Ramadan fasting & kidney disease may 2019

Ramadan Fasting
1439 Hijri
&
Kidney DiseasePROF NAGY SAYED-AHMED
MANSOURA UNIVERSITY

Fasting Ramadan is unique
metabolic model
Ramadan fasting is not a prolonged or continuous
fasting, but consists of alternate fasting and feasting
periods (i.e.: intermittent feeding).

‫ال‬ ‫وقلة‬ ‫الحرارة‬ ‫النخفاض‬ ‫الشتاء‬ ‫فترة‬ ‫في‬ ‫تصوم‬ ‫الحيوانات‬ ‫بعض‬،‫غذاء‬
)‫ة‬َ‫ر‬ْ‫ب‬ِ‫ع‬َ‫ل‬ ِ‫م‬‫َا‬‫ع‬ْ‫ن‬َ ْ‫اْل‬ ‫ي‬ِ‫ف‬ ْ‫م‬ُ‫ك‬َ‫ل‬ َّ‫ن‬ِ‫إ‬َ‫و‬(
‫الحيوانات‬ ‫بعض‬‫تمت‬ ‫متوالية‬ ‫شهورا‬ ‫بل‬ ‫أياما‬ ‫جحورها‬ ‫في‬ ‫تسكن‬‫نع‬
‫والطعام‬ ‫الحركة‬ ‫عن‬ ‫فيها‬
‫الطيور‬ ‫من‬‫مواسم‬ ‫في‬ ‫الطعام‬ ‫عن‬ ‫ويمتنع‬ ‫عشه‬ ‫في‬ ‫يكمن‬ ‫ما‬
‫عام‬ ‫كل‬ ‫معينة‬
‫اْلسماك‬ ‫بعض‬‫معين‬ ‫لفترة‬ ‫النهر‬ ‫أو‬ ‫البحر‬ ‫قاع‬ ‫في‬ ‫نفسه‬ ‫يدفن‬‫بدون‬ ‫ة‬
‫طعام‬
‫البرمائيات‬ ‫بعض‬‫ك‬ ‫الشتاء‬ ‫فترة‬ ‫في‬ ‫الطين‬ ‫في‬ ‫نفسها‬ ‫تدفن‬‫تفعل‬ ‫ما‬
‫الش‬ ‫البيات‬ ‫في‬ ‫الضفادع‬

‫لنفس‬ ‫يلتمس‬ ‫فإنه‬ ‫بالمرض‬ ‫يشعر‬ ‫عندما‬ ‫حيوان‬ ‫أي‬‫ه‬
‫أ‬ ،‫الطعام‬ ‫تناول‬ ‫عن‬ ‫يمتنع‬ ‫ثم‬ ‫فيه‬ ‫يرتاح‬ ‫هادئا‬ ‫مكانا‬‫ي‬
‫المرض‬ ‫فترة‬ ‫طوال‬ ‫طعام‬
‫لت‬ ‫أنها‬ ‫بل‬ ،‫مريضة‬ ‫تكون‬ ‫حينما‬ ‫الطعام‬ ‫تترك‬ ‫األبقار‬‫حكم‬
‫علي‬ ‫إجبارها‬ ‫وأطباؤها‬ ‫مربوها‬ ‫حاول‬ ‫إذا‬ ‫فكيها‬ ‫إغالق‬
‫الطعام‬ ‫تناول‬
‫الم‬ ‫وقت‬ ‫الطعام‬ ‫عن‬ ‫تمتنع‬ ‫المنزلية‬ ‫والقطط‬ ‫الكالب‬‫رض‬
‫إجب‬ ‫يحاولون‬ ‫عندما‬ ‫ألصحابها‬ ‫المضنية‬ ‫الجهود‬ ‫وتقاوم‬‫ارها‬
‫الطعام‬ ‫علي‬
‫ط‬ ‫بال‬ ‫ساكنا‬ ‫ويظل‬ ً‫ا‬‫جانب‬ ‫يأخذ‬ ‫المريض‬ ‫والدجاج‬ ‫البط‬‫عام‬
‫المرض‬ ‫فترة‬ ‫طوال‬ ‫شراب‬ ‫وال‬

