March 23, 2010

Fasting and Science

Does fasting flush away toxins and detox the whole body? Is fasting the most ancient, practical and effectice method for a whole physical detox (and its not only free, but saves you money)? What are the effects of Orthodox Christian fasting on serum lipids and obesity?

Although the scientific/physical benefits of Orthodox Christian fasting is not the greatest benefit or reason for doing so, its still a proven fact that being Orthodox lowers your cholesterol, risk for heart disease & cancer, boosts immunity, resets the bodies internal and external functions to default, energizes the organs and lowers chance of depression, stress and mental health. But the greatest benefits of fasting are spiritual, for by cutting off and cutting down certain things that go in the mouth and belly, we gain self-control and are stronger, more determined and we struggle against the sinful passions of the flesh better. We can control our thoughts, anger, and what comes OUT OF OUR MOUTH much better. Meat inflames the passions of the flesh, so we cut meat consumption during the fasting period (while monks and some others cut it out completely). Fasting tempers our will, teaches us patience, humility, obedience and many virtues lost in todays twisted society which has abandoned and rejected this great ancient Sacred Tradition Christ Himself established and taught. Also fasting teaches us to use the minimal of the earths resources, so that we don’t overspend and overconsume in this materialistic consermerist world, and this gives us the chance to give more alms to the needy and share.

After all, the point of fasting is to improve one’s inner spiritual condition and help them pray and be in communion with God. Oddly enough, those who through God’s grace have become masters of their own bodies, thus having detached the physical desires of the flesh (food, clothing, and material goods – becoming the master of their own body, rather than the body becoming master of the person) experience deep joy, lasting peace, stronger faith, and a deep sense of purpose and direction. The bottom line is that our interest in the condition of our soul should be our primary concern. The spiritual exercise of fasting is the first step in the direction of placing our internal life first. Discipline is the fist step to freedom, and finding out that less truly is more is one of life’s key lessons. Why, if 24 million Americans are willing to try the most recent fad, the Atkins Diet, in order to improve their lives, why shouldn’t they be willing to try a 2,000 year-old resolution: fasting Christian style. So we see that apart from being a spiritual discipline, fasting is also very healthy. Everyone should avoid meat and dairy products two days per week, in order to help keep animal fats and related cholesterol problems under control.

Contemporary physicians are making no great discovery of what the Church has known for thousands of years. The original commandment that God gave to our ancestors Adam and Eve in the Garden of Eden was a fasting commandment: "Eat of the fruit of all the trees but this one.” If the fall of mankind and the loss of paradise were the result of breaking a fasting commandment, we should probably not ignore the fasts. Yes, fasting is the most ancient Tradition and command, given to our forefathers Adam and Eve, when they were told to simply not eat the fruit of only ONE tree in all of Paradise (the Garden of Eden). What was the outcome? Its called the ancestral sin and fall of mankind!

Orthodox Christians fast for a total of about 180 days a year. This is an ancient tradition done from the time of the Apostles and Apostolic and Early Fathers of the Church Christ founded, which still exists and is practiced today. Fasting is an essential aspect of practicing the Orthodox Christian spiritual, ascetical and mystical life. You cannot be Christian and not fast. Unfortunately, many in the Church today do not participate in this grace-bestowing and life-giving ascetic practice. They do this to the loss of their own spiritual and bodily health.

St. Nektarios the Miracleworker of Aegina & Pentapolis (1846-1920), on Fasting:

“Fasting is an ordinance of the Church, obliging the Christian to observe it on specific days. Concerning fasting, our Savior teaches: 'When thou fastest, anoint thine head, and wash thy face; that thou appear not unto men to fast, but unto thy Father Who is in secret: and thy Father, Who seeth in secret, shall reward thee openly.' From what the Savior teaches we learn (a) that fasting is pleasing to God, and (b) that he who fasts for the uplifting of his mind and heart towards God shall be rewarded by God, Who is a most liberal bestower of Divine gifts, for his devotion. In the New Testament fasting is recommended as a means of preparing the mind and the heart for divine worship, for long prayer, for rising from the earthly, and for spiritualization.”

