Water and dry fasting retreats

1. Introduction

Version followed: water-only fasting as described by the TrueNorth Health Center and TrueNorth Health Foundation (Natural Hygiene tradition, International Association of Hygienic Physicians standards); the Buchinger-style "fasting therapy" expert consensus (Wilhelmi de Toledo et al., 2013) for comparison of contraindications and supervision; dry fasting as promoted by Sergey Filonov (Siberia) and on social media. This guide covers the psychotherapist's work alongside fasting retreats: the psychotherapist does not run, sell, recommend or supervise any fast. Section 4 is the therapist's own work with clients who are considering, attending or returning from a fasting retreat.

What it is. A fasting retreat is a residential stay where a person stops eating for a period under the retreat's supervision. Two forms are covered here:

Water-only fasting. Abstaining from everything except pure water, at rest, in a residential facility. TrueNorth's founder describes it as taking place in a quiet setting, separated from family and friends, with round-the-clock access to a trained doctor [source: Goldhamer, "Therapeutic Fasting", TrueNorth Health Foundation]. TrueNorth's research director and director state that clinicians there have supervised more than 15,000 water-only fasting patients [source: Myers & Goldhamer, "Clinical Fasting", Sonoma Medicine, 2017].
Dry fasting. Abstaining from food and from water and all other fluids. Cleveland Clinic defines it as abstaining from water and all beverages during a fast [source: Cleveland Clinic, "Dry Fasting: Why You Should Avoid It", 2024]. Its best-known clinical proponent is Sergey Filonov, a doctor who uses dry fasting in his practice and says he built on Soviet fasting methods [source: Goodreads listing of Filonov, 20 Questions & Answers About Dry Fasting, Siberika Books, 2019]. A residential programme he oversees in Siberia is described in a published memoir [source: Library Journal review of Starving to Heal in Siberia, Greenleaf, 2022]. Dry fasting is also promoted on Instagram and other social media [source: 1News, 2020].
Not covered here: religious fasts, some of which also exclude water (Ramadan, Yom Kippur). They have a different meaning, community and set of exemptions; see Domain XIII. Breatharianism ("living on light") is related to dry fasting and appears in the harm account below.

Core idea of change, as proponents state it. Proponents say fasting triggers physiological responses that support the body's self-healing: ketogenesis, hormone changes, reduced inflammation and oxidative stress, more autophagy, and energy redirected from digestion to cell regeneration. TrueNorth's own authors say the exact mechanisms are unknown, and that fasting is "not a cure or treatment in the traditional sense". In their account, results depend on a health-promoting lifestyle afterwards (whole plant foods, sleep, exercise) [source: Myers & Goldhamer 2017]. Dry-fasting proponents claim it shortens a water fast and is better tolerated [source: Filonov book description]. Other claims include weight loss, better immunity, cell regeneration and slower ageing [source: Cleveland Clinic 2024]. All of these are the proponents' claims. No fast is presented here as a treatment for any disease.

Evidence status (one line each). Water-only fasting: an observational chart review from TrueNorth reports mostly mild to moderate adverse events under its own protocol; it does not show that fasting treats disease [source: Finnell et al. 2018]. Dry fasting: little good data, and clinicians advise against it [source: Cleveland Clinic 2024; 1News 2020].

2. Framework

The retreat's framework, as its organisations publish it, comes first. The therapist's own framework follows.

A. The retreat course (water-only, TrueNorth / Natural Hygiene version) [source: Goldhamer, "Therapeutic Fasting"; Myers & Goldhamer 2017]

Pre-fast evaluation. A health history, physical examination and laboratory tests such as urinalysis or blood work. Their stated purpose is a baseline that helps staff tell a "healing crisis" from physiological compromise.
Supervised fast. Water only, at complete rest, residential and away from home. Staff monitor signs and symptoms daily. The fast is ended at a stable point and before nutrient reserves run out. Staff, not the guest, decide when it ends, based on clinical monitoring. No schedule is given here.
Refeeding. TrueNorth's founder calls refeeding the most important phase. Fluids and foods are brought back gradually, in increasing complexity.
Post-fast lifestyle. A whole-food, plant-based diet, sleep and exercise, which TrueNorth presents as necessary to keep any results.

