Fasting and Chronic Kidney Disease: Helpful or Not?

Summary: Article is a summary of what impact fasting has on chronic kidney disease. Chronic kidney disease and fasting has a lot of research due to Ramadan. The Muslim month of fasting and praying and other religious activities. Hundreds of studies have been completed on the topic of fasting and chronic kidney disease. Also, see our short video about this topic “Fasting and Chronic Kidney Disease.”

The phenomenon of intermittent fasting is a trend that has become popular among individuals who want to maintain good health. While fasting may be novel in North America, it has been practiced for centuries in the Orient and the Middle East for religious reasons.

However, today intermittent fasting is done for a variety of perceived health reasons by people all over the world. Intermittent fasting  involves a period of not eating solid foods anywhere from 8-20 hours. Some people fast for a day every 7-14 days, others fast for a day every month and yet many Muslims fast for the 11-20 hours during the daytime for an entire month.

Aside from Muslims and some Christians who fast on specific days, there is no rule or law that mandates when one should practice fasting and for how long. As long as the individual is able to tolerate fasting, he or she can practice it anytime and anywhere. Fasting is not an abnormal physiological activity, we all fast from 6-9 hours every night while sleeping and intermittent fasting is just an extension of this nocturnal period. The human body is well equipped to handle all functions during fasting.

Is Intermittent Fasting Of Any Benefit?

Some studies show that intermittent fasting may help with weight loss, and may enhance metabolic health, prevent disease, and perhaps even increase the lifespan. The majority of people who fast state that this activity makes them feel better, more energetic, refreshed and rejuvenated. For most people, hunger is not a major issue if the practice is started with short term fasting. Once the body gets used to not eating, one can extend the hours.

To date, there is still much research being done on this topic and internet claims sometimes exaggerate the benefits. Talk to your doctor before trying fasting with or without any health problems you have. 

How Should One Practice Fasting?

The key thing about intermittent fasting is that the type of food consumed after the event is not relevant. As long as one eats everything in moderation, that is fine. The other thing about intermittent fasting is that it is not designed to cause pain and suffering. One may feel hunger pangs but any pain is not normal and should be reported to one’s healthcare provider. Thus, the hours of fasting can be selected based on personal preferences. One can fast for 6, 8,12 or 24 hours on any day and start the fast at any one point in time. Fasting for more than 24 hours for more than a day is not recommended as this can affect health. The ideal way to practice intermittent fasting is not eating for 12-16 hours every 7-14 days. 

Can one drink during fasting?

Because of the weather in North America, most people do not consume any solids during the fast but will take in sips of water to remain hydrated. Fasting should not be done in a manner where the individual becomes ill and then requires admission to a hospital. Fasting can be performed by all individuals over the age of 16. Fasting is not recommended for children and the elderly who can easily become dehydrated. 

For those who are just starting to practice fasting, go slow. Start by skipping breakfast and eat your first meal at noon and the last one before bedtime. If you can tolerate this phase, then you are already fasting for 16 hours a day. This is how most people fast. Others fast by not having breakfast or lunch and only have a large meal in the evening. This increases the duration of the fast and is not well tolerated by everyone. The key is to be comfortable fasting and not suffer. If you feel awful during the fast, then it is unlikely you will practice fasting again. 

During fasting one should try to avoid snacks or even small amounts of solid food; instead one can drink water, tea, or other non-alcoholic beverage to remain hydrated. Some people who fast for 12-18 hours, often consume small amounts of low-calorie foods like low-fat yogurt or a cracker. In addition, one can even take herbs and supplements while fasting as long as they are not rich in calories. Breaking a fast is not a sin.

What Happens During Fasting?

During fasting, there is a decrease in metabolic activity and consequently one will see a decrease in blood sugar, insulin, and fat. On the other hand, there is a marked increase in human growth hormone. 

Should Individuals With Chronic Kidney Disease Fast?

  • Chronic kidney disease affects a significant number of people globally and the disorder is categorized into 5 stages. It is the category of kidney disease that determines if fasting is safe.
    For example, individuals who have developed acute kidney failure should not fast until they have fully recovered. These patients need all the energy for recovery. For patients who have chronic kidney disease with stage 3 disease or higher are advised not to fast, because this makes the kidney more susceptible to further damage. 
  • Experts indicate that short fasting periods of 6-8 hours are fine for individuals with kidney disease and not on dialysis but prolonged fasting like the entire month of Ramadan is not recommended.

  • Individuals who are on hemodialysis typically undergo the procedure 2-3 times a week and are not able to fast because the procedures around 4 hours and fluid is removed from the body. Fasting on top of this can worsen the state of dehydration.

  • Individuals who have had a kidney transplant should not fast because they have rigid requirements for prescription medications. In addition, many of these patients are diabetic and fasting may worsen the overall health.

  • Individuals with kidney disease who want to fast should consult with a dietitian to determine what foods they should eat at the end of the fast or what they can drink during the fast. Many individuals with kidney disease often overlook the importance of a healthy kidney and a balanced diet during fasting.

  • To avoid weakness, individuals with kidney disease should not avoid the early morning meal prior to fasting. These individuals require adequate calories to last the entire day. At the time after the fast, these individuals should avoid a high intake of foods containing potassium, sodium, and phosphorus.

  • If the healthcare provider does approve of fasting in an individual with kidney disease who’s not on dialysis, then after the fast the individual should consume a low protein diet to avoid extra burden on the kidneys. At the same time, these individuals should drink 2-3 liters of fluid per day as long as they are not retaining any fluid. Thus daily body weight measurements are necessary. Plus the individual should be in the habit of regularly monitoring the blood pressure and heart rate.

  • On the other hand, individuals who are on dialysis need more protein to compensate for the protein lost during dialysis. These individuals should not drink more than 1 liter of water a day to prevent water retention, otherwise the extra water will enter the lungs.

  • During the month of Ramadan, the fast often ends at the end of the day and all types of festive foods, desserts, and sweets are prepared. However, individuals with kidney disease have to be very careful about what they eat and how much they eat. These foods are not only high in calories but also high in sugar which can speed up the process of atherosclerosis and worsen diabetes.

  • For individuals with kidney disease who fast, one should avoid spending a long time in high temperatures as the risk of dehydration is real.

  • If the individual is fasting and becomes ill, a visit to the nearest hospital is recommended. Blood work should be done to check for kidney function and electrolytes like sodium and potassium.

  • Several studies show that during prolonged fasting, the dehydration that results can lead to the formation of kidney stones. Hence, a little water throughout the day is highly recommended.

Alarm Symptoms During A Fast With Chronic Kidney Disease Include The Following:

  • Anorexia
  • Dizziness
  • Extreme lethargy
  • Facial swelling
  • Fatigue
  • Shortness of breath

Conclusion For Fasting With Kidney Disease 

Fasting can result in significant dehydration which can be detrimental to people with kidney disease. Individuals who have kidney disease should always first speak to their healthcare provider to assess the severity of their disorder and risks associated with fasting. And, of course, be sure to drink plenty of water if you do decide to try fasting. If you enjoyed this article, be sure to read our backlog of articles on kidney disease and diet tips.

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