Fasting and Science

Following the fasting regimes laid down by the Orthodox Church could reduce your chances of suffering from heart disease. So says a recent article in BMC Public Health. A group of researchers from the University of Crete found that Orthodox Christians who avoided specified foods three times a year had lower levels of cholesterol and lower levels of the cholesterol-binding proteins called low density lipoproteins (LDL) in their blood after 'fasting', compared with other Christians who did not follow the fasting regimes. The levels of other cholesterol-binding proteins called high-density lipoproteins (HDL) did not change.

"The Orthodox Christians' diet, which is based on vegetables, legumes, fruit, cereals, bread and olive oil, is a Mediterranean-type of diet with periodic abstinence from meat and other products during the fasting periods", write the authors.

There are three major recognized fasting periods in the Orthodox Church: 40 days before Christmas, 48 days at Easter and 15 days in August for the Dormition. Each of these is associated with a different regime. For example, at Christmas the faithful are advised to avoid meat, eggs and dairy products and eating fish is not allowed on Wednesdays and Fridays.

The Crete study followed 120 Orthodox Christians, half of whom followed the regime to the letter. The researchers measured each of the participants at the beginning and end of each fast period, recording their height and weight, their waist and hip size and the level of cholesterol and lipoproteins in a blood sample.

There is a clear link between high levels of cholesterol and LDL in the blood and heart disease, whereas HDL appears to be protective against heart disease. Orthodox Christian 'fasting' reduced the levels of total cholesterol in the blood by 9% and the levels of LDL by 12%. As the levels of HDL did not change significantly the HDL/LDL ratio increased, which is generally thought to be good for the heart. Unfortunately, these levels rose again as the fasters resumed eating their normal diet, but not to the original levels, showing that regular fasting may give some long-term protection against heart disease.

1. Background

No study to date has focused on the impact of Greek Orthodox Christian fasting on serum lipoproteins and obesity yet.


120 adults were followed longitudinally for one year. Sixty fasted regularly in all fasting periods (fasters) and 60 did not fast at all (controls). The three major fasting periods under study were: Christmas (40 days), Lent (48 days) and Dormition (August, 15 days). A total of 6 measurements were made during one year including pre- and end-fasting blood collection, serum lipoprotein analysis and anthropometric measurements.


Statistically significant end-fasting total and LDL cholesterol differences were found in fasters. Fasters compared to controls presented 12.5% lower end-total cholesterol (p < 0.001) and 1.5% lower end-BMI (p < 0.001). The end- LDL/HDL ratio was lower in fasters (6.5%, p < 0.05) while the change in end- HDL cholesterol in fasters (4.6% decline) was not significant. Similar results were found when the pre- and end-fasting values of fasters were compared. No change was found in control subjects. Conclusions

Adherence to Orthodox fasting periods contributes to a reduction in the blood lipid profile including a non-significant reduction in HDL cholesterol and possible impact on obesity.

2. Background

Fasting, the voluntary abstention from all restricted foods, is a feature of many religions, and the putative health benefits have attracted both scientific and popular interest. Commonly, religious doctrines prescribe foods from animal sources permanently or for particular periods.

There are several religions, such as Hinduism, Buddhism, Judaism, Islam, Seventh-Day-Adventism that have often been studied regarding their relation to health [1-14]. However, the studies on Orthodox Christianity are very limited.