‫ويرف‬ ‫الشهية‬ ‫يفقد‬ ‫المريض‬ ‫اإلنسان‬‫ض‬
‫عليها‬ ‫هللا‬ ‫فطره‬ ‫التي‬ ‫بغريزته‬ ‫الطعام‬‫إال‬
‫يحضونه‬ ‫حوله‬ ‫من‬ ‫أن‬‫ال‬ ‫على‬‫تشبث‬
‫ل‬ ‫ولو‬ ‫حتى‬ ‫مريضا‬ ‫يكون‬ ‫حينما‬ ‫بالطعام‬‫م‬
‫للطعام‬ ‫شهية‬ ‫له‬ ‫تكن‬
‫والشراب‬ ‫الطعام‬‫علي‬ ‫مرضاكم‬ ‫تكرهوا‬ ‫ال‬‫إن‬‫ف‬
‫ويسقيهم‬ ‫يطعمهم‬ ‫ربهم‬

Autolysis is the breaking down of fat stores
in the body in order to produce energy.
Free fatty acids are released into the blood
stream and are used by the liver for energy.
Liver is in charge of converting the fats into
a ketone body, and then distributing these
bodies throughout the body

• "Detoxification is a normal body process of
eliminating or neutralizing toxins through the
colon, liver, kidneys, lungs, lymph glands, and
skin.“
• When the fat reserves are used for energy during
a fast, it releases accumulated toxic chemicals
from the fatty acids into the blood which are
then eliminated through the aforementioned
organs

• During a fast energy is diverted away from the GIT due
to its lack of use and towards the metabolism and
immune system.
• Abnormal growths within the body, tumors and the like,
do not have the full support of the body's supplies and
therefore are more susceptible to autolysis
• fewer 'mistakes' are made by the DNA/RNA genetic
controls
• This is one reason that animals stop eating when they
are wounded, and why humans lose hunger during
influenza. Hunger has been proven absent in illnesses
such as gastritis, tonsillitis and colds.

Growth hormones are also released during a
fast, due to the greater efficiency in
hormone production
Following a drop in blood sugar level and
using the reserves of glucose found in liver
glycogen, the basal metabolic rate (BMR) is
reduced in order to conserve as much
energy within the body as can be provided

feeling of rejuvenation and
extended life expectancy
"The only reliable way to extend
the lifespan of a mammal is under-
nutrition without malnutrition."

• The experiment was performed in the 1930s by isolating
one worm and putting it on a cycle of fasting and
feeding. The isolated worm outlasted its relatives by 19
generations, while still maintaining its youthful
physiological traits. The worm was able to survive on its
own tissue for months. Once the size of the worm began
to decrease, the scientists would resume feeding it at
which point it showed great vigor and energy. "The life-
span extension of these worms was the equivalent of
keeping a man alive for 600 to 700 years."

Antiaging effects
Better attitude
Better resistance to
disease
Better sleep
Change of habits
Clearer planning
Clearer skin
Creativity
Diet changes
Drug detoxification
Improved senses
(vision, hearing, taste)
Inspiration
More clarity (mentally
and emotionally)
More energy
More relaxation
New ideas
Purification
Reduction of allergies
Rejuvenation
Rest for digestive organs
Revitalization
Right use of will
Spiritual awareness
Weight loss

• Emotionally, you will feel calmer, clearer and
happier.
• Fasters often report that depression lifts, goals
begin to feel more obtainable as obstacles are
put into proper focus.
• Doctors have reported patients experiencing
improved concentration, less anxiety, sleeping
better and waking more refreshed.

• most medical experts agree that fasting is not a healthy
weight loss tool.
– quick fluid loss, not substantial weight loss
• Fasting slows your metabolic rate down so your diet from
before the fast is even more fattening after you fast
• Fasting for weight loss carries other health risks as well.
• More risky if you've got liver or kidney problems, any
kind of compromised immune system functioning, or are
on medication -- even Tylenol,"

There is no scientific evidence it
will detox the body
"We know that the body is unable to
rid itself of toxins when we eat a
diet low in nutrients,“ (Fuhrman)
Fuhrman, J., Sarter, B., Calabro, D.J., Alternative Therapies, 2001; 8(4):1-3.

• "Fasting followed by a vegetarian diet interferes
with the immune system's activities, especially if
the immune system is overreacting, as it does with
lupus and other auto-immune diseases. Half a
dozen studies published in medical journals
ranging from the American Journal of Physiology -
Endocrinology and Metabolism to the Scandinavian
Journal of Rheumatology were cited .

