{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T14:53:43Z","timestamp":1788533623926,"version":"build-2803163510"},"reference-count":45,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2024,11,20]],"date-time":"2024-11-20T00:00:00Z","timestamp":1732060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Objective: This single-arm, pre\u2013post interventional trial (clinicaltrials.gov, NCT04515095) investigates the safety, feasibility, and potential effectiveness of prolonged water-only fasting followed by a whole-plant-food diet in the long-term management of hypertension and other cardiometabolic disorders. Methods: Safety was assessed based on adverse events (AEs) that were recorded according to Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Feasibility was assessed based on retention rate, ability to complete minimal fast length, and intervention acceptability. Twenty-nine participants with stage 1 and 2 hypertension and without type 2 diabetes were enrolled from a residential fasting center. Results: Study retention was 100% at the end of the refeed and 93% at the six-week follow-up visit. Median (range) fasting and refeeding duration were 11 (7\u201340) and 5 (3\u201317) days, respectively, and 90% of participants were able to complete at least 7 days of fasting. The majority of AEs were mild (grade 1) and transient and there were no higher-grade or serious AEs. At the end of the intervention, median systolic\/diastolic blood pressure had normalized to below 130\/80 mmHg, body weight reduced by &gt;5%, and anti-hypertensive medication was completely discontinued. These results were sustained for at least six weeks and potentially up to one year. Conclusions: Our data suggest that the intervention may be a feasible, well-tolerated, low-risk option for lowering and managing high blood pressure, excess body weight, and other cardiometabolic disorders in people with stage 1 and 2 hypertension.<\/jats:p>","DOI":"10.3390\/nu16223959","type":"journal-article","created":{"date-parts":[[2024,11,20]],"date-time":"2024-11-20T03:57:04Z","timestamp":1732075024000},"page":"3959","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Prolonged Water-Only Fasting Followed by a Whole-Plant-Food Diet Is a Potential Long-Term Management Strategy for Hypertension and Obesity"],"prefix":"10.3390","volume":"16","author":[{"given":"Evelyn","family":"Zeiler","sequence":"first","affiliation":[{"name":"TrueNorth Health Foundation, Santa Rosa, CA 95404, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahmla","family":"Gabriel","sequence":"additional","affiliation":[{"name":"TrueNorth Health Foundation, Santa Rosa, CA 95404, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mackson","family":"Ncube","sequence":"additional","affiliation":[{"name":"TrueNorth Health Foundation, Santa Rosa, CA 95404, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Thompson","sequence":"additional","affiliation":[{"name":"TrueNorth Health Foundation, Santa Rosa, CA 95404, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8666-0728","authenticated-orcid":false,"given":"Daniel","family":"Newmire","sequence":"additional","affiliation":[{"name":"School of Health Promotion and Kinesiology, Texas Women\u2019s University, Denton, TX 76204, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2928-3924","authenticated-orcid":false,"given":"Eugene L.","family":"Scharf","sequence":"additional","affiliation":[{"name":"Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4120-3694","authenticated-orcid":false,"given":"Alan C.","family":"Goldhamer","sequence":"additional","affiliation":[{"name":"TrueNorth Health Center, Santa Rosa, CA 95404, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8328-7366","authenticated-orcid":false,"given":"Toshia R.","family":"Myers","sequence":"additional","affiliation":[{"name":"TrueNorth Health Foundation, Santa Rosa, CA 95404, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,20]]},"reference":[{"key":"ref_1","unstructured":"Ostchega, Y., Fryar, C.D., Nwankwo, T., and Nguyen, D.T. (2020). Hypertension Prevalence Among Adults Aged 18 and Over: United States, 2017\u20132018, NCHS Data Brief."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1002\/clc.23303","article-title":"Hypertension in older adults: Assessment, management, and challenges","volume":"43","author":"Oliveros","year":"2020","journal-title":"Clin. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1161\/01.CIR.103.9.1245","article-title":"Does the relation of blood pressure to coronary heart disease risk change with aging? The Framingham Heart Study","volume":"103","author":"Franklin","year":"2001","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e008731","DOI":"10.1161\/JAHA.118.008731","article-title":"Trends in Healthcare Expenditures Among US Adults with Hypertension: National Estimates, 2003\u20132014","volume":"7","author":"Kirkland","year":"2018","journal-title":"J. Am. Hear. Assoc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e127","DOI":"10.1016\/j.jacc.2017.11.006","article-title":"2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"71","author":"Whelton","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"100044","DOI":"10.1016\/j.ijchy.2020.100044","article-title":"Prevalence and control rates of hypertension in the USA: 2017\u20132018","volume":"6","author":"Chobufo","year":"2020","journal-title":"Int. J. Cardiol. Hypertens."