ACTA SCIENTIFIC NUTRITIONAL HEALTH
Volume 3 Issue 1 January 2019

Review Article

Wellness Fasting and Intestinal Microbiota in Chronomedicine

Shaw Watanabe1*, Izumi Utada2, Takayoshi Hisada3 and Reiko Takiguchi2
1

Lifescience Promoting Association, Asia Pacific Clinical Nutrition Society, Japan

2

ABO Group ARSOA Co. Ltd, Japan

3

TechnoSuruga Laboratory Co. Ltd, Japan*Corresponding Author: Shaw Watanabe, Lifescience Promoting Association, Asia Pacific Clinical Nutrition Society, Japan.

Received: November 27, 2018; Published: December 14, 2018

Abstract
Since ancient times, fasting has been performed for religious reasons or as a cure of illnesses. However, a suitable fasting method

for healthy longevity or daily wellness has not been established as of yet.

The possibility of BHB absorption from intestinal lumen like butyrate is not known. Therefore, we tried to clarify the occurrenceof ketogenesis during fasting by measuring concurrent changes in glucose, ketone bodies, fatty metabolism and various hormonalchanges in both blood and urine in relation to the intestinal microbiota.
Keywords: Microbiota; Fasting; Ketone; Glucose; Macrobiotics

Introduction
The importance of ketone body metabolism in diabetic pa-

tients has been well known since the 1970s, but recently,
β-hydroxybutyrate (BHB) has been identified as a key componentof a metabolic signaling pathway [1-9].

Recently the relationship between fasting and circadian rhythmhas been reported [10]. The bidirectional relationship between cir-cadian disruption and metabolic abnormalities is found in diabetic
patients.

The circadian rhythm in food intake should be strongly affectedby fasting. When glucose function is altered, circadian behavior
should be altered.

Mitsuo Koda [11] developed fasting dietary therapy and con-firmed beneficial effects for many patients with intractable diseases. About 900-1000 kcal/day by unpolished brown rice, green
vegetable paste and tofu constitute the basic regimen of Koda’s

therapy. We found a successful patient who had recovered fromspino-cerebellar degeneration at a young age by Koda’s dietary
therapy [12,13]. She had been living on only one glass of fresh veg-

etable juice per day for 18 years since her acute episode at age 20.
Her ketone bodies, especially BHB in the blood, were more than 3
mM, so the main energy should come from ketone bodies.

Her biochemical changes coincided with the metabolic adapta-

tion to yield BHB, as shown by elevated aspartate aminotransfer-ase (AST) and creatine kinase (CK). High aspartate was a reflectionof above metabolic change. Increased BHB was observed in two
participants among five, and both of them had Bifidobacteriacae inthier fecal bacteria [14] Some Bacteroides had xylanase or cellu-

lose activities, so these species may play an important role in fiber
degradation in a strict vegetarian. Hayashi., et al [15]. had previously analyzed the fecal bacteria of Mori 15 years ago. They foundthat Clostridium and Bacteroides were the dominant groups. They

also found many Bifidobacterium by direct culture.

Our previous study in wellness fasting and BHB production by

Pass analysis showed that the decreased BMR and insulin signifi-

cantly contributed to the increase in BHB and AcAc [12]. From ourexperience of the Mori case, we considered different gut microbiome should influence the production of BHB.

Subjective and physical change by wellness fasting
We have practiced Kushi macrobiotics for more than 10 years

and developed the teaching and practicing system of a 4-day “Well-

ness-fasting”. In this paper I would like to focus on the changes ofintestinal microbiota during wellness fasting.

Citation: Shaw Watanabe., et al. “Wellness Fasting and Intestinal Microbiota in Chronomedicine”. Acta Scientific Nutritional Health 3.1 (2019): 35-43.

Wellness Fasting and Intestinal Microbiota in Chronomedicine
36

In ARSOA Wellness Fasting program, participants received a

combination of a very low-energy vegetarian diet, physical exer-

cise, meditation, and lectures about healthy lifestyles [12,16] (Figure 1). Peripheral blood was collected on days 1 and 4 for routine
biochemical analyses and for the determination of serum levels of

insulin, glucagon and other hormones. Glucose and BHB were mea-

sured every morning by finger-tip blood. The stools were collectedin the pre-, mid- and post-fasting stage, and profiles of microbiota
were analyzed by the metanalytic cytotechnicon [17-21].

