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EFFECTS OF RAMADAN FASTING ON HEALTH – Book Sample

Ramadan Fasting and Immunity System

Abstract

Ramadan fasting represents the ninth month of the Muslim lunar calendar and the fourth of the five pillars of the Islam creed. Even though patients and pregnant women are exempted from observing this religious duty, they may be willing to share this particular moment of the year with their family and peers, by attending the special prayers (such as the tarawih), social gatherings and other ceremonies.

However, there are no guidelines or standardized protocols that can help clinicians to properly address the issues and concerns of patients and pregnant women eager to fast in Ramadan and correctly advising them. Despite the extensive body of studies conducted on Ramadan fasting, no clear information is available concerning the changes of immunity system during the fasting month.

We systematically searched ISI Web of Science (WoS), Scopus, MEDLINE/PubMed, Google Scholar, DOAJ, EbscoHOST, Scirus, Science Direct, the Cochrane Library and ProQuest. We used a proper string made up of a combination of key-words such as “Islam”, “Ramadan”, “Fasting” and “Immunity”. 30 original research articles were included in the current review: 14 studies focusing on immunity changes in healthy subjects, 7 in athletes, 5 in patients with metabolic disorders, 3 in individuals suffering from cardiovascular diseases and hypertension, and only 1 in pregnant women.

From the collected evidences, we can conclude that: 1) Ramadan fasting does not result in severe immunological disturbances, being all the changes transient and recovering to normal values and ranges after the fasting month; 2) maternal fasting during the second trimester does not have a significant impact on maternal oxidative stress, fetal development or fetal birth weight; 3) Ramadan fasting can have beneficial effects on patients suffering from metabolic disorders (obesity and diabetes mellitus); 4) Ramadan fasting can have positive effects on patients with stable cardiac diseases and hypertension, improving cardiovascular, lipids profile and oxidative stress; 5) Ramadan can affect and impair the activity of athletes. However, the majority of the studies has been conducted among healthy volunteers and there is a dearth of data about patients suffering metabolic and cardiovascular diseases. No data are available for patients with autoimmune disorders. Further research in the field is urgently needed.

Introduction

The Holy month of Ramadan, the ninth month of the Muslim lunar calendar (Hijra), is particularly blessed and of great value and significance among Muslims, representing the month of the descent of the Qu’ran. Ramadan is not only abstinence from food and drinking, but also from smoking, medication and sexual intercourses (Surat 2 “Al-Baqarah”, ayyat 183 and following verses).

Ramadan fasting is not, however, a prolonged or continuous fasting, but consists of alternate fasting and feasting (re-feeding) periods [1]. The fast is broken, taking two traditional meals, pre-dawn meal which is termed as suhoor, whilst after-sunset meal is called iftar. Ramadan duration is variable (29-30 days), mean fasting duration is usually 12-14 hours, but depending on the place and the year it can last also up to 18 hours [1] or even 22 hours, in the extreme latitudes regions [1].

Patients and pregnant women are exempted from this religious duty (Surat 2 “Al- Baqarah”, ayyat 185-186). However, they could be willing to fast and share the spirituality of this month with their family and peers, by attending the special prayers (such as the tarawih, usually prayed in pairs of two in at least 20 raka‘at according to Hanafis and Shafi’i schools, while some scholars believe that 8, 12 or 20 raka‘at can be done, with a break after every 4 rak’ah), social gatherings and other special ceremonies [3].

The effects of Ramadan fasting on human physiology and physiopathology is not a mere academic and speculative topic or of limit interest for only the Arabic countries. It has instead clinically relevant and pragmatic implications: in a globalized society, the physicians have to face with issues like the management of diabetes mellitus and Chronic Kidney Diseases (CKDs) in Muslim patients that want to fast during Ramadan [4]. However, information is sparse and no guidelines or standardized protocols exist [4,5].

For these reasons, we carried out an extensive overview on the impact of Ramadan fasting on the immunity system.

Materials and Method

We systematically searched ISI Web of Science (WoS), Scopus, MEDLINE/PubMed, Google Scholar, DOAJ, EbscoHOST, Scirus, Science Direct, the Cochrane Library and ProQuest. We used a proper string made up of a combination of key-words such as “Islam”, “Ramadan”, “Fasting” and “Immunity”.

Gray literature was also manually searched. Review articles or research manuscripts not pertinent with the aim of this systematic review were excluded, while all the other research articles (including editorials, letters, case reports) were retained. No time and language filters were applied.

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