Renin, Aldosterone and Glucagon in the Natriuresis of Fasting

Bleich, Howard L.; Boro, Emily S.; Spark, Richard F.; Arky, Ronald A.; Boulter, Philip R.; Saudek, Christopher D.; O’Brian, John T.

doi:10.1056/nejm197506192922506

Cited by 81 publications

(8 citation statements)

References 16 publications

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“…In a prospective study with obese subjects a fast over 16 days led to substantial weight loss paralleled by decreased basal and exercise-induced serum concentrations of noradrenaline, adrenaline, and dopamine [31]. Moreover, fasting is associated with increases in concentrations of growth hormone and glucagon and leads to pronounced initial natriuresis and diuresis [32]. …”

Section: Discussionmentioning

confidence: 99%

Metabolic and Psychological Response to 7-Day Fasting in Obese Patients with and without Metabolic Syndrome

Ostermann

Hardt

et al. 2013

Complement Med Res

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Background: Extended modified fasting is a frequently practiced tradition in Europe. It is claimed to improve the cardiometabolic state and physical and psychological well-being by an evolutionary co-developed adaptation response. We aimed to investigate the cardiometabolic and psychological effects of a 7-day fast and differences of these responses between patients with or without metabolic syndrome (MetS). Methods: We investigated 30 female subjects (49.0 ± 8.1 years, BMI 30.4 ± 6.7 kg/m²) with (n = 12) and without (n = 18) MetS. All subjects participated in a 7-day fast according to Buchinger with a nutritional energy intake of 300 kcal/day and stepwise reintroduction of solid food thereafter. Outcomes were assessed baseline and after fasting and included measures of metabolic and glucoregulatory control, adipokines as well as psychological well-being as assessed by Profile of Mood States (POMS) and Hospital Anxiety and Depression Scale (HADS). Results: Mean weight decreased from 85.4 ± 18.8 kg to 79.7 ± 18.2 kg accompanied by systolic/diastolic blood pressure (BP) reduction of -16.2 mm Hg (95% CI: -9.1; -23.3 mm Hg) and -6.0 mm Hg (95% CI: -1.8; -10.3 mm Hg), each p < 0.001 and p = 0.005. Fasting led to marked decreases of levels of LDL-cholesterol, leptin, and insulin and increases of levels of adiponectin, leptin receptors, and resistin. Fasting-induced mood enhancement was reflected by decreased anxiety, depression, fatigue, and improved vigor. Patients with MetS showed some greater changes in B P, LDL-cholesterol, triglycerides, adiponectin, leptin, and sleep quality. Fasting was well-tolerated. Conclusions: Our results point to marked beneficial responses to 7-day modified fasting and a potential role in the prevention of the MetS. Randomized trials with longer observation periods should test the clinical effectiveness of fasting in metabolic diseases.

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Section: Discussionmentioning

confidence: 99%

Metabolic and Psychological Response to 7-Day Fasting in Obese Patients with and without Metabolic Syndrome

Ostermann

Hardt

et al. 2013

Complement Med Res

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“…Clinically, fasting leads to a pronounced initial (days 1-3) natriuresis and diuresis. The mechanisms of fasting-induced natriuresis remain partly unclear; however ketoacidosis and fasting-induced increases of blood levels of aldosterone, glucagon, and natriuretic peptides are involved [51]. Studies on VLCD demonstrated an enhanced blood pressure-reducing effect of natriuretic peptides, which points to improved receptor sensitivity following a fasting intervention [52].…”

Section: Mechanisms Of Fasting Effectsmentioning

confidence: 99%

“…Fasting led to an average blood pressure reduction of 37/13 mm Hg, and in patients with stage 3 hypertension to an average reduction of 60/17 mm Hg. Despite the initial fasting-induced activation of the HPA axis the pronounced natriuresis of fasting, the increased concentration of and sensitivity to natriuretic peptides, the lack of salt intake, and the orchestrated endocrine effects of fasting including pronounced decreases in insulin may mediate this clinically relevant blood pressure reduction [51,52,97]. The blood pressure-reducing effect of fasting has also led to the recommendation of fasting experts to strictly reduce or withdraw antihypertensive medication when initializing fasting therapy, in order to avoid symptomatic hypotension as well as hyponatremia.…”

Section: Clinical Effects Of Fastingmentioning

confidence: 99%

Fasting Therapy for Treating and Preventing Disease - Current State of Evidence

Michalsen

2013

Complement Med Res

112

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Periods of deliberate fasting with restriction of solid food intake are practiced worldwide, mostly based on traditional, cultural or religious reasons. There is large empirical and observational evidence that medically supervised modified fasting (fasting cure, 200-500 kcal nutritional intake per day) with periods of 7-21 days is efficacious in the treatment of rheumatic diseases, chronic pain syndromes, hypertension, and metabolic syndrome. The beneficial effects of fasting followed by vegetarian diet in rheumatoid arthritis are confirmed by randomized controlled trials. Further beneficial effects of fasting are supported by observational data and abundant evidence from experimental research which found caloric restriction and intermittent fasting being associated with deceleration or prevention of most chronic degenerative and chronic inflammatory diseases. Intermittent fasting may also be useful as an accompanying treatment during chemotherapy of cancer. A further beneficial effect of fasting relates to improvements in sustainable lifestyle modification and adoption of a healthy diet, possibly mediated by fasting-induced mood enhancement. Various identified mechanisms of fasting point to its potential health-promoting effects, e.g., fasting-induced neuroendocrine activation and hormetic stress response, increased production of neurotrophic factors, reduced mitochondrial oxidative stress, general decrease of signals associated with aging, and promotion of autophagy. Fasting therapy might contribute to the prevention and treatment of chronic diseases and should be further evaluated in controlled clinical trials and observational studies.

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“…Next, the action of insulin promotes sodium retention contributing to the edematous state. Insulin therapy promotes renal tubular sodium reabsorption by stimulating the Na+/K+-ATPase as well as the expression of Na+/H+ exchanger 3 in the proximal tubule and is balanced by glucagon, which serves to increases natriuresis at the distal tubules [11][12]. The actions of insulin when reintroduced into the insulin-deficient state leads to the promotion of sodium retention and the inhibition of natriuresis by the suppression of glucagon.…”

Section: Discussionmentioning

confidence: 99%