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Effects of Fasting on Neuroendocrine Function and Follicle Development in Lean Women¹

William Beaumont Army Medical Center (R.A.), El Paso, Texas 79922; Warren G. Magnuson Clinical Center, Departments of Nursing (L.K., M.L.), Diet and Nutrition (N.S.), and Nuclear Medicine (J.R.), Developmental Endocrinology Branch, National Institutes of Child Health and Human Development (L.N.), National Institutes of Health, Bethesda, Maryland 29892; and Waterbury Hospital (B.R.O.), Waterbury, Connecticut 06702

Address all correspondence and requests for reprints to: Dr. Ruben Alvero, Department of Obstetrics and Gynecology, William Beaumont Army Medical Center, 5005 North Piedras, El Paso, Texas 79922-5000.

A 72-h fast in normal weight women during the follicular phase results in transient alterations in neuroendocrine function, but follicle development and follicular phase length remain unaltered. In this study we evaluated neuroendocrine and ovulatory function in lean women (body fat, 20%) undergoing a similar 72-h fast.

Compared to fed controls, fasted lean women experienced significant weight loss, blunting of the diurnal variation of cortisol, suppression of the nocturnal TSH rise, and a decrease in T₃ levels after a 72-h fast. In contrast to similarly fasted, normal weight women, lean women have significantly higher evening cortisol levels and do not exhibit a normal nocturnal TSH rise after the fast. Lean fasted women exhibited a 19% decrease in the number of LH pulses over 24 h compared to fed women (12.9 ± 1.3 vs. 16.0 ± 1.9; P < 0.05). Fasting did not result in significant differences in mean LH, LH amplitude, LH area under the curve, and mean FSH levels in these lean women. Of the seven fasted cycles, two were anovulatory. In the five women studied in fed and fasted cycles, one had interrupted lead follicle development with anovulation, and four had significant lengthening of the follicular phase compared to those during their fed cycles (14.4 ± 1.2 vs. 13.2 ± 1.0 days; P = 0.01).

The clinical observations made in this small sample of lean women showing more profound changes in neuroendocrine function, anovulation, and lengthened follicular phase after fasting suggest that lean women may be more vulnerable to fasting stress than normal weight women.

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