Orthodox Christian holy books recommend a total of 180–200 days of fasting per year. The faithful are advised to avoid olive oil, meat, fish, milk and dairy products every Wednesday and Friday throughout the year. Additionally, there are three principal fasting periods per year: 1) a total of 40 days preceding Christmas (meat, dairy products and eggs are not allowed, while fish and olive oil are allowed except on Wednesdays and Fridays). 2) a period of 48 days preceding Easter (Lent). During Lent fish is allowed only two days whereas meat, dairy products and eggs are not allowed. Olive oil consumption is allowed only at weekends. 3) a total of 15 days in August (the Dormition) when the same dietary rules apply as for Lent with the exception of fish consumption which is allowed only on August 6th. Seafood such as shrimps, squid, cuttlefish, octopus, lobsters, crabs as well as snails are allowed on all fasting days throughout the year. The Orthodox Christian fasting practices can therefore be characterized as requiring a periodic vegetarian diet including fish and seafood.

The variant of vegetarianism followed during fasting periods by Orthodox Christians, with a diet of vegetables, legumes, nuts, fruits, olives, bread, snails and seafood, is a type of the so-called Mediterranean diet [15,16]. To date little is known as to the effects of this 'hidden' element of the traditional Orthodox Christian diet on health and no data exist on the effect of Orthodox Christianity's dietary rules on blood lipid levels and obesity. The objective of this study was therefore to assess the effects of intermittent short-term religious fasting, according to the dietary rules of the Orthodox Christian Church, on blood lipoprotein profile and the prevalence of obesity.


The subjects of this study were selected from an adult population in the region of Heraklion, Crete. One hundred-twenty Orthodox Christians were asked to participate in this study. Sixty individuals (31 males, 29 females), mean age (x ± SD) 41 ± 12 years, fasted regularly according to the dietary rules and the fasting periods of the Christian Orthodox Church. Fasters had been practicing the fasting rituals for a mean of 20 ± 14 years. Another group of sixty subjects (24 males, 36 females), mean age (x ± SD) 38 ± 9 years, were control subjects that did not fast. Among the fasting group, 20 were lay persons (fasted for 13 ± 10 years) and 40 were under religious order (fasted for 23 ± 15 years): 19 nuns living in a convent and 21 priests living with their families in community parishes. The family history of each subject was recorded with regard to diabetes, CHD, smoking, hormonal disturbances and drug intake.

Study design

Three pairs of measurements were made over a 1-year period (2000–2001), coinciding with the beginning and end of each of the three major fasting periods of the Christian Orthodox Church: Christmas, Lent and the Dormition. All measurements were made between 8.00–10.00am and they included fasting blood collection, anthropometric measurements and the completion of questionnaires.


All subjects signed informed consent forms and completed questionnaires on fasting, health habits (coffee and alcohol consumption, smoking), certain items of personal data (marital status, educational level), physical activity, dietary habits (24 h recall, 3-day dietary record). Fasters were defined as those who fasted regularly during all three principal fasting periods, while current smokers as those who smoked at least one cigarette per day.

Anthropometric variables

Body weight was measured all six times by a digital scale (Seca, Hamburg, Germany, Model 770) with an accuracy of ± 100 g. Subjects were weighed barefoot in very light clothing. Standing height was measured once without shoes to the nearest 0.5 cm with the use of a stadiometer with the shoulders in relaxed position and arms hanging freely. Body Mass Index (BMI) was calculated by dividing weight (kg) by height squared (m2). Waist and hip circumferences were measured twice, at the first and sixth measurement of the study [17]. Blood pressure (BP) was measured all six times in the right arm with a traditional sphygmomanometer. Three seated BP measurements were taken for each subject spaced two minutes apart.

Biochemical assays

Serum lipoprotein concentrations were always determined after 12 h of fasting. Blood samples were transferred to the University Hospital of Crete in tanks containing ice packs that maintained the temperature at 3–4°C. Total cholesterol was determined by Allain's method [18], HDL-C was measured by the heparin-manganese precipitation method [19] and triacylglycerols were determined using Fossati's method [20], while LDL-C was calculated as follows: LDL-C = TC - (HDL -C + TG/5) [21]. During the period October 2000 – September 2001 the coefficient of variation for the biochemical analysis of total cholesterol was 2,85%, for HDL was 5,40% and for triacylglycerols was 3,92%. DNA extraction was performed according to the method of Miller et al [22]. Apo E genotype was determined by PCR amplification and subsequent digestion with the restriction enzyme Hha I (New England Biolabs) as described by Reymer et al [23] in Harokopio University of Athens.