B. The Buchinger-style "fasting therapy" model (for comparison) [source: Wilhelmi de Toledo et al. 2013]. This consensus describes modified fasting, not water-only fasting. Its phases are preparation (lighter, mostly vegetarian eating, no stimulants, mental preparation), the fast itself with ongoing medical monitoring, then a gradual fast-break and refeeding. It treats fasting as multidisciplinary and lists psychological support and emotional stabilisation among the accompanying measures. It also expects "fasting crises", especially early on, and recommends empathic support for them.

C. Dry-fasting retreats. Proponents describe progressively longer fasts without food or water, plus rules on enemas and on when to break the fast [source: Filonov book description; Library Journal review]. A reviewer of the Siberian memoir warns that going without water can have serious, dangerous consequences. The reviewer says no reader should try the protocols without medical supervision and calls publishing them as DIY instructions irresponsible [source: Library Journal review]. No safe protocol is described here.

Regulation (one line each, main jurisdictions) [uncertain: not verified beyond the sources listed]

United States: fasting supervision is not a separately licensed profession. IAHP-certified supervisors are licensed medical doctors, chiropractors or osteopaths who have completed a residency at a fasting institution [source: Goldhamer, "Therapeutic Fasting"]. Other retreats may have no licensed clinician on site [uncertain: not verified].
Germany / Europe (Buchinger tradition): the consensus expects physicians or therapists trained and certified in fasting therapy. Non-medical "fasting guides" run fasting for healthy people, with physician backup where possible [source: Wilhelmi de Toledo et al. 2013].
Social-media dry-fasting advice: unregulated, according to the New Zealand Medical Association spokesperson quoted by 1News [source: 1News 2020].
UK, Australia, Canada: no specific licensing is cited here; claims in advertising fall under general advertising and consumer law [synthesis] [uncertain: not verified].

D. The psychotherapist's framework alongside it [synthesis]

There is no fixed number of sessions. The work fits into ongoing therapy or a short consultation, in four overlapping phases:

Notice and ask. Use routine screening for diet, fasting and complementary practices.
Understand. Explore meaning, hopes and the client's explanatory model, and screen for eating-disorder and medical risk.
Decide and coordinate. Support an informed, values-based decision. With consent, liaise with the GP or physician, who handles medicines and fitness to fast.
Follow up. Debrief after the retreat, watch for restrictive patterns and the refeeding period, and report if needed.

When to move on: from 1 to 2 once the client has disclosed a plan. From 2 to 3 once risk screening is done. Escalate straight to medical or urgent care at any point when red flags appear (see 4.6).

3. Guiding principles

[Principles are synthesis unless a source is given.]

Alongside, never in charge. You do not recommend, sell, supervise or advise on fasting. Practical meaning: no opinions on how long to fast, how to break a fast, or which retreat to choose; route those questions to a physician. [synthesis]
Curiosity before correction. Clients disclose more when they are not judged. Practical meaning: ask what draws them before giving any information. [synthesis]
Proponents' claims are attributed, not adopted. Practical meaning: say "the retreat says...", not "fasting does...". [synthesis]
Fasting is not a treatment for disease. Even TrueNorth's own authors say it is not a cure in the usual sense [source: Myers & Goldhamer 2017]. Practical meaning: if a client is fasting instead of medical treatment, treat that as a risk conversation.
Eating disorders are a contraindication. The fasting-therapy consensus lists anorexia nervosa and eating disorders as absolute contraindications, and psychotic disorders and addictions as relative ones [source: Wilhelmi de Toledo et al. 2013]. Practical meaning: screen every client who mentions a fasting retreat.
Medical supervision is the floor, not a guarantee. Practical meaning: a supervised setting lowers risk but does not remove it. Unsupervised, home or social-media fasting, and any dry fasting, raise the level of concern. [synthesis, informed by Goldhamer; Library Journal review; Cleveland Clinic]
Medicines belong to prescribers. The consensus says many drugs need adjusting during a fast, including antihypertensives, diuretics, antidiabetics, anticoagulants, psychotropics and anticonvulsants [source: Wilhelmi de Toledo et al. 2013]. Practical meaning: never advise on medicines; ask the client to talk to the prescriber before any fast.
Autonomy with safeguarding. Adults may choose to fast. Children, people who lack capacity, and adults at serious risk trigger different duties. Practical meaning: know your safeguarding route before you need it. [synthesis]
No dual relationships or commercial interest. Practical meaning: do not refer to, earn from, or co-host retreats; declare any conflict of interest. [synthesis]
Respect for faith-based fasting. Practical meaning: keep religious fasting separate (Domain XIII). Work with the person's own tradition's exemptions and with faith leaders rather than against them. [synthesis]