Pregnant women.
People with wasting diseases or
malnutrition.
Those with a history of cardiac arrhythmias.
People with hepatic or renal insufficiency.

• Food consumed during the pre-dawn and dusk meals may
lead to some unintended weight gain. But if you approach
the fast with discipline, it can be an opportunity to lose
weight and become healthier
• Heartburn
• Poor control of diabetes
• Headache
• Dehydration
• Constipation
• Stress
• Weight control

Water
Sallt
Nutritional Impact
Other Aspect of health
Progression of Renal Disease

• The body continues to lose water and salts through
breathing, perspiring and urinating
• If you don’t drink sufficiently before a fast your risk of
dehydration is increased. This risk is higher in older
people and in those taking tablets such as diuretics.
• If you are unable to stand up due to dizziness, or you
are disoriented, you should urgently drink regular,
moderate quantities of water – ideally with sugar and
salt

Water Mainly
Hypertonicity
Water with salt
Isotonic Dehadration
Salt only (after water
compensation:
Hypotonicity

Decreased time available for eating
Decreased Gastric filling Capacity
Nausea and Vomiting
Type of food in Ramadan:
Hyperkalemia
Hyperphosphatemia

Effect of Dehydration
Effect on Stone formation
Effect on renal nutrition
UTI
Effect on Immune System

Hijri May
Day
Fajr Dhuhur Asr Magrib Isha Magrib Fasting
1439 2018 AM PM PM PM PM PM Duration
01, Ramadan 16 Wednesday 3:27:00 AM 11:51 3:28 6:42 8:12 6:42:00 PM 15:15:00
02, Ramadan 17 Thursday 3:26:00 AM 11:51 3:28 6:43 8:13 6:43:00 PM 15:17:00
03, Ramadan 18 Friday 3:26:00 AM 11:51 3:28 6:43 8:13 6:43:00 PM 15:17:00
04, Ramadan 19 Saturday 3:25:00 AM 11:51 3:28 6:44 8:14 6:44:00 PM 15:19:00
05, Ramadan 20 Sunday 3:24:00 AM 11:52 3:28 6:45 8:15 6:45:00 PM 15:21:00
06, Ramadan 21 Monday 3:23:00 AM 11:52 3:28 6:45 8:15 6:45:00 PM 15:22:00
07, Ramadan 22 Tuesday 3:23:00 AM 11:52 3:28 6:46 8:16 6:46:00 PM 15:23:00

15.5
8.5
Fating & Iftar Durations in hours
Fasting Iftar

Studies
divided
according to
their main
topic

 A small body mass loss is a frequent, but not universal,
outcome of Ramadan. During the daylight hours of
Ramadan fasting, practising Muslims are undoubtedly
dehydrating, but it is not clear whether they are
chronically hypohydrated during the month ofRamadan.
No detrimental effects on health have as yet been
directly attributed to negative water balance at the
levels that maybe produced during Ramadan.

 Controversies in CKD) and hemodialysis patients
 Absence of strict guidelines
 Renal transplant recipients with stable kidney function for 1
year post-transplantation
 Concern in hot weather for patients with kidney stone
diseases.
 CKD stages 4 and 5 and CKD stage 3 patients: very high risk
and high risk categories, respectively: ? To be exempted from
fasting.

The authors’ recommendations for
kidney diseases patients for
Ramadan fasting

922
1133
Fasting in CKD HDx Patients in Egypt 2016
Fasting Non-Fasters
Saudi Journal of Kidney Diseases and Transplantation (2018; in press)

375
547
Frequency of Fasting in CKD HDx Patients
in Egypt 2016
Frequent Infrequent
Saudi Journal of Kidney Diseases and Transplantation (2018; in press)

My conclusion!
 CKD Patients Who should not Fast:
?? GFR < 30
?? GFR < 15
 CKD with other associated problems:
Liver Disease
Diabetes
CVD
Neurological Disease
 What if the patient insisted to fast??

Ramadan fasting & kidney disease may 2019

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

Ähnlich wie Ramadan fasting & kidney disease may 2019

Ähnlich wie Ramadan fasting & kidney disease may 2019 (20)

Mehr von FarragBahbah

Mehr von FarragBahbah (20)

Kürzlich hochgeladen

Kürzlich hochgeladen (20)