Statistical methods

Differences in gender, tobacco use, educational level and apolipoprotein E distribution were compared using χ2 analysis, while differences in age were compared by ANOVA analysis. Regression analysis was used to compare end-fasting lipid concentrations and BMI with age, sex, smoking, educational level, BMI, WHR, fasting and the pre-fasting values. The influence of fasting on end-fasting values was examined using ANCOVA analysis. Paired samples T-test and Mann-Whitney test were used to compare pre and end-fasting values in fasters.

Pre-fasting values comprise the mean of the three measurements that were made before the beginning of the Christmas, Lent and Dormition fasting periods, while end-fasting values are the mean of the three measurements that were made at the end of each one of the fasting periods.


Demographic data on a hundred and twenty subjects are presented in Table 1. Sixty of the subjects were fasters (26% male, 24% female) with a mean age of 42 ± 12; the other sixty were control subjects (20% male, 30% female) with a mean age of 38 ± 9. There was no statistically significant difference in the age of the two groups (ANOVA). The subjects in the fasters group had been observing the fasting rituals for a mean of 20 ± 14 years. The rate of compliance with the fasting rules was 100%. All subjects in both groups did not suffer from any disease like thyroid, diabetes, cancer, cardiovascular diseases, and did not take any medication.

Table 1. Sociodemographic characteristics of the population.

The levels of serum lipids, blood pressure and body measurements of all three periods for fasters and controls are presented in table 2.

Table 2. Levels of serum lipids, blood pressure and body measurements.

Effect of fasting on end-fasting values

Multiple Linear Stepwise Regression Analysis indicated that fasting is a significant determinant for end-total cholesterol, end-LDL cholesterol, end-LDL/HDL ratio and end-BMI (Table 3), showing that fasters have lower levels of these variables.

Table 3. Effect of various variables including fasting on serum lipids and BMI.

Females have higher levels of end-HDL cholesterol while men have higher levels of end-TC/HDL and end-LDL/HDL ratios. Waist-to-hip ratio was positively related to end-total cholesterol and end-LDL cholesterol.

Comparisons of end-fasting values between the two groups

Comparisons of mean end-fasting values between fasters and controls are shown in Table 4. Mean end-TC, end-LDL and end-BMI were statistically lower (p < 0.001) in fasters compared to controls. Fasters presented 12.5% lower end-TC, 15.9% lower end-LDL cholesterol and 1.5% lower end-BMI compared to controls. Moreover, fasters had significantly lower LDL/HDL ratios (p < 0.05). All results were adjusted for age, sex, BMI and smoking. Table 4. ANCOVA analysis.

Effect of fasting on end-fasting mean ratios with covariates the respective pre-fasting mean ratios between fasters and control subjects.

Comparisons of pre and end-fasting values in the fasters' group

The fasters who had 3 complete pairs of measurements were included in this analysis (Table 5). Paired samples T-test showed that fasters presented 9.1% decline in end- total cholesterol, 12.4% decline in end- LDL, 8.5% decline in end- HDL and 1.4% decline in end- BMI compared to their respective pre-values. All these differences were significant (p < 0.001). As for the ratios end- TC/HDL and end- LDL/HDL although they declined the changes were not significant. The same analysis was done in controls that presented no significant changes over the year. A further step was to categorize fasters in two subgroups: 1) nun-priests and 2) lay people and to compare their pre- and end- fasting values. Mann-Whitney test showed that the changes seen in fasters' group remained when each subgroup was analyzed separately though they were not significant. It was observed that between the major fasting periods studied (between the end of Christmas and the beginning of Lent; and between the end of Lent and the beginning of the Assumption fasting period) when fasters returned to their usual dietary habits (non-fasting periods) total cholesterol and LDL cholesterol were increased by 6% and 9% respectively. Table 5. Pared samples T-test.

