The “Linking Lifestyle, BP, and Kidney Diseases: What Is the Evidence?” session was held on Nov 7, 2019, at the ASN #KidneyWk in Washington, DC.

Click here for more KidneyWk 2019 coverage on AJKD Blog. This is Part 2 of the Kidney STARS’ write-up of KidneyWk sessions.

Adipose Tissue and Modulation of Hypertension

As medical students, we are taught to educate our patients on healthy eating and physical activity. However, we are rarely taught the most recent evidence-based recommendations regarding lifestyle modification. When our patients tell us that they are busy and want to make the most out of their limited time, what advice do we give them? I attended the “Linking Lifestyle, BP, and Kidney Diseases” session to answer that question.

It was fascinating to learn the evidence supporting intermittent fasting in patients with kidney disease. Dr Hoon-Ki Sung demonstrated that in a recent study, two groups of mice were subjected to either time-restricted eating or allowed to eat as much as they desired (ad libitum). Despite having the same caloric intake, the former (intermittent fasting) had lower body weight at the end of the study, while the latter became obese.

If we apply this to our patients, is it possible for them to maintain their current diet, with a daily 10-hour eating period, and still be able to lose weight? The answer lies in the fact that ‘brown fat can be induced.’ We learned that intermittent fasting leads to “browning” of white adipose tissue, and that uncoupling protein 1 (UCP-1) is a marker of brown adipocytes.

During the feeding-fasting cycle, adipose tissue undergoes remodeling; after 6-hours re-feeding, white adipocytes return.

Because brown fat has increased thermogenesis (UCP-1 is also called thermogenin) compared to that of white fat, it leads to higher energy expenditure and decrease in body weight.

In a study of Ob/Ob mice, intermittent fasting led to increased glucose clearance due to increases in GLP-1 and insulin. The evidence for intermittent fasting also holds true in human studies. In patients with metabolic syndrome, intermittent fasting led to weight loss and blood pressure reduction. In patients with polycystic kidney disease, intermittent fasting also reduced cyst growth due to its ability to also decrease fibrosis. It has also been shown that intermittent fasting also leads to decreased CD9 (the precursor to fibrotic, inflamed adipose tissue).

Taking all of this into consideration, when patients ask me what lifestyle intervention they can try beyond the standard “diet and exercise,” I now have a new suggestion: intermittent fasting.

-Blog post prepared by:

Danielle Vazquez, Medical Student at University of California, San Francisco, CA,

and Edgar Lerma @edgarvlermamd, AJKD Social Media Advisory Board Member