at 98. Remember, this was a guy whose doctors didn’t think he’d make it past 40.

Cornaro’s plan is what we now call calorie restriction, or CR, and it’s been the template for both weight loss and life extension ever since.

There are two basic ways to achieve it, says Spencer Nadolsky, a family physician who specializes in weight loss:

1. Track daily calories, usually with the goal of cutting about 500 a day.

2. Choose a low-fat or low-carb diet, “which ends up cutting those calories without having to track directly."

Either way, the goal is to cut about a quarter of daily calories, similar to the deficit created by alternate-day fasting. Is there any reason to think one is better than the other?

“We found people lose the same amount of weight,” Varady says, based on the results from a just-completed yearlong study. “We thought that with ADF they’d lose more weight, since they have every other day off.”

The study did show one potential advantage to fasting: “It may be better for weight maintenance,” she says. The subjects who fasted didn’t gain back any weight during the 6-month maintenance phase, whereas the CR group regained 3 to 4 pounds, on average.

“Probably all these diets work,” Varady says. “We’re just trying to figure out viable options for people.”

Eating less, and subsequently weighing less, is what drives all the beneficial effects of any diet, she adds. “It doesn’t really matter how you do it, as long as it’s not unhealthy.”

That brings us back to Angus Barbieri and his 382-fast. If nothing else, it landed him in the Guinness Book of World Records. But was it healthy? Nobody today would think so.

William Stewart, his doctor, says Barbieri regained just 16 pounds in the next 5 years. And Barbieri himself told a reporter at the time that he felt good.

I hope he went on to live a long and healthy life, like Luigi Cornaro, but I couldn’t find any evidence that he did or didn’t.

As for Bernarr Macfadden, his lifelong enthusiasm for fasting leaves us with a cautionary tale, described by Robert Ernst in Weakness Is a Crime: “Early in October 1955, Macfadden developed a digestive disorder, which he tried to cure by fasting for 3 days.” A hotel manager found him passed out in his room and had him rushed to a hospital, “where his malady was diagnosed as jaundice, complicated by his fast.”

He died a few days later, at 87 years old.

Lou Schuler is an award-winning journalist and the author, with Alan Aragon, of The Lean Muscle Diet.

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