4. Intervention inventory

These are the psychotherapist's own interventions with a client who is considering, attending or returning from a water or dry fasting retreat. None of them involves advising on how to fast. Unless a source is tagged, the procedures are [synthesis] built on the clinical sources cited.

4.1 Routine, non-judgemental asking and recording

Purpose / when: at intake and at review, with every client. Fasting plans often come up indirectly ("I'm going on a retreat", "I'm doing a reset").
Steps: (1) Include diet, fasting, cleanses and complementary practices in your standard intake questions. (2) If fasting comes up, ask what kind (water-only, dry, juice or modified, religious), where it will happen, who supervises and what their qualifications are, and whether the client's doctor knows. (3) Write down the facts and the client's own words, without judgemental language. (4) Note any current medicines and medical conditions the client mentions, so you can suggest they check with their prescriber. Do not interpret these yourself.
Example language (illustrative): "Lots of people try fasts or retreats. Is anything like that part of your plans this year?" "Will it be water only, or without water too? Who looks after you while you're there?"
Watch for: vagueness about supervision ("the host has done it many times"), a plan to fast without water, fasting at home following online instructions, or secrecy from family and doctor. It is working when the client brings up later plans with you on their own initiative.

4.2 Exploring meaning, hopes, expectations and explanatory model

Purpose / when: once a plan has been disclosed. People choose fasting for many reasons. Knowing the client's reasons shows you the risk and the therapeutic opportunity.
Steps: (1) Ask what draws them: control, hope after a chronic illness, distrust of medicine, a spiritual or purifying meaning, identity, a community or influencer, weight or appearance. (2) Draw out their explanatory model: how they think fasting will work and what they expect to feel. Name the retreat's ideas as theirs (for example, a "healing crisis" or toxins leaving). (3) Ask what a good outcome would be and how they would know. (4) Ask what happens if it does not work. (5) Reflect back the values underneath, such as wanting to feel in charge of their body or wanting to be well for their family.
Example language (illustrative): "What are you hoping will be different afterwards?" "The retreat talks about the body healing itself. What does that mean to you?" "If you came home feeling no different, what would that be like?"
Watch for: fasting framed as punishment, purification after eating, or a way to undo food; hopelessness after medical care (one published memoir describes considering assisted suicide before travelling to a dry-fasting programme [source: Library Journal review]); all-or-nothing beliefs. It is working when the client can tell their hopes apart from the retreat's promises.

