A one-size-fits-all approach to IF is inappropriate, particularly for those with renal and cardiac vulnerability. Photograph used for representational purposes only
| Photo Credit: Getty Images/iStockphoto

The trend of intermittent fasting is growing in the community, and it has gained popularity among those trying to improve their general health or control their weight. There has also been interest in the possible benefits of intermittent fasting (IF) in promoting health and combating chronic diseases. But it is important to understand how IF works in order to avoid health issues and ensure optimal outcomes.

The kidney is essential to maintain the body’s equilibrium. Maintaining the body’s balance depends on the kidneys’ ability to filter waste, regulate blood pressure, and control fluid and mineral levels. Any substantial change in eating habits can affect how they operate.

Who can and cannot practice IF

When done correctly, intermittent fasting is generally safe for those with healthy kidneys. It might even be beneficial, by improving blood sugar regulation and reducing inflammation, both of which, over time, can support kidney function. A family history of kidney problems, diabetes, high blood pressure, or pre-existing renal disease, on the other hand, raises concerns. Long-term meal skipping or inadequate hydration can lead to dehydration, which strains the kidneys. Certain forms of fasting that restrict fluid intake, particularly when done for extended periods or in heated environments, could raise the risk of kidney stones or perhaps serious kidney damage.

These days, different salt compositions are increasingly consumed with different kinds of food, which may cause harm rather than benefit a patient with kidney and cardiac problems in particular. Fluid intake in excess can also be a problem with already weak kidneys. While intermittent fasting holds promise as a metabolic intervention, its effects on kidney health depend heavily on individual patient profiles. A one-size-fits-all approach is inappropriate, particularly for those with renal and cardiac vulnerability. It is important to counsel patients on both the potential benefits and risks of IF, offering personalised strategies for safe implementation.

Also Read:Intermittent fasting inhibits hair regeneration in mice: study

If in doubt, ask a doctor

Fasting may sometimes create imbalances and may also damage kidney function if done without a doctor’s instructions. Also, deterioration of kidney function can lead to the need for dialysis or a kidney transplant. Dialysis, which occurs multiple times each week, is when a machine is used to filter the body’s waste and fluids. A kidney transplant is where the damaged kidney is replaced with a functioning kidney from a donor. Typically, when patients are on dialysis, it is best not to fast because it may impair their ability to take in their fluids and electrolytes.

Intermittent fasting can be beneficial in certain circumstances, but how it affects kidney function depends on the person’s general health. Before beginning any fasting regimen, anyone with known renal problems or risk factors should speak with a doctor. Simple dietary adjustments can have a significant impact on important organs, and thus, it is always safer to proceed under supervision.

(Dr. Saurabh Khiste is a consultant nephrologist at Manipal Hospital, Baner, Pune. Email: saurabh.khiste@manipalhospitals.com)

A: The increase in core temperature observed during illness is commonly called fever and occurs in response to infection by a pathogen or certain types of physical injury. When a person becomes infected with bacteria, the white blood cells of the immune system recognise the incoming pathogen as foreign and initiate the first stages of the immune response: the acute phase.

In this reaction, white blood cells called monocytes release a variety of proteins called cytokines. They are central to the immune response. In particular, there is a predominance of two types of cytokine called interleukin-1 and tumour necrosis factor-alpha. These cytokines cause an increase in body temperature.

It is not clear how but it is known that they also cause the production of other chemicals in the brain. The main group of chemicals here are the postaglandins. They react very strongly with the hypothalamus area of the brain, which then sends a signal to the body to increase the temperature.

The mechanisms that the brain employs to effect this are not certain but are known to include increasing the metabolic rate and shivering. These two processes burn metabolic fuel faster than normal, and body heat is given off.

Experimental work shows that elevated temperatures can enhance certain aspects of the immune response. The growth rates of various types of bacteria are slowed at temperatures above normal body temperature.

– Nigel Eastmond, University of Liverpool

Migraine and depression often co-exist, and traditional antidepressants are not consistently effective for treating migraine. Fremanezumab may reduce the cumulative burden on patients with both conditions, potentially marking a breakthrough in integrated treatment | Image used for representational purpose only
| Photo Credit: Getty Images

A migraine drug has shown to significantly reduce symptoms of depression in patients — the first trial to show improvements in both the conditions using a single drug, researchers said.

Dual benefit of fremanezumab

In the study involving 540 patients, ‘fremanezumab’ was found to reduce days of migraine in a month and symptoms of depression, compared to a placebo (inactive substance producing no effects). The drug, administered as an injection beneath the skin (subcutaneous), is available in India.

Published in The Journal of the American Medical Association (JAMA) Neurology, the study is the first to demonstrate significant improvements in migraine and depressive symptoms — often seen to co-exist in patients — with a single drug, the researchers, including those from Albert Einstein College of Medicine, US, said.

Migraine and depression

Patients of migraine — a common neurological condition marked by recurring headaches — have been studied to be two to four times more likely to develop depression. The two conditions are suggested to have common genetic basis and biological processes that control levels of brain chemicals, such as serotonin and glutamine.

The researchers said that patients having migraine and depression are treated with antidepressants — which work by improving serotonin levels. Serotonin helps regulate mood, and low levels can cause sadness, anxiety and irritability.

However, antidepressants are not uniformly effective for migraine. Further, data is limited on the efficacy of migraine therapy in people also experiencing psychiatric conditions.

Trial across 12 countries

The trial was conducted over a 28-week period at 61 centres across 12 countries, including the US, UK, France, and Germany, between July, 2020, and August, 2022.

The participants were randomly assigned to receive a monthly dose of fremanezumab (225 milligrams) or a placebo at the study’s start and at the end of week four and week eight. “Although treatment with fremanezumab and placebo both resulted in clinically meaningful reductions in depressive symptoms, fremanezumab achieved statistical significance vs placebo at week 8,” the authors wrote.

They suggested that the reduced depressive symptoms could be an indirect effect of the drug actively treating migraine, although further analyses are required to understand this.

The results “suggest that fremanezumab was effective in a difficult-to-treat clinical population with migraine and comorbid major depressive disorders and may also be effective in alleviating psychiatric comorbidities, therefore reducing the cumulative burden on patients.”