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"n189","DOI":"10.1136\/bmj.n189","article-title":"investigators, Association between antihypertensive treatment and adverse events: Systematic review and meta-analysis","volume":"372","author":"Albasri","year":"2021","journal-title":"BMJ"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e017723","DOI":"10.1136\/bmjopen-2017-017723","article-title":"Effectiveness of blood pressure-lowering drug treatment by levels of absolute risk: Post hoc analysis of the Australian National Blood Pressure Study","volume":"8","author":"Ho","year":"2018","journal-title":"BMJ Open"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e254","DOI":"10.1161\/CIR.0000000000000950","article-title":"Heart Disease and Stroke Statistics-2021 Update: A Report from the American Heart Association","volume":"143","author":"Virani","year":"2021","journal-title":"Circulation"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1161\/CIR.0b013e3181e8edf1","article-title":"American Heart Association Prevention Committee of the Council on Cardiovascular, Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults: A scientific statement from the American Heart Association","volume":"122","author":"Artinian","year":"2010","journal-title":"Circulation"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2181","DOI":"10.1111\/jocn.16033","article-title":"Adherence to lifestyle modifications and its associated factors in hypertensive patients","volume":"31","author":"Dhakal","year":"2022","journal-title":"J. Clin. Nurs."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1067\/mmt.2001.115263","article-title":"Medically supervised water-only fasting in the treatment of hypertension","volume":"24","author":"Goldhamer","year":"2001","journal-title":"J. Manip. Physiol. Ther."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1089\/107555302320825165","article-title":"Medically supervised water-only fasting in the treatment of borderline hypertension","volume":"8","author":"Goldhamer","year":"2002","journal-title":"J. Altern. Complement. Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Finnell, J.S., Saul, B.C., Goldhamer, A.C., and Myers, T.R. (2018). Is fasting safe? A chart review of adverse events during medically supervised, water-only fasting. BMC Complement. Altern. Med., 18.","DOI":"10.1186\/s12906-018-2136-6"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Gabriel, S., Ncube, M., Zeiler, E., Thompson, N., Karlsen, M.C., Goldman, D.M., Glavas, Z., Beauchesne, A., Scharf, E., and Goldhamer, A.C. (2022). A Six-Week Follow-Up Study on the Sustained Effects of Prolonged Water-Only Fasting and Refeeding on Markers of Cardiometabolic Risk. Nutrients, 14.","DOI":"10.3390\/nu14204313"},{"key":"ref_16","first-page":"e24689","article-title":"Potential Effects of Prolonged Water-Only Fasting Followed by a Whole-Plant-Food Diet on Salty and Sweet Taste Sensitivity and Perceived Intensity, Food Liking, and Dietary Intake","volume":"14","author":"Myers","year":"2022","journal-title":"Cureus"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1080\/16506073.2015.1053407","article-title":"The Treatment Acceptability\/Adherence Scale: Moving Beyond the Assessment of Treatment Effectiveness","volume":"44","author":"Milosevic","year":"2015","journal-title":"Cogn. Behav. Ther."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Fruge, A.D., Smith, K.S., Riviere, A.J., Demark-Wahnefried, W., Arthur, A.E., Murrah, W.M., Morrow, C.D., Arnold, R.D., and Braxton-Lloyd, K. (2019). Primary Outcomes of a Randomized Controlled Crossover Trial to Explore the Effects of a High Chlorophyll Dietary Intervention to Reduce Colon Cancer Risk in Adults: The Meat and Three Greens (M3G) Feasibility Trial. Nutrients, 11.","DOI":"10.3390\/nu11102349"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2014A metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J. Biomed. Inform."},{"key":"ref_20","unstructured":"NIH (2024, October 21). Common Terminology Criteria for Adverse Events (CTCAE), Available online: https:\/\/ctep.cancer.gov\/protocoldevelopment\/electronic_applications\/ctc.htm."},{"key":"ref_21","unstructured":"Team, R.C. (2022). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v082.i13","article-title":"lmerTest Package: Tests in Linear Mixed Effects Models","volume":"82","author":"Kuznetsova","year":"2017","journal-title":"J. Stat. Softw."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v067.i01","article-title":"Fitting Linear Mixed-Effects Models Using lme4","volume":"67","author":"Bates","year":"2015","journal-title":"J. Stat. Softw."},{"key":"ref_24","unstructured":"Bolker, B., Robinson, D., Menne, D., Gabry, J., Buerkner, P., Hua, C., Petry, W., Wiley, J., Kennedy, P., and Sz\u00f6cs, E. (2024, October 21). broom.mixed: Tidying Methods for Mixed Models. Available online: https:\/\/github.com\/bbolker\/broom.mixed."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Wiley, J.F. (2020). multilevelTools: Multilevel and Mixed Effects Model Diagnostics and Effect Sizes, R Foundation for Statistical Computing.","DOI":"10.32614\/CRAN.package.multilevelTools"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v075.i06","article-title":"robustlmm: An R Package for Robust Estimation of Linear Mixed-Effects Models","volume":"75","author":"Koller","year":"2016","journal-title":"J. Stat. Softw."