4.3 Eating-disorder awareness and screening

Purpose / when: for every client who mentions a fasting retreat. Anorexia nervosa and other eating disorders are listed as absolute contraindications to fasting therapy [source: Wilhelmi de Toledo et al. 2013]. Fasting retreats can also attract, mask or set off restrictive and orthorexic patterns.
Steps: (1) Ask about current and past eating difficulties, weight changes, compensatory behaviours, and how the person feels about breaking food rules. (2) Listen for orthorexic features as Beat describes them: cutting out foods or food groups seen as unhealthy; preoccupation that affects relationships or work; judging other people's food; feeling unable to break one's own rules; guilt, anxiety or feeling "unclean" after "unhealthy" food; low mood or poor concentration; physical signs of poor nutrition such as weakness, fatigue or feeling cold [source: Beat, quoted in Irish News 2022]. Remember that a very healthy diet alone does not mean orthorexia [same source]. (3) Use your service's validated eating-disorder screen if it has one. Do not adapt its items. (4) If you suspect an eating disorder, share your concern openly. Ask the client to see their GP for a physical assessment and refer to a specialist eating-disorder service. Beat says early specialist treatment gives the best chance of recovery [same source]. (5) Do not discuss fasting lengths, weights or food amounts with the client, even to reassure them.
Example language (illustrative): "Some people find that a fast is a relief from difficult feelings about food. Does any of that fit for you?" "I'm noticing how strict the rules have become and how anxious you feel when you break them. I'd like us to look at that together, and I'd like your GP to check you over."
Watch for: repeated retreats, fasting after binge episodes, rapid weight loss, hiding food behaviour, fasting promoted by pro-restriction online communities, and the period after a retreat, when rules can tighten. It is working when the client can talk about food rules openly and accepts a medical check.

4.4 Medical-risk awareness and coordination with the doctor or pharmacist

Purpose / when: before any fast the client still plans to do, and whenever a client mentions medicines or medical conditions.
Steps: (1) Tell the client that fasting carries medical risks that only a doctor can assess, and that many medicines need a prescriber's review before fasting. The consensus names antihypertensives (especially beta-blockers and diuretics), antidiabetics, anticoagulants, psychotropics, anticonvulsants, corticosteroids, NSAIDs and contraceptives [source: Wilhelmi de Toledo et al. 2013]. (2) Never advise starting, stopping or changing a medicine. Route every such question to the prescriber or pharmacist. (3) Ask for consent to contact the GP or physician. Share only what is needed: the plan to fast, the setting, and any mental-health concerns relevant to fitness to fast (eating disorder, psychosis, addiction). The consensus lists psychotic disorders and addictions as relative contraindications that need an experienced physician [source: Wilhelmi de Toledo et al. 2013]. (4) Record the consent and what you shared. (5) If the client takes psychiatric medication, ask them to talk to the prescriber about the fast before going.
Example language (illustrative): "I can't advise you on your tablets, but fasting can change how some medicines work. Would you be willing to ask Dr X before you go, or let me write to them?"
Watch for: a retreat that tells clients to stop medicines without their prescriber's involvement, or a client who hides the fast from their doctor. It is working when the client's doctor knows and has assessed them.

4.5 Supporting an informed, values-based decision

Purpose / when: when the client is undecided or asks your view.
Steps: (1) Say plainly that you will not recommend for or against it, and that you want them to decide with full information. (2) Help them write down what they want from the retreat, what they have read, what is claimed and by whom, and what their doctor has said. (3) Suggest questions to put to the retreat: who supervises and what their licence is; what pre-fast assessment is done; how staff decide to stop a fast; what happens in an emergency; how refeeding is managed; whether people with eating disorders are excluded. These follow the elements TrueNorth and the consensus describe [source: Goldhamer; Wilhelmi de Toledo et al. 2013]. (4) Name dry fasting clearly as the option clinicians warn against [source: Cleveland Clinic 2024; 1News 2020]. (5) Check the decision against the client's values, not yours. (6) No published decision aid for fasting retreats is cited here [uncertain: not verified]. Use a general values exercise instead.
Example language (illustrative): "My job isn't to talk you into or out of this. It's to help you make the choice you'd stand by whatever happens. What would you need to know about the people looking after you?"
Watch for: pressure from others (partner, group, influencer), deadlines ("spaces close Friday"), or paying in advance before getting medical advice. It is working when the client can say the risks and their reasons in their own words.