Mean pre-fasting values compared to mean end-fasting values in the group of fasters (n = 43).

Dietary data

Table 6 shows that at end-fasting periods fasters had 10% reduction in energy intake (EI), 17% reduction in total fat (%EI), 23% increase in carbohydrates (%EI) and 43.5% increase in fiber consumption, whereas the respective percentages for the controls are +7%, +1%, +1.7% and +3.3%. All the differences found between the two groups are significant.

Table 6. Ancova analysis.

Dietary differences between fasters and controls among pre and end-fasting periods based on the 24 h dietary record.

Distribution of Apo E polymorphism

Subjects in this study were screened for the common apolipoprotein E (apoE) polymorphism, as genetic variation at the apoE locus has been shown to influence serum lipid responsiveness to dietary interventions and account for much of the interindividual variability in dietary response [24,25] Several studies, for example, support the concept that the ε4 allele is associated with an increased cholesterol response to dietary manipulation, and that subjects carrying the ε4 allele are the most responsive to diets restricted in saturated fat and cholesterol [24-27].

Fasters and control subjects were classified in three groups according to their apoE genotype: subjects homozygous for the common ε3 allele (apoE3/3 genotype, (38 fasters and 40 controls); subjects with the apoE2/3 genotype (nine fasters and four controls); carriers of the ε4 allele (apoE3/4 and apoE4/4 genotypes; four fasters and six controls, respectively). Chi-square analysis showed that apoE genotype distribution did not differ between fasters and controls (data not shown).