Figure 2: Changes of subjective and physical condition

during 4-day fasting Males (blue line), females (red line).
BMR decreased from 1107+/-101 kcal/day at 1st day to

Figure 1: Schedule of Wellness Fasting.
Body weight decreased from 55 kg to 53.5 kg, and it continued

at least one month later. Waist circumference decreased from 85
cm to 82 cm at day 4, and it also continued for one month. Body
weight reduction was 2.6 kg in males and 1.7 kg in females. Body fat

rate decreased 1.3% and 0.7% in males and females, respectively,

and muscular weight decreased 1.4 kg in males and 0.8 kg in females. Systolic blood pressure decreased 12 mmHg in both males

and females, and 5 mmHg and 6 mmHg in diastolic pressure inmales and females, respectively. On the contrary, the median pulse

1087+/-96 kcal/day on the 3rd day.

Biochemical data showed decrease of triacylglycerol (TG) andmarked increase of free fatty acids (FFA) (Table 1). Glucose andinsulin became lower and glucagon increased. AST increased one
third, while ALT and γ-GTP did not change significantly. Growth

hormone lowered, but changes of thyroid hormone did not occur.

Urinary catecholamins were variable, but all catecholamins, suchas adrenalin, noradrenalin and dopamine increased in the high
BHB producer. Creatinin was slightly increased and estimated glomerular filtration rate (eGFR) lowered about 10% in all groups.
Fasting and hyperketosis

Decreased gluconeogenesis less than 4.5 mM seemed to stimu-

rate increased 10/min in males and 7.5/min in females. Body tem-late ketogenesis (Figure 3).

pulse rate, and glucose decrease correlated with lowered diastolic

to 2.0±1.2 mM at the day 4 of fasting, while the glucose level de-perature decreased 0.2 – 0.3oC in both sexes. By correlation analy-

sis BHB difference only correlated to the body temperature andpressure.

Although headaches, hunger, GI tract distress, emesis, depres-sion and cold feeling occurred toward the 2nd day of fasting, these
symptoms dramatically disappeared at the 3rd day, and active andvivid feeling increased on the 4 day and after (Figure2). Headachethwas common in females but improvement was better than males.
Skin condition also improved by fasting.

BHB in the blood increased from 0.3±0.2 mM at the day 1

creased from 5.6±1.6 mM to 3.9±1.3 mM at 4th day. According to theincrease of blood ketone bodies, urinary excretion of median acety-lacetate increased to 40.9 mM (7.76-159.2) (min-max), BHB 25.1
mM (2.72-597.0) and total ketone bodies 66.1 mM (10.5-756.5) on

the 4th day. These values returned to 0.16 mM (0-10.1) on 14th day(10 days after fasting).

Citation: Shaw Watanabe., et al. “Wellness Fasting and Intestinal Microbiota in Chronomedicine”. Acta Scientific Nutritional Health 3.1 (2019): 35-43.

Wellness Fasting and Intestinal Microbiota in Chronomedicine
37

Various factors to correlate with increase of BHB was analyzed

Changes of serum biochemical markers on
day 1 and 4th day of Fastingday 1

n = 53

Mean sd

TG

FFA

glucoseInsulinglucagon
AST

day 4

Mean sd

dif

Mean sdby AMOS (Figure 4).

99.8 ±60.2

56.0 ± 20.9

-45.5 ± 58.0

736.2 ± 344.8 1900.2 ± 535.5 1181.4 ±607.3***

6.2 ± 5.3

2.8 ±1.7-3.5 ±5.2***

5.0 ± 1.2

3.9 ±1.2

1.1 ±1.0

153.7±33.6

183.1 ± 60.0

26.0 ± 63.7

21.4± 52.

31.5 ±8.9

***

***

14.3 ± 6.8
28.3 ± 32.1

27.1 ±28.3-1.6 ± 5.4

eGFR

84.4 ± 14.8

74.0 t 15.0

-10.1 ± 10.3

AcAc

0.0± 0.0

0.3 ± 0.2
1.8 ± 1.1

-0.3 ± 0.2-1.7 ± 1.1***

total ketol

0.0± 0.0

2.2 ± 1.3

-2.1 ± 1.3

***

Cre

0.6 ±0.1

0.1± 0.1BNB

1.8 ±3.3

***

ALT

y_GTP

16.1±7.5

10.0 ±6.5***

0.1 ± 0.1

0.7 ±0.1

0.113

***

TO; tryglyceride, FFA; free fatty acids, AST; ALT y_GTP, Cr, creatinine, eGFR; estimated glomelular filtration rae, AcAc: acetoacetate,
BHB: B -hydroxybutyrate
Table 1: Changes of serum biochemical markers
on day 1 and 4th day of fasting.

Figure 4: Correlation analysis by AMOS.

