https://www.straitstimes.com/life/fasting-including-for-ramadan-could-lower-risk-of-chronic-kidney-disease
2024-03-26
SINGAPORE – During the holy month of Ramadan, Muslims refrain from consuming food and water from sunrise to sunset. It is akin to intermittent fasting, and both practices have been associated with improved kidney health, among other potential health benefits.
Though the religious and cultural contexts differ, fasting during Ramadan and intermittent fasting share several similarities.
The duration of daily fasting during Ramadan varies according to the time from sunrise to sunset in a particular location. Muslims in Singapore began fasting on March 12 in 2024, and typically fast for about 13 hours each day.
Intermittent fasting, on the other hand, is voluntary. The 16/8 method, for example, also known as time-restricted eating, involves fasting for 16 hours a day and leaving an eight-hour window during the day to eat.
Comparing the two, Dr Wong Weng Kin, a senior consultant nephrologist at Mount Elizabeth Hospital, says fasting during Ramadan and daily time-restricted eating are similar, as individuals eat only at specific times a day.
However, fasting during Ramadan requires a Muslim to abstain from food and drink during the fasting hours, while people can still consume water and other zero-calorie drinks during intermittent fasting periods.
Both fasting practices appear to improve kidney health, a growing area of concern.
The Straits Times recently reported that for every one million Malays, 459 required dialysis in 2022, compared with 150 per million for Chinese, and 183 for the Indian population.
A study published in the Saudi Journal of Kidney Diseases and Transplantation in 2010 found that patients with chronic kidney disease experienced enhanced kidney function after fasting throughout the month of Ramadan.
Research by the American Society of Nephrology in 2020 showed that 62.5 per cent of patients with chronic kidney disease, who practised intermittent fasting for 12 months, experienced an average 18.8 per cent improvement in the Glomerular Filtration Rate, which is used to measure the level of kidney function.
Experts tell ST that fasting practices have been linked to health benefits, including the prevention or improvement of conditions such as diabetes and high blood pressure, which are major causes of chronic kidney disease in Singapore.
Diabetes and high blood pressure, also known as hypertension, can damage blood vessels in the kidneys and impair their function over time.
“Preventing or managing diabetes and hypertension can help lower the risk of developing chronic kidney disease. Fasting has been shown to control these common conditions,” says Dr Wong.
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However, he highlights that the management of diabetes and hypertension also requires a comprehensive approach through medication, diet and lifestyle changes.
Dr Kevin Tan, a consultant endocrinologist from Kevin Tan Clinic for Diabetes, Thyroid & Hormones, says fasting during Ramadan can improve insulin sensitivity, which is the body’s ability to respond effectively to insulin, the hormone responsible for regulating blood sugar levels.
“During fasting, the body utilises stored glucose and fat for energy, which can help regulate blood sugar levels and improve insulin sensitivity over time. This improvement may reduce the risks of Type 2 diabetes and metabolic syndrome,” he adds.
According to a 2018 study published in peer-reviewed journal Cell Metabolism, pre-diabetic patients with consistently high insulin levels showed decreased insulin levels and increased insulin sensitivity after five weeks of time-restricted eating.
Intermittent fasting can also lower high blood pressure, another risk factor for chronic kidney disease.
Dr Wong says studies suggest that the nervous system tends to be in a more relaxed state during fasting periods, which reduces the frequency of heart contractions and hence lowers blood pressure.
Intermittent fasting and fasting during Ramadan have shown to improve kidney health. PHOTO: ISTOCKPHOTO
Maintaining a healthy weight is also important to reduce the risk of obesity-related conditions, including diabetes and hypertension, says Dr Tan.
Ms Diane Seto, a senior dietitian at Mount Elizabeth Hospital, says fasting during Ramadan has been shown to be effective in reducing fat mass and body weight. These changes may be more pronounced when combined with exercise.
Fasting can also help rebalance ghrelin and leptin levels, leading to improved appetite control, reduced food cravings and better weight management, notes Dr Tan.
Ghrelin and leptin are hormones that regulate hunger and satiety. Ghrelin, often called the “hunger hormone”, stimulates appetite, while leptin signals fullness and regulates energy balance.
Dr Aziz Noordin, a family physician and director at Tampines Family Medicine Clinic, has observed both improved and worsened blood pressure and sugar levels among Muslim patients fasting during Ramadan.