The most important finding of this study is that most serum lipid variables decreased significantly over the fasting periods. Fasters, as compared to controls, had decreased levels of mean end- total cholesterol, LDL-C, LDL/HDL-C ratio and BMI. Several genetic factors account for the variation in cholesterol levels and obesity indices, however, we believe that the possibilities of genetic differences between the two groups are minimal since the population of Crete is stable with a long history over 4000 years. In addition to this, the ApoE genotype distribution found no differences between the two groups (fasters vs controls). In the fasters' group the mean decrease within all three fasting periods was 9% for total cholesterol and 12% for LDL-C. However, it was observed that during non-fasting periods when fasters returned to their usual dietary habits, total cholesterol and LDL-C increased by 6% and 9% respectively. This shows that the reduced end-total and LDL cholesterol concentrations that were observed within the fasting periods were not sustained when the subjects returned to their usual dietary habits even though the increase did not reach the initial pre- levels. The reduction in HDL that occurred in fasters is a common finding with low-fat and vegetarian diets [28-31]. The findings above are in agreement with the results reported by Barnard et al who conducted a strict vegetarian-diet intervention study for 5 weeks on 35 women [30]. The intervention diet consisted of grains, legumes, vegetables and fruit. After the intervention diet phase total cholesterol, LDL and HDL were decreased by 13.2%, 16.9% and 16.5% respectively [30]. BMI was also significantly reduced (p < 0.001) while, in agreement with our findings, the TC/HDL and LDL/HDL ratios remained unchanged (table 5)[30]. Similar were the findings in another 6-week vegetarian-diet intervention study by Masarei et al [28] and in a 12-week low-fat-vegan-diet intervention study by Nicholson et al [32]. Lee [33] and Hoffman [34], who compared omnivores with lacto-ovo-vegetarians, found no difference in LDL/HDL ratio between the two groups. The contrasting results on LDL/HDL ratio could be attributed to differences in the population samples studied. Nieman et al [14] and Toohey et al [35] investigated Seventh-Day Adventists with similar demographic and life-style factors and with comparable diets and dietary habits to our cohort. They found that lacto-ovo-vegetarians and lifetime strict vegetarians had lower concentrations of total and LDL cholesterol when compared with non-vegetarians and lacto-ovo-vegetarians respectively (p < 0.05) [14]. Toohey et al found also found lower levels of BMI, triacylglycerols and TC/HDL ratio [35]. The present study showed that women had lower levels of LDL/HDL ratio and TC/HDL ratio, which is also a better predictor for CHD in women [36-38]. This is explained by the higher concentrations of HDL that women have compared to men [39]. The positive association of waist-to-hip ratio with total and LDL cholesterol is in agreement with other studies that correlate waist-to-hip ratio with coronary risk factors and CHD prevalence [40-42]. Waist-to-hip ratio measurement is a simple and cost-effective measure that contributes in predicting abnormal lipoprotein levels and increased risk of cardiovascular disease. Both the fasting and control groups had mean BMI in the overweight category. Fasting had a small but statistically significant impact on fasters' BMI at the end of the fasting periods that was not sustained in non-fasting periods. In accordance to the results in this study, Haddad et al studying a group of vegans and nonvegetarians found significantly lower BMI levels in the vegan group [43]. Moreover, others found that vegetarians have lower BMI than meat eaters [44-46]. At the same time following a Mediterranean-style diet has also been proven to be beneficial to weight loss [47]. As regards religious fasting some studies associate it with weight loss and decline in BMI [2,3] while others do not [4,5,48]. Educational level was not found to influence any of the blood lipid variables in this study (Table 3). This was an unexpected result since higher education is associated with better health care and awareness whereas low educational level has been related to unfavorable lipid profile [49], all-cause and CAD mortality [50] and hypertension [51]. The beneficial changes seen in fasters diet during the fasting periods, especially regarding energy intake, total fat and fiber consumption, can also explain the reductions in the biochemical and obesity indices. A recent study of the University of Crete showed that the Christian Orthodox nuns' diet was very low in cholesterol and in saturated fat intake (6% of total energy intake), and high in fiber and antioxidant vitamins [16]. This could be attributed to nuns' high consumption of fruit, vegetables, cereals and legumes. In another study Haddad et al found that vegans consume more grains, vegetables, fruit, legumes and seeds and as a result their diet consists of more dietary fiber and less dietary cholesterol [43]. It is well known that reduced intakes of dietary SFA and cholesterol lower total and LDL cholesterol concentration and are associated with low risk of cardiovascular diseases [52,53]. The Orthodox Christians' diet, which is based on vegetables, legumes, fruit, cereals, bread and olive oil, is a Mediterranean-type of diet with periodic abstinence from meat and other animal products during the fasting periods. Numerous investigators [54-56] have recognized the beneficial role of the Mediterranean diet in cardiovascular diseases, and the protective effect in terms of cancer and longevity have also been noted [57,58]. In addition, supplementary studies have associated religiosity with good health [10]. This has been confirmed in a recent study by Chliaoutakis et al [59], which is the only published work to date which investigates the association between the Orthodox Christian lifestyle and health. Chliaoutakis et al found that devout Orthodox Christians adopt healthier life-styles and that religion has a substantial impact on mental and physical health-related behaviors [59]. In the present study, contrary to Chliaoutakis' findings, the physical activity of the two groups (fasters vs controls) did not differ in any of the testing periods. Our study attempts to provide an understanding of the impact of Christian Orthodox fasting on serum blood lipids and obesity indices before and at the end of the three major fasting periods. Compared to controls, fasters presented decreased lipoproteins and BMI levels. These results support our hypothesis by highlighting the beneficial influence of Christian Orthodox fasting on lipoprotein profile and prevalence of obesity. Competing interests

None declared.

Authors' contributions

Author K.S mainly organized and performed the study, and drafted the manuscript.

Author N.T participated in the design of the study and supervised the manuscript.

Author M.L performed the statistical analyses.

Author G.M performed part of the statistical analysis.

Author A.K conceived of the study, participated in its design, and supervised the study and the manuscript.