Changes of glucose, insulin, BMR, and body weight affected the

BHB increase. Acetoacetate had positive correlation with BHB andnegative correlation with body weight and insulin change.

Changes of microbiota by fastingMore than 600 microbiotas were determined by our system[17-21]. Rejected hits were 29.6% and undetermined rate was

9.4%. These were summarized to 60 genus, 29 families, 14 orders, 11 classes and 9 phyla. Most common bacteria in phylum was
Firmicutes (36-40%), next Bacteroidetes (24%), Actinobacteria(11-16%), and then Proteobacteria (0.7-1.9) and Verrucomicrobia(0.602%.). When compared bacterial profiles in 3 different times,
pre-, mid- and post-fasting period, Actinobacteria, Proteobacteria
and Verrucomicrobia showed significant changes by fasting (Table
2).

The number of species in the prefasting stool was 201 speci-

mens, which decrease to 140 specimen at the mid fasting, and increased to 221 specimens the post fasting stool. Long term stabili-

Figure 3: Decrease and increase of glucose
and β- hydroxybutyrate.

ty of human gut microbiota was reported [22,23], but rapid change

was also reported by David., et al [24]. like our cases. Diversity increased about 10% after fasting.

Citation: Shaw Watanabe., et al. “Wellness Fasting and Intestinal Microbiota in Chronomedicine”. Acta Scientific Nutritional Health 3.1 (2019): 35-43.

Wellness Fasting and Intestinal Microbiota in Chronomedicine

Timephyllum

Firmicutes
Bacteroidetes
Actinobacteria
Proteobacteria
Verrucomicrobia
Fusobacteria
Lentisphaerae
Spirochaetes
Synergistetes
Rejected hit

Prefasting
Mean

40.31

sd

median

7.59

10.04

8.12

24.06

10.93

0.69

1.71

11.70
6.65

0.38

0.00

0.00

0.00

16.20

Midfasting

6.51

1.46

0.00

0.00

0.01

7.76

mean

sd

median

12.52

13.85

40.57

36.88

11.03

3.94

3.90

4.77

23.19
0.02

0.00

0.00

0.00

0.00

15.80

24.11

16.63
1.93

0.31

0.00

0.00

0.01

16.24

11.17
3.88

1.16

0.00

0.00

0.03

9.70

Postfasting

ANOVA

sd

median

p

11.87

10.73

8.73

0.024*

0.18

0.69

0.00

0.68

mean

38.61

41.09

1.58

7.04

24.80
0.01

0.00

0.00

0.00

0.00

14.36

24.05
0.70

0.00

0.00

0.00

15.06

9.38

7.99

7.74

1.84

0.00

0.00

0.02

6.69

40.71

23.86
3.61

0.01

0.00

0.00

0.00

15.43

Table 2: Comparison of microbiotic profile at phylum level by pre-, mid-, and post fasting period.

Fasting caused quick disappearance of Bacteroides, Blautia and

Akkermansia. They returned to the prefasting state in post fastingstool with increased diversity of microbiota (Table 3).

38

0.057

0.999

0.026*

0.024*
nd

nd

nd

0.699

Correlation of BHB levels and microbiota

Microbiota profile at family level in the different fasting stage

divided by BHB levels by the 4th day.

Table 3: Increased diversity of microbiota by pre-, mid- and post fasting. Yellow shows Firmicutes, blue Bacteroides, pink.
Actinobacteria, brown Proteobacteria and circled is Akkermansia

Citation: Shaw Watanabe., et al. “Wellness Fasting and Intestinal Microbiota in Chronomedicine”. Acta Scientific Nutritional Health 3.1 (2019): 35-43.

Wellness Fasting and Intestinal Microbiota in Chronomedicine

BHB concentration at the 4th fasting day showed variety, so it

was categorized to less than 1 mM, 1-2 mM, 2-3 mM and more than
3 mM. If we examined various relationship, significant correlation

was found between highest BHB group and Enterobacteriacea family in the pre-fasting (Figure 5).

39

Syntrophic and suppressive changes of microbiota by ketone
production
Further analysis of bacterial profile at the species level clari-fied that 15 species were directly or indirectly related to BHB level,such as Providencia vermicola, P. rustigianii, P. sneebia, Morganella
morganii, M. psychrotolerans, Proteus hauseri, Butyricimonas virosa, etc. Five cases with very low Enterobacter presence showed

lowest plasma BHB increase. Only one case with high BHB level

did not show any attributable bacterium. Plasma concentration of

BHB was related to Enterobacteriaceae directly or indirectly. The
latter suggested syntrophic effects on Enterobacteriaceae. Known

butyrate producing bacteria seemed to suppress by competitive

Seven species directly related to BHB level, such as Providencia

Figure 5: Microbiota profile at family level in the different fast-vermicola, P. rustigianii, P. sneebia, Morganella morganii, M. psy-and Enterobacteriaceae (red) in the pre-fasting stool.

sa coexisted with Providencia rustigianii (CC = 1.000***) and Mor-ing stage divided by BHB level at 4th day

Significant correlation was found between highest group of BHB

chrotolerans, Proteus hauseri, and Butyricimonas virosa (Table 4).