4.6 Recognising and responding to acute risk

Purpose / when: when a client is fasting now, has just finished, or is restarting food, especially without medical supervision or after any dry fast.
Steps: (1) Know the warning signs the clinical sources name. Refeeding syndrome can follow restarting food after starvation or fasting. Its features include low phosphate, potassium and magnesium, thiamine deficiency, and fluid and sodium retention. It can lead to arrhythmias, heart failure, cardiac arrest, respiratory failure, confusion, seizures, weakness, coma, Wernicke–Korsakoff syndrome and death. Problems typically start within the first few days of refeeding. The guideline advises suspecting it in anyone who deteriorates after feeding begins [source: NHS Highland TAM refeeding guideline]. Electrolyte disturbance, including hyponatraemia, and circulatory problems appear among fasting adverse effects [source: Wilhelmi de Toledo et al. 2013]. Water intoxication from excessive, uncontrolled water intake can be fatal [source: Myers & Goldhamer 2017]. Dehydration and kidney problems are the main risks of dry fasting [source: Cleveland Clinic 2024; 1News 2020]. (2) If a client in session reports or shows confusion, fainting, chest pain or palpitations, breathlessness, seizures, marked weakness, very little urine, or deterioration after restarting food, stop the session's agenda and direct them to urgent medical care (emergency services if severe). Do not offer food or fluid advice. (3) If they are at a retreat, encourage them to tell the medical supervisor now, and to seek independent emergency care if there is none. (4) Record what you saw and did.
Example language (illustrative): "What you're describing needs a doctor today, not next week. Can we call now, together?"
Watch for: staff reframing alarming symptoms as a "healing crisis" or "detox" without medical assessment, or the client minimising symptoms. TrueNorth itself says baseline tests are needed to tell a healing crisis from physiological compromise [source: Goldhamer]. It is working when the client gets medical assessment promptly.

4.7 Children, pregnancy and dependants

Purpose / when: when a client plans to bring a child to a retreat, to make a child fast, or is pregnant or breastfeeding.
Steps: (1) Note that pregnancy and nursing are absolute contraindications in the fasting-therapy consensus. That document does not address children at all [source: Wilhelmi de Toledo et al. 2013]. (2) Encourage a pregnant or breastfeeding client to discuss any fasting plan with her midwife or obstetrician first. (3) If a child is being deprived of adequate food or fluids, or of medical care, follow your local safeguarding procedure. Consult your safeguarding lead and refer to children's services. (4) Where an older child is involved, take into account their own views (assent) and their capacity to consent, as well as the parent's. (5) Record your reasoning. Never name the child outside the necessary safeguarding channels. [synthesis]
Example language (illustrative): "I can hear how much you believe this helps. With children, I have a duty to make sure they get enough to eat and drink and see a doctor when they need to, so I need to talk with you about that."
Watch for: children copying a parent's restrictive eating, dry fasting in any minor, or a teenager encouraged online to fast. It is working when the child's GP is involved and the child is safe.

4.8 Commerce, influencers and group pressure

Purpose / when: when the decision is shaped by marketing, an online following, tiered programmes or a group.
Steps: (1) Ask how they found the retreat, what it costs, and whether there are follow-on packages, coaching or product sales. (2) Explore the influence of social media: dry fasting spreads on Instagram, often from people without medical training [source: 1News 2020]. (3) Look for high-control features: discouraging contact with family or doctors, shaming people who stop, framing symptoms as personal failure or "toxins", testimonials in place of information. (4) Support the client to step back without loss of face. (5) Keep your own boundaries: no referral fees, no co-hosting, no selling courses or products to clients. [synthesis]
Example language (illustrative): "What would happen with the group if you decided to stop early, or not to go?"
Watch for: debt, repeated paid fasts, isolation from people who question it. It is working when the client can talk about doubts without feeling disloyal.