We appreciate the assistance of Bishop Nektarios of Crete in supporting the study and the Monasteries of Sabbathiana, Isodia Theotokou and Kremaston for their participation. We are also grateful to Dr N.Yiannakouris, Mrs C.Codrington, Dr C.Hatzis, Ms F.Bervanaki, Mr M.Kiriakakis and Mr G.Tsibinos.


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Am J Cardiol 2001, 88(7):737-43. Solymoss BC, et al.: Relation of coronary artery disease in women < 60 years of age to the combined elevation of serum lipoprotein (a) and total cholesterol to high-density cholesterol ratio. Am J Cardiol 1993, 72(17):1215-9. 37. Hong MK, et al.: Usefulness of the total cholesterol to high-density lipoprotein cholesterol ratio in predicting angiographic coronary artery disease in women. Am J Cardiol 1991, 68(17):1646-50. 38. Price JF, et al.: Influence of high-density lipoprotein cholesterol and rheological factors on the sex difference in cardiovascular disease. J Cardiovasc Risk 2000, 7(1):49-56. 39. Onat A, Sansoy V, Uysal O: Waist circumference and waist-to-hip ratio in Turkish adults: interrelation with other risk factors and association with cardiovascular disease. Int J Cardiol 1999, 70(1):43-50. 40. Mansfield E, McPherson R, Koski KG: Diet and waist-to-hip ratio: important predictors of lipoprotein levels in sedentary and active young men with no evidence of cardiovascular disease. J Am Diet Assoc 1999, 99(11):1373-9. 41. Perry AC, et al.: Clinical predictability of the waist-to-hip ratio in assessment of cardiovascular disease risk factors in overweight, premenopausal women. Am J Clin Nutr 1998, 68(5):1022-7. 42. Haddad EH, et al.: Dietary intake and biochemical, hematologic, and immune status of vegans compared with nonvegetarians. Am J Clin Nutr 1999, 70(3 Suppl):586S-593S. 43. Burr ML, Butland BK: Heart disease in British vegetarians. Am J Clin Nutr 1988, 48(3 Suppl):830-2. 44. Key TJ, Davey GK, Appleby PN: Health benefits of a vegetarian diet. Proc Nutr Soc 1999, 58(2):271-5. 45. Key T, Davey G: Prevalence of obesity is low in people who do not eat meat. Bmj 1996, 313(7060):816-7. 46. De Lorenzo A, et al.: Effects of weight loss on body composition and pulmonary function. Respiration 1999, 66(5):407-12. 47. el Ati J, Beji C, Danguir J: Increased fat oxidation during Ramadan fasting in healthy women: an adaptative mechanism for body-weight maintenance. Am J Clin Nutr 1995, 62(2):302-7. 48. Verschuren WM, Boerma GJ, Kromhout D: Total and HDL-cholesterol in The Netherlands: 1987–1992. Levels and changes over time in relation to age, gender and educational level. Int J Epidemiol 1994, 23(5):948-56. 49. Hardarson T, et al.: The relationship between educational level and mortality. The Reykjavik Study. J Intern Med 2001, 249(6):495-502. 50. Tedesco MA, et al.: Educational level and hypertension: how socioeconomic differences condition health care. J Hum Hypertens 2001, 15(10):727-31. 51. Law M: Dietary fat and adult diseases and the implications for childhood nutrition: an epidemiologic approach. Am J Clin Nutr 2000, 72(5 Suppl):1291S-1296S. 52. Shahar DR, et al.: Seasonal variations in dietary intake affect the consistency of dietary assessment. Eur J Epidemiol 2001, 17(2):129-33. 53. Kafatos A, et al.: Heart disease risk-factor status and dietary changes in the Cretan population over the past 30 y: the Seven Countries Study. Am J Clin Nutr 1997, 65(6):1882-6. 54. Panagiotakos DB, et al.: The association of Mediterranean diet with lower risk of acute coronary syndromes in hypertensive subjects. Int J Cardiol 2002, 82(2):141-7. 55. Kris-Etherton P, et al.: AHA Science Advisory: Lyon Diet Heart Study. Benefits of a Mediterranean-style, National Cholesterol Education Program/American Heart Association Step I Dietary Pattern on Cardiovascular Disease. Circulation 2001, 103(13):1823-5. 56. Trichopoulou A, Vasilopoulou E: Mediterranean diet and longevity. Br J Nutr 2000, 84(Suppl 2):S205-9. 57. Trichopoulou A, et al.: Cancer and Mediterranean dietary traditions. Cancer Epidemiol Biomarkers Prev 2000, 9(9):869-73. 58. Chliaoutakis JE, et al.: Greek christian orthodox ecclesiastical lifestyle: could it become a pattern of health-related behavior? Prev Med 2002, 34(4):428-35. A great book to read is Fasting and Science by Dr. Constantine Cavarnos, (The Center for Traditionalist Orthodox Studies): this is the best short work I have read on the subject. Dr. Cavarnos knows this subject well. In his famous Anchored in God he writes (pp. 29-30):