They showed syntrophic growth among them. Butyricimonas viro-

ganella morganii (CC = 0.763***). Bacteroides finegoldii and Para-

Table 4: Correlation between microbiota with significant association with BHB concentration.
Citation: Shaw Watanabe., et al. “Wellness Fasting and Intestinal Microbiota in Chronomedicine”. Acta Scientific Nutritional Health 3.1 (2019): 35-43.

Wellness Fasting and Intestinal Microbiota in Chronomedicine

bacteroides distasonis in Bacteroidaceae and some Firmicutes, such

40

These associations were confirmed by individual level. Entero-as Clostridium bolteae, C. lavense, Enterococcus avium, Megamonas

bactereciae species were recognized in 20/22 high BHB producers,

Flavonifractor plauti (Table 4).

terobacteriacea species, and in these cases, Clostridium bolteae, C.

repellensis, Allisonella histaminiformans and Flavonifractor plautii

were indirectly associated with Enterobacter families, except for

Roseburia faecis and Blautia faecis were negatively associatedwith BHB concentration, but they showed syntrophic correlation

with Providencia rettgeri, Hafnia paralvei, and other enterobacters.
Five cases with very low Enterobacter profile showed lowest BHB

13/17 moderate BHB producers and 15/16 low producers. Two
in high BHB, 4 in middle BHB, and 1 in low BHB did not have en-lavalense, Enterococcus avium, Hunatella hathewayi, Megamonas
rupellensis and Ruminococcus bromii seemed to be related to BHB
production by coexistence with Enterobacteriaceae.

Cooperation (syntrophic) or suppression (competitive) of bacil-level. Only one case with high BHB level showed no positive asso-

li was suggested by correlation network among individual species

bacterium adolescentis, Faecalibacterium prausnizii, etc.

level and network of microbiota is shown in table 5.

ciation to proteobacteriae, but broad association was present, suchas Megamonas funiformis, Prevotella copri and P. stercorea, Bifido-

Directcorrelation

CC with BHB

phylumProvidencia vermicola.418**

P

.332*

P

Providencia rustigianii
Providencia sneebia
Morganella morganii
Proteus hauseri
Butyricimonas virosa
Clostridium lavalenseEnterococcus avium
Parabacteroides distasonis
Bacteroides finegoldii
Megamonas rupellensis
Allisonella histaminiformans
Clostridium bolteae
Flavonifractor plautii

Negativecorrelation

butyrate producing bacteria. Summary relationship between BHB

Primary correlation

Morganella psychrotoleransIndirectcorrelation(Table 4). Generally, BHB producing bacteria seemed to suppress

Roseburia faecis
Blautia faecis
Rejected hit.400**.399**.399**.281*

Secondary relationship

P
P
P
P

Providencia rustigianii.400**

B.360**

B

.285*

F

Proteus, Hafnia

F

Enterobacter, Hafnia, Klebsiella.399**.399**
.318*

.293*

.282*
.272*

-.288*-.350**-.285*CC with left
columnF

E. coli/shigela

F

P. sneebia, P.vermicola, MorganellaF

Kluyvera, citrobacter

F

many

Providencia

B

Providencia, ButyricomonasF

E. coli/shigela

F

many

1.000***.385**

1.000***.990***.442***.390***.994**.385**.600***.405***.400-.500***

Table 5. Microbiota with direct and indirect correlation with serum BHB level.

Relationship to butyrate producing bacteria

Cahill studied the glucose metabolism of people who fasted for

40 days, and found that in the starving human adult, BHB and ace-

to-acetate were produced in the liver from long-chain fatty acids

and BHB could be the energy source in the brain and other tissues.
A rise of BHB blood concentration to approximately 6 mM wascharacteristic. Approximately all of the lactate, pyruvate, glycerol,

and amino acid carbons which are removed by the liver and kid-

ney are converted into glucose, as evidenced by substrate balancesacross these organs to keep the basic level [25]. Increased AST is areflection of metabolic change. BHB is considered to be producedin the liver, kidney and astrocytes in the brain, but our case reportsuggested the involvement of intestinal microbiota [14]. Fastingcaused hyperketonemia, but the degree was different from indi-vidual to individual.