4.9 Health anxiety and somatic symptom presentations

Purpose / when: when fasting is driven by persistent worry about illness, unexplained bodily symptoms, "toxins", or idiopathic environmental intolerance.
Steps: (1) Acknowledge that the symptoms are real and distressing. (2) Assess for health anxiety or somatic symptom disorder, using the established cognitive-behavioural formulation and treatment. Cross-refer to Domain II for protocols. (3) Map the cycle: worry, body checking, searching online, a cleanse or fast, short-lived relief, the next worry. (4) Work with the client on what they could do instead of fasting to get control and relief, with medical review as the base. [synthesis]
Example language (illustrative): "It sounds like each fast gives you a few days of feeling in charge, then the worry comes back. Shall we look at that pattern together?"
Watch for: more and more repeated fasts, avoiding medical tests, or fasting as reassurance seeking. It is working when the client's worry and urge to fast decrease without a fast.

4.10 Post-retreat debrief

Purpose / when: after any retreat, especially during refeeding and the return home.
Steps: (1) Ask how it went physically and emotionally, and whether a medical team guided the restart of eating. (2) Check for red flags (see 4.6) and for disordered eating that has started or got worse (see 4.3). (3) Explore the meaning of the experience. Some people describe clarity or spiritual experiences; attribute these to the client's own account without endorsing them as effects of the fast. (4) Watch for disappointment, shame or a drive to "do it properly" next time. (5) Look at lasting changes the client values (sleep, activity, relationship with food) and what support they need. [synthesis]
Example language (illustrative): "What was the hardest part, and what was the part you'd want to keep?"
Watch for: rigid new food rules, plans for a longer or dry fast, low mood. It is working when the client integrates the experience flexibly.

4.11 Reporting routes

Purpose / when: when you learn of serious harm, dangerous claims, or unsafe practice.
Steps: (1) Immediate danger to anyone: emergency services. (2) A child or an adult at risk: your safeguarding lead and the local children's or adult safeguarding service. (3) A licensed health professional practising unsafely (for example a doctor, chiropractor or osteopath supervising fasts): their licensing board or regulator. (4) Misleading health claims in advertising: the advertising regulator (for example the Advertising Standards Authority in the UK, the Federal Trade Commission in the US). Consumer fraud: the consumer protection body. (5) Do this with the client's consent unless safeguarding or legal duty overrides confidentiality, and record it. [synthesis] [uncertain: specific regulator positions on fasting retreats not verified]
Example language (illustrative): "What happened to you shouldn't happen to others. Would you like to think about reporting it? I can help with that."
Watch for: fear of the group, embarrassment, or not wanting to get the retreat in trouble.

5. Handling problems

[synthesis throughout unless a source is given]

The client wants your endorsement or your opinion. Say you neither recommend nor rule it out, and that you want them to be safe. Then move to their questions for a doctor (4.4, 4.5).
The client is determined to go and hides it from their doctor. Respect autonomy. Keep the alliance, explore what they fear from the doctor, and offer to help them have the conversation. Agree on which warning signs mean they will seek help (4.6).
Resistance and distrust of medicine. Validate the experiences behind it, such as dismissal or treatments that failed. Do not argue about fasting science. Focus on what the client would need to stay safe and how they would know if something was wrong.
The client describes a "healing crisis" while unwell. The sources themselves say a baseline assessment is needed to tell a healing crisis from physiological compromise [source: Goldhamer]. Use the client's own framework to urge medical assessment now.
Suspected eating disorder that the client denies. Share your concern without arguing. Stay curious about food rules. Ask for a GP physical check. Use your service's eating-disorder pathway and discuss in supervision. Avoid any conversation that compares amounts or durations.
Overwhelm or grief after a failed fast, especially when a chronic illness persists. Normalise the disappointment. Explore regret and self-blame, and move gently towards medical care and the client's other values. Psycho-oncology or chronic illness clinicians may be involved; coordinate with consent.
Rupture: the client feels judged. Name it, apologise for anything that came across as dismissive, and repeat that your role is to help them decide, not to decide for them.
Non-adherence to medical advice after the retreat. Explore what makes the advice hard to follow, coordinate with the doctor, and avoid a power struggle.
Religious fasting overlaps with a retreat plan. Separate the two. Respect the religious meaning and draw on the tradition's own exemptions for illness, pregnancy and children. Cross-refer to Domain XIII.
Your own reactions, such as alarm, contempt or fascination. Bring them to supervision. Don't let them drive pressure on the client.
Dry fasting in particular. Clinicians quoted in the sources advise against it [source: Cleveland Clinic 2024; 1News 2020]. Be explicit that this is the higher-risk option and that kidney problems and dehydration are the main concerns. Ask the client to talk to their doctor before attempting it.

