In 1960-1990, Russian doctors successfully used fasting to treat a number of diseases: hypertension, coronary heart disease, asthma, rheumatoid arthritis, and diseases of the gastrointestinal tract. The protocols used by doctors were somewhat different, but all of them were based on the method introduced by Yuri Nikolaev (1905-1998). He was an outstanding Russian psychiatrist who used the prolonged water fasting method to treat schizophrenia and certain other mental illnesses. After obtaining positive results, he and his students and followers expanded the use of fasting to treating patients with somatic diseases. The method introduced by Yu. Nikolaev was named RDT. Below is a brief description of this method.

Therapeutic Fasting Technique Introduced by Yuri Nikolaev

(Source: Guidelines for the Differentiated Use of RDTfor Certain Internal and Neuropsychiatric Diseases, USSR Ministry of Health, Moscow, 1990.)

RDT is prescribed after a comprehensive clinical and laboratory examination (complete blood count, urine, stool ova test; biochemical blood tests: total protein, albumin, globulins, sugar, aspartate aminotransferase, alanine aminotransferase, bilirubin, creatinine, potassium, sodium), instrumental examination (fluorography, ultrasound, esophagogastroduodenoscopy, ECG), as well as doctors’ consultations –gynecologist, dentist, otolaryngologist, and others, if necessary.

A laxative salt is prescribed to cleanse the intestines: 40-60 g of magnesia sulfate internally, dissolved in 100 ml of warm water. At night, a cleansing enema is conducted using 2 liters of room-temperature water. After that, food intake is completely halted.
The duration of abstinence from food is prescribed individually, depending on the initial body weight, physical condition, and age. In most patients with normal initial body weight, the therapeutic effect of RDT is achieved after 12-21therapeutic fasting, less often after 25 or more days.

Clinical signs of the completion of therapeutic fasting are: the tongue is cleared from plaque, bad breath disappears, complexion improves, a strong hunger sensation, dreams of food, hypersalivation, increased irritability, excitability, and general weakness, almost complete cessation of feces excretion after an enema. On average, during the period of complete alimentary deprivation, patients lose about 10% of their body weight. A loss of over 10% of the initial weight should not be allowed.
As a rule, patients should be immediately informed about the therapeutic fasting timetable. Smoking and drinking alcoholic beverages are prohibited during fasting. Due to the ongoing acidotic shift in the body, daily liquid intake should equal 1-1.5 liters of regular water, rosehip decoction, or alkaline mineral water. During the entire therapeutic fasting period, the following daily regimen is observed.
In the morning, a cleansing enema is conducted with 1-1.5 liters of body-temperature water, colored with potassium permanganate to a light pink color. After the enema, the patients take a 10-minute hygienic bath or shower with a water temperature of 37-38°C.
In the morning, a full-body massage with soap is conducted to cleanse the skin. After resting, there is an outdoor walk. A moderate movement that does not lead to fatigue is recommended. Some patients may be engaged in respiratory and light gymnastic exercises. The walk lasts 2-3 hours, followed by bed rest.

Another walk is scheduled for the afternoon. Being outside for prolonged periods of time and active movement facilitate the tolerance of complete alimentary deprivation and improve the patients’ well-being. All the time that is free from walking and sleeping can be used for work therapy, reading, and playing board games.
Before going to bed, patients brush their teeth and tongue with a soft brush and gargle with a weak solution of potassium permanganate. Lips usually dry out during this phase of RDT, so it is advisable to lubricate them with petroleum jelly, lanolin, or baby cream.
Rooms should be well-ventilated during sleep. In winter, it is essential to dress warmly during the day and cover oneself well at night due to the increased chilliness that appears during therapeutic fasting.
Enemas, baths, and massage are discontinued when fasting ends. It is best to start refeeding patients with fresh fruit or vegetable juices. Restorative nutrition may begin with vegetable or oat broth, or with curdled milk whey. For the first 2-3 days of refeeding, partial bed rest is prescribed due to general weakness.

Possible Complications During Therapeutic Fasting and Their Prevention

Somatic complications rarely lead to a premature break of a therapeutic fast if the patient was well-examined before treatment and all contraindications to RDT were taken into account. Nausea, headache, and a feeling of general malaise may occur during the acidotic shift and the subsequent acidotic crisis. In such cases, the patient should increase the intake of alkaline mineral waters or baking soda and spend more time outdoors. Full body massage also improves well-being.

During therapeutic fasting, exacerbations of certain chronic diseases may occur. Patients with a tendency towards arterial hypotension or those who experience a rapid drop in blood pressure due to fasting may go into a circulatory collapse, with a heart rhythm disturbance. Orthostatic collapse may occur during a rapid change in body position from horizontal to vertical. For prophylactic purposes, patients are advised to get up slowly, without sudden movements. The patient is brought out of the circulatory collapse in a regular manner. Occasionally, with long periods of therapeutic fasting, tonic convulsions may occur due to the excretion of sodium chloride, calcium, and phosphorus salts from the body. Fingers may be cramped at first, then the calves, and sometimes the chewing muscles. A warm 1% solution of table salt is prescribed in such cases; 200 ml is taken once or twice. The muscle cramps subsequently subside.

During the refeeding period, complications may arise due to a violation of the diet and feeding regime. It is essential to strictly follow the refeeding regimen, since dyspeptic disorders (pain, discomfort, and swelling in the epigastric region) may occur as a result of violations. In cases of dyspeptic disorders, it is necessary to rinse the stomach and prescribe a laxative. Sometimes a one-day fast is advisable.
Complications include swelling of the subcutaneous tissue, which may be a result of premature consumption of table salt. Edema is more pronounced on the face, in the infraorbital hollows. When a salt-free diet is prescribed, they disappear within 24 hours. In case of complications associated with an exacerbation of the underlying disease during RDT, therapeutic fasting should be halted and adequate therapy prescribed.
If the signs of exacerbation of the underlying disease are not significant, then adequate pharmacotherapy may be prescribed without stopping the therapeutic fasting process.

Approach to Recovery Period

The recovery period (refeeding) begins after the end of fasting period and lasts as long as the fasting period.
On the first day, the patient is prescribed 500 g of freshly prepared diluted carrot juice, 100 g 5 times a day (8, 11, 15, 19, 21 hours). It should be taken in small portions (1-2 teaspoons) every 10-15 minutes, gradually increasing the dose; juice temperature should not exceed 50°C. The total amount of protein will equal 5.5 g, fat –0.5 g, carbohydrates –29 g, calorie content –142 kcal.
On the second day, 1 liter of undiluted carrot juice is prescribed, 200 g5 times a day. The total amount of protein will equal 11 g, fat –1 g, carbohydrates –58 g, calories –285 kcal.
In addition to freshly prepared carrot juice, in the first days of the recovery period, tomato or apple, tangerine, or orange juices diluted with boiled water may be prescribed to patients.
If the patient is intolerant to juices, replace them with vegetable or slimy (oat) broths without salt; curdled milk whey, a decoction of dried fruits (apples, pears, prunes).
Starting on the third day of the recovery period, the food ration may be gradually expanded, both in quantity and range of foods. It should be conducted gradually and slowly, in compliance with the fractional diet. On the 3rd day calorie intake should be equal to 536 kcal.

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