Citation: Shaw Watanabe., et al. “Wellness Fasting and Intestinal Microbiota in Chronomedicine”. Acta Scientific Nutritional Health 3.1 (2019): 35-43.

Wellness Fasting and Intestinal Microbiota in Chronomedicine

Butyrate-producing bacteria may represent a functional group,

41

It was suggested that the metabolic pathway of butyrate synthe-

rather than a coherent phylogenetic group, within the microbial

sis and BHB production seemed to be done by different microbiota.

implies that certain features of energy metabolism and microbial

The possible absorption of BHB through intestinal wall could becommunity of the human large intestine. Butyrate formation canplay a special role in bacterial energy metabolism [26-29] and thisecology may be shared between phylogenetically distinct groups

Absorption of BHB from intestinal microbiota could occur like a

BHB supplement use, so dietary effects should be clarified more.
accepted independently from butyrate production.

of butyrate-producing bacteria. Numerically, two of the most im-

Conclusion

Roseburia spp., which belong to the Clostridium coccoides cluster

clinical symptom. The magnitude of changes in ketone body con-butyrate-kinase via butyry-l-phosphate or with the enzyme bu-

worthy under metabolic change of fasting. Enhanced ketone body

portant groups appear to be Faecalibacterium prausnitzii, which
belongs to the Clostridium leptum cluster, and Eubacterium rectale/of firmicute bacteria. After reduction to butyryl-CoA, butyrate canbe formed either with the enzymes phosphotransbutyrylase andtyryl-CoA: acetate CoA-transferase, which utilizes acetate as a cosubstrate and generates acetyl-CoA (Figure 6).

Four days of fasting induced hyperketosis without concurrent

centrations correlates with the levels of insulin, glucose, free fatty

acids and several hormones. Very stable glucose levels were noteproduction occurred when the blood glucose level was less than

4.5 mM (90 mg/dl). The urinary excretion of BHB/acetylacetate(AcAc) ratio increased from 0.56 among low ketone concentration,and 3.36 among high ketone concentratuin. The highest excretionof ketone bodies into the urine was 756 mmole/g creatinine. Further studies are needed to clarify the hormonal effects and to es-

tablish whether high urine excretion rates of ketone bodies could
affect the renal function.

Wellness fasting caused metabolic and physiological changes,

and induced hyperketonemia which showed correlation with prefasting microbiota profile.

High BHB level showed association with family Enterobacteria-

ceae directly or indirectly.

The dominance of Enterobacteriaceae seemed to suppress bu-

Figure 6: Synthesis and degradation of ketone bodies.
Reference pathway and bacteria with key enzyme.

Could synthesis of BHB come from butyrate? The current datasuggested Enterobactericeae mainly correlated to the BHB production, but several other species in Clostridium and Bacteroides that

had correlation with BHB were indirectly related to Enterobactericeae. Enterobacter seemed to suppress Firmicutes, so butyrate producing bacteria would be suppressed in the colon. The possibilityof metabolism by intestinal microbiota from butyrate to BHB in the
body seemed to be unlikely.

tyrate producing bacteria. So, the BHB production seemed to be
independent from butyrate pathway in the gut. The rout of BHB

synthesis would be multiple by syntrophic and/or competitive
growth of bacteria. Composition of Intestinal microbiota influ-

enced the level of plasma BHB. Prefasting Enterobacteriaceae
increased BHB level. Suppression of butyrate producing bacteria
was noticed. Direct and indirect relationship to produce BHB levels was present.

As the legacy effects of wellness fasting, improved lifestyles,

normalized blood pressure, increased diversity of intestinal microbiota. Dietary intervention is effective for continuation of agood healthy state.

In addition, there are many bacteria in the soil that can synthe-

size poly (3-hydroxy butyrate-co-3 hydroxyvalerate) oly-beta hydroxyl butyrate [30-32].

Citation: Shaw Watanabe., et al. “Wellness Fasting and Intestinal Microbiota in Chronomedicine”. Acta Scientific Nutritional Health 3.1 (2019): 35-43.

Wellness Fasting and Intestinal Microbiota in Chronomedicine

Acknowledgement
We thank to staffs of ARSOA wellness fasting, and contributionof participants as the research volunteers.

Conflict of Interest

The authors do not have COI with any companies. Funding of

this research was provided from the Lifescience Promoting Association.

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Citation: Shaw Watanabe., et al. “Wellness Fasting and Intestinal Microbiota in Chronomedicine”. Acta Scientific Nutritional Health 3.1 (2019): 35-43.

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