Harm account

What was actually done

Unsupervised total fasting inspired by "breatharian" teaching (Switzerland, reported April 2012). A woman in her early fifties in eastern Switzerland had watched the 2010 Swiss documentary In the Beginning There Was Light, about men who claimed to live without food, and had read a book by Ellen Greve, known as Jasmuheen. She first went without both food and fluids, going as far as spitting out her saliva. She then drank again but took no food, and grew visibly weaker. She told her worried children she would stop if her condition became critical. She was found dead at home; the autopsy found starvation and no other contributing cause [source: The Local, 2012]. The practice was carried out alone, with no medical assessment, and her own judgement was the only stopping rule.
Dry fasting promoted on social media (2020). Promoters on Instagram presented fasting without any water as a lifestyle with mind and body benefits, to large followings. Doctors called the claims unfounded and warned about the kidneys and about impressionable people seeking quick fixes [source: 1News, 2020].
Residential dry-fasting programmes. A Siberian programme overseen by Sergey Filonov used progressively longer fasts without food or water, and participants continued the practice on their own afterwards. A published memoir presents this as recovery from chronic illness. A reviewer warned that the protocols are dangerous and must not be tried without medical supervision [source: Library Journal review]. Filonov's own book adds rules on enemas and on breaking the fast [source: Filonov book description]. These are described here only qualitatively.
Water-only fasting in supervised settings. In TrueNorth's own chart review of 768 supervised fasting visits, most adverse events were mild to moderate. The most serious grade recorded at any single visit was grade 3 in 212 visits and grade 4 in one, and two visits involved a serious adverse event [source: Finnell et al. 2018]. TrueNorth's authors warn that excessive, uncontrolled water intake can cause fatal water intoxication [source: Myers & Goldhamer 2017].
Further deaths reported in the news. Press reports from Nigeria and India describe deaths after prolonged dry or total fasts, mostly in religious settings (see Domain XIII) [uncertain: not verified].

How it caused harm

Starvation. Prolonged absence of food leads to weakness and death; in the Swiss case the autopsy found starvation as the cause of death [source: The Local, 2012].
Dehydration. With no fluids, dehydration follows, with kidney, urinary and other organ effects; this is the main risk clinicians cite for dry fasting [source: Cleveland Clinic 2024; 1News 2020].
Refeeding syndrome. When food is restarted after starvation or fasting, insulin drives phosphate, potassium and magnesium into cells and thiamine is used up quickly. The results can include arrhythmia, heart failure, respiratory failure, seizures, coma, Wernicke–Korsakoff syndrome and death. People at highest risk include those with very low body weight, recent unintentional weight loss, prolonged little or no intake, low electrolytes before refeeding, alcohol misuse, anorexia nervosa or insulin-dependent diabetes, and those taking certain medicines [source: NHS Highland TAM refeeding guideline].
Electrolyte disturbance and water intoxication. Hyponatraemia, circulatory dysregulation, hypoglycaemia, arrhythmias and fainting appear in the fasting-therapy consensus as adverse effects and reasons to stop a fast [source: Wilhelmi de Toledo et al. 2013]. Uncontrolled water intake can be fatal [source: Myers & Goldhamer 2017].
Medicine interactions. Medicines whose effects change during fasting, such as antidiabetics, antihypertensives, diuretics, anticoagulants, psychotropics and anticonvulsants, can become dangerous without a prescriber's review [source: Wilhelmi de Toledo et al. 2013].
Psychological harms. Fasting can reinforce or mask eating disorders, which the consensus treats as an absolute contraindication [source: Wilhelmi de Toledo et al. 2013]. It can also feed orthorexic rules and the shame of breaking them [source: Beat, via Irish News 2022]. Other psychological harms include delayed medical care, hopelessness when the hoped-for result fails, and financial or group pressure [synthesis].
Who is most at risk. People with eating disorders or low body weight, people who are pregnant or breastfeeding, children, people with kidney, heart or liver disease, diabetes, psychosis or addiction, people on the medicines above, people fasting alone or following online instructions, and anyone dry fasting [synthesis from the sources above].