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Koller, M., and Stahel, W.A. (2023). Robust Estimation of General Linear Mixed Effects Models. Robust and Multivariate Statistical Methods, Springer.","DOI":"10.1007\/978-3-031-22687-8_14"},{"key":"ref_28","unstructured":"L\u00fcdecke, D., Bartel, A., Schwemmer, C., Powell, C., Djalovski, A., and Titz, J. (2023). sjPlot: Data Visualization for Statistics in Social Science, R Package Version 2.8.15, R Foundation for Statistical Computing."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.jclinepi.2003.08.009","article-title":"Subgroup analyses in randomized trials: Risks of subgroup-specific analyses; power and sample size for the interaction test","volume":"57","author":"Brookes","year":"2004","journal-title":"J. Clin. Epidemiol."},{"key":"ref_30","first-page":"291","article-title":"Brief Report: Post Hoc Power, Observed Power, A Priori Power, Retrospective Power, Prospective Power, Achieved Power: Sorting Out Appropriate Uses of Statistical Power Analyses","volume":"1","year":"2010","journal-title":"Commun. Methods Meas."},{"key":"ref_31","unstructured":"Bolger, N.L., and Philippe, J. (2013). Intensive Longitudinal Methods: An Introduction to Diary and Experience Sampling Research, Guilford Press."},{"key":"ref_32","unstructured":"Pinheiro, J., Bates, D., DebRoy, S., Sarkar, D., Heisterkamp, S., Willigen, B.V., Ranke, J., and Team, R.C. (2023). nlme: Linear and Nonlinear Mixed Effects Models, Version 3.1-166, R Foundation for Statistical Computing."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1038\/nrneph.2010.33","article-title":"Metabolic acidosis: Pathophysiology, diagnosis and management","volume":"6","author":"Kraut","year":"2010","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Dai, Z., Zhang, H., Wu, F., Chen, Y., Yang, C., Wang, H., Sui, X., Guo, Y., Xin, B., and Guo, Z. (2022). Effects of 10-Day Complete Fasting on Physiological Homeostasis, Nutrition and Health Markers in Male Adults. Nutrients, 14.","DOI":"10.3390\/nu14183860"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1016\/j.stem.2014.04.014","article-title":"Prolonged fasting reduces IGF-1\/PKA to promote hematopoietic-stem-cell-based regeneration and reverse immunosuppression","volume":"14","author":"Cheng","year":"2014","journal-title":"Cell Stem Cell"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"21649561211031178","DOI":"10.1177\/21649561211031178","article-title":"Is Water-Only Fasting Safe?","volume":"10","author":"Pilis","year":"2021","journal-title":"Glob. Adv. Integr. Med. Health"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1970","DOI":"10.1038\/s41467-021-22097-0","article-title":"Fasting alters the gut microbiome reducing blood pressure and body weight in metabolic syndrome patients","volume":"12","author":"Maifeld","year":"2021","journal-title":"Nat. Commun."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1690","DOI":"10.1002\/jcsm.12766","article-title":"Is muscle and protein loss relevant in long-term fasting in healthy men? A prospective trial on physiological adaptations","volume":"12","author":"Laurens","year":"2021","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1007\/s13679-021-00424-2","article-title":"Time-Restricted Eating, Intermittent Fasting, and Fasting-Mimicking Diets in Weight Loss","volume":"10","author":"Fanti","year":"2021","journal-title":"Curr. Obes. Rep."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2150132720940519","DOI":"10.1177\/2150132720940519","article-title":"Twenty-Four-Hour Ambulatory Blood Pressure Monitoring","volume":"11","author":"Nugent","year":"2020","journal-title":"J. Prim. Care Community Health"},{"key":"ref_41","first-page":"459","article-title":"Increasing complexity: Which drug class to choose for treatment of hypertension in the elderly?","volume":"2014","author":"Kaiser","year":"2014","journal-title":"Clin. Interv. Aging"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40885-018-0104-6","article-title":"Adverse effects and non-adherence to antihypertensive medications in University of Gondar Comprehensive Specialized Hospital","volume":"25","author":"Gebreyohannes","year":"2019","journal-title":"Clin. Hypertens."},{"key":"ref_43","unstructured":"LabCorp (2024, October 21). Blood Specimens: Chemistry and Hematology. Available online: https:\/\/www.labcorp.com\/test-menu\/resources."},{"key":"ref_44","unstructured":"(2024, October 21). ICD10 Data. Available online: https:\/\/icd.who.int\/browse10\/2019\/en."},{"key":"ref_45","unstructured":"Weir, C.B., and Jan, A. (2023). BMI Classification Percentile and Cut Off Points, StatPearls."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/22\/3959\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:35:33Z","timestamp":1760114133000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/22\/3959"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,20]]},"references-count":45,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["nu16223959"],"URL":"https:\/\/doi.org\/10.3390\/nu16223959","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,20]]}}}