“Fasting takes into account both the quantity and the quality of food. The idea is to eat a smaller amount of food during a fasting day; to abstain from fats and oils, as these tend to fatten the body and thereby to arouse lust and make one physically and spiritually lazy; to abstain from meat, fish, and products of animal origin, as these tend to excite carnal desire; and also to abstain from mere delicacies, as the consumption of these is a form of self-indulgence. St. John Climacus (c. 525-605) says: ‘Satiety of food is a begetter of unchastity.’ He also says, ‘Let us cut down fatty and greasy foods that inflame carnal desire, and foods that sweeten and tickle the larynx’ (The Ladder, Migne PG 88, 864, 865).

The practice of fasting is not regarded as an end in itself, as something having instrinsic value, but only as a means, as a necessary condition for the spiritual life. It belongs to the category of what the Eastern, Byzantine Fathers call "bodily virtues," among which are prostrations, standing, and vigils. Referring to these, St. John Damascene (c. 676-c. 754) says that they "are rather instruments for the virtues; they are necessary, in one practices them with humility and spiritual knowledge. For without them neither do the virtues of the soul come into being, but in themselves they are of no benefit, any more than plants without fruit" (Philokalia, 2, 17). And St. Gregory the Sinaite (1289-1360), speaking specifically of fasting, observes: "Constant fasting whithers lust and gives birth to self-restraint" (Philokalia, 2, 272); while Callistos and Ignatios Xanthopoulos remark: "Fasting and self-restraint are the first virtue, the mother, root, source and foundation of all good" (Philokalia, 2, 370).”

Other food for thought, from the wise Nicephorus Theotokis:

"When we fast, we search the earth and sea up and down: the earth in order to collect seeds, produce, fruit, spices, and every other kind of growing edible; the sea to find shellfish, mollusks, snails, sea-urchins, and anything edible therein. We prepare dry foods, salted foods, pickled foods, and sweet foods, and from these ingredients we concoct many and motley dishes, seasoned with oil, wine, sweeteners, and spices. Then we fill the table even more than when we are eating meat. Moreover, since these foods stimulate the appetite, we eat and drink beyond moderation. And after that we imagine that we are fasting...And whoever taught those who fast in this way that such a variety and such quantities of food constitute a fast? Where did they read or hear that anyone who simply avoids meats or fish is fasting, even if he eats a great amount and different kinds of food? Fasting is one thing, great variety in food another; fasting is one thing, eating great amounts of food another." [Fasting and Science, 18-19]

“Gluttony makes a man gloomy and fearful, but fasting makes him joyful and courageous.And, as gluttony calls forth greater and greater gluttony, so fasting stimulates greater and greater endurance.When a man realizes the grace that comes through fasting, he desires to fast more and more. And the graces that come through fasting are countless....” - Saint Nikolai Velimirovich of Zicha