Recognising it today

Phrases and rationales: "living on light" or "pranic nourishment"; "dry fasting is more powerful than water fasting"; "healing crisis" used to explain away alarming symptoms; "detox" or "the body heals itself" presented as a reason to avoid medical care; fasting sold as a cure for a named disease. [source: The Local 2012; 1News 2020; Filonov book description; synthesis]
Red flags in a retreat or practitioner: no licensed clinician on site; no pre-fast history, examination or laboratory tests; no emergency plan; no exclusion of eating disorders, pregnancy or children; telling guests to stop medicines; refeeding left to the guest; encouragement to keep fasting at home afterwards; isolation from family; upfront payment for tiered programmes; testimonials instead of information. [synthesis, contrasted with the safeguards in Goldhamer and Wilhelmi de Toledo et al. 2013]
Red flags in a colleague: a therapist recommending, selling, hosting or earning referral fees from fasting retreats; advising on fast lengths or medicines; treating fasting as therapy for an eating disorder. [synthesis]
How the more careful versions differ. Published water-fasting and fasting-therapy models include a medical assessment before the fast, licensed supervisors, ongoing monitoring, staff-led decisions to stop, managed refeeding, and contraindications that include eating disorders and pregnancy [source: Goldhamer; Wilhelmi de Toledo et al. 2013]. These features reduce but do not remove risk, and they do not make fasting a treatment for disease. For dry fasting, comparable published safeguards are not established [uncertain: not verified].

What to do instead and how to help those harmed

Safer alternatives (for the client to discuss with their doctor or dietitian): medically guided nutrition and lifestyle change. Cleveland Clinic's dietitian notes that any benefits people seek from fasting can be pursued more safely in other ways than dry fasting [source: Cleveland Clinic 2024]. For health anxiety or somatic presentations, use established psychological treatment (Domain II). For eating disorders, refer for specialist treatment early [source: Beat, via Irish News 2022].
Assessing someone who has been harmed: a medical review first if they are still fasting or refeeding (4.6). Then screen for eating disorders, depression, health anxiety, trauma from a medical emergency, and financial and relationship consequences. [synthesis]
Treatment considerations: non-blaming exploration of why the choice made sense at the time; work on shame and regret; rebuilding trust in medical care at the client's pace; eating-disorder-informed care where indicated; support for families, including bereaved families, who may feel anger, guilt or conflict with the group. [synthesis]
Ethical, reporting and legal duties: safeguarding referral when children or adults at risk are deprived of food, fluids or medical care; reporting licensed professionals to their regulator; reporting misleading advertising to the advertising or consumer regulator; documenting your concerns and actions; keeping clear of any commercial link with retreats (see 4.11). [synthesis] [uncertain: professional ethics-code wording not verified]

Sources

Web sources:

Books cited [uncertain: contents known from publisher description and review]: Filonov S. (2019). 20 Questions & Answers About Dry Fasting. Siberika Books. Starving to Heal in Siberia (2022). Greenleaf.

Not verified: news reports of deaths after dry or religious fasts in Nigeria and India [uncertain: not verified]; national regulator positions on fasting retreats [uncertain: not verified]; professional ethics codes [uncertain: not verified].

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