The impact of supervised beego, a traditional Chinese water-only fasting, on thrombosis and hemostasis

Beego is a traditional Chinese complete water-only fasting practice initially developed for spiritual purposes, later extending to physical fitness purposes. Beego notably includes a psychological induction component that includes meditation and abdominal breathing, light body exercise, and ends with a specific gradual refeeding program before returning to a normal diet. Beego has regained its popularity in recent decades in China as a strategy for helping people in subhealthy conditions or with metabolic syndrome, but we are unaware of any studies examining the biological effects of this practice. To address this, we here performed a longitudinal study of beego comprising fasting (7 and 14 day cohorts) and a 7-day programmed refeeding phase. In addition to detecting improvements in cardiovascular physiology and selective reduction of blood pressure in hypertensive subjects, we observed that beego decreased blood triacylglycerol (TG) selectively in TG-high subjects and increased cholesterol in all subjects during fasting; however, the cholesterol levels were normalized after completion of the refeeding program. Strikingly, beego reduced platelet formation, activation, aggregation, and degranulation, resulting in an alleviated thrombosis risk, yet maintained hemostasis by sustaining levels of coagulation factors and other hemostatic proteins. Mechanistically, we speculate that downregulation of G6B and MYL9 may influence the observed beego-mediated reduction in platelets. Fundamentally, our study supports that supervised beego reduces thrombosis risk without compromising hemostasis capacity. Moreover, our results support that beego under medical supervision can be implemented as noninvasive intervention for reducing thrombosis risk, and suggest several lines of intriguing inquiry for future studies about this fasting practice (, number,ChiCTR1900027451). ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial , number, ChiCTR1900027451 ### Funding Statement This study was supported by the National Natural Science Foundation of China (to JW) by grants 91649113 and 31771640, and by Soochow University (to JW) by grant H190443, and by the Natural Science Foundation of Jiangsu Province, China (to YF) by grant SBK2020043689, and by The Postdoctor Science Foundation of Jiangsu Province (to YF) by grant 2020Z064, and by the Priority Academic Program Development of Jiangsu Higher Education Institutions, Jiangsu Province, China. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Approval No. ECSU-2019000153 by Ethics Review Board at Soochow University, China All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The data that support the findings of this study are available from the corresponding authors upon request. * AIx : augmentation index APTT : activated partial thromboplastin time AT III : antithrombin III testing BDNF : brain-derived neurotrophic factor CNS : central nervous system COGs : cluster of orthologous groups DBP : diastolic blood pressure DDA : data-dependent acquisition DIA : data-independent acquisition DTT : dithiothreitol ELISA : Enzyme-linked immunosorbent assay FIB : Fibrinogen FITC : fluoresceine isothiocyanate GO : Gene ontology HDL-C : high-density lipoprotein cholesterol INR : international normalized ratio LC-MS/MS : liquid phase chromatography LDL-C : low-density lipoprotein cholesterol MPV : Mean platelet volume PCT : platelet hematocrit PDW : platelet distribution width PE : phycoerythrin PLT : platelet PPI : protein-protein interaction PRP : platelet-rich plasma PT : prothrombin time PWA : pulse wave PWV : pulse wave velocity rFD : refeeding days RM : repeated measures ROS : reactive oxygen species RT : room temperature SBP : systolic blood pressure SEM : standard error of the mean SOP : standard operating procedures SPE : solid phase extraction TC : total cholesterol TG : triacylglycerol TPO : thrombopoietin TT : thrombin time wFD : water-only fasting day.