“The disciplined eating pattern during the eating window may encourage a person to make healthier food choices and practise portion control. But dehydration, overeating during non-fasting hours, missing their medications or reducing the dose on their own can cause patients’ blood pressure and sugar levels to worsen,” says Dr Aziz.
The benefits of fasting, Ms Seto says, can be reaped when one eats sensibly during the eating window.
She advises people to use the Health Promotion Board’s My Healthy Plate as a guide. This includes sticking to a balanced diet rich in nutrient-dense foods such as whole grains, vegetables, fruit and lean protein.
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There are, however, some adverse effects associated with fasting for those with chronic kidney disease.
One study published in the Saudi Medical Journal in 2017 found that fasting during Ramadan was associated with worsening of kidney function in patients with Stage 3 or higher chronic kidney disease, particularly in summer when the weather was hot.
There are five stages of chronic kidney disease, and the last stage is known as kidney failure.
The study advised clinicians to warn patients with chronic kidney disease against fasting during Ramadan.
Dehydration arising from a lack of fluid intake during fasting could worsen kidney function, cautions Ms Seto.
Those who want to fast, including those with chronic kidney disease and diabetes, should consult a doctor or dietitian to find out if fasting is appropriate for them.
Says Dr Wong: “There is a lack of large-scale research study supporting the use of fasting to improve chronic kidney disease. In fact, patients with advanced chronic kidney disease or poorly controlled diabetes are considered high-risk for fasting based on the International Diabetes Federation and Diabetes and Ramadan International Alliance.”
High risk for fasting refers to individuals who may face potential adverse effects or complications if they engage in the practice.
Dr Wong also highlights that everyone’s response to fasting can vary, and a more comprehensive understanding of the long-term effects of different fasting patterns on kidney health requires further research.
Who should avoid fasting?
Fasting during Ramadan requires a Muslim to abstain from food and drink during the fasting hours. PHOTO: PEXELS
Fasting may not be suitable for everyone, especially those with certain medical conditions. People who may need to avoid fasting, or consult a healthcare professional before attempting such a regimen, include the following groups.
Children and adolescents
Children and teenagers have specific nutritional requirements for growth and development, says Dr Tan. Fasting may interfere with their nutritional needs, affecting their physical and cognitive development.
Pregnant and breastfeeding women
This group of women, Dr Tan highlights, requires more nutrition to support foetal growth and lactation. Fasting may lead to inadequate nutrient intake and dehydration, which could affect the mother’s and foetus’ well-being.
Older adults
This group of people has special nutritional needs and may have underlying medical conditions that could be negatively affected by fasting, says Ms Seto.
For instance, some seniors may suffer from malnutrition or have vitamin and mineral deficiencies that could worsen with fasting.
People with Type 1 diabetes and on insulin therapy
While an increasing number of clinical trials have shown that intermittent fasting is safe for people with Type 2 diabetes – which is characterised by high blood sugar, insulin resistance and relative lack of insulin – there have been a lack of studies in those with Type 1 diabetes, says Dr Tan.
Type 1 diabetes is an autoimmune disease in which the cells that make insulin are destroyed by the body.
“Fasting may not be advisable for people with Type 1 diabetes as the intermittent fasting eating pattern may result in unsafe levels of hypoglycemia during the fasting period,” he notes.
Hypoglycemia is a condition characterised by low blood sugar levels. It typically occurs in people with diabetes who take insulin or other medications to lower blood sugar levels.
If fasting is not managed carefully, people with hypoglycemia, especially those taking blood sugar-lowering medications, may experience symptoms such as dizziness, fatigue and fainting, says Ms Seto.
Even among those with Type 2 diabetes, some may be considered high-risk and should not fast, cautions Dr Tan. This includes those taking multiple daily injections and people with brittle diabetes, which is a term sometimes used to describe hard-to-control diabetes.
People with a history of eating disorders
Dr Tan says intermittent fasting can lead to people in this group restricting themselves from eating and then binge eating, perpetuating a cycle that can worsen their disordered eating patterns.
This can lead to physical and psychological harm, adds Ms Seto.
Individuals with compromised immune function
People with cancer or those undergoing treatment may be vulnerable to a poor nutritional status, which refers to a condition in which an individual’s diet does not provide an adequate balance of essential nutrients to support optimal health and well-being.
Fasting may deprive the body of sufficient calories, protein and nutrients needed to fight off infections and illnesses, says Ms Seto.
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