Ramadan starts on the Evening of Wed, Mar 22 and we were approached by Members with regards to fasting advice around this time, Dr Zainab Wasim has shared the following. If you have other topics you’d like to hear more of, please get in touch.
Ramadan is the ninth month of fasting in the Islamic lunar calendar from dawn to dusk. It marks the first revelation of the holy book, the Quran to prophet Muhammad (PBUH). It represents a complete physical and mental reset as fasting is an act of going back to the basics : eating mindfully and stopping eating when nearly full, meditation with prayer and qur’anic recitation and gratitude and communities coming together to celebrate the month with opening of the fast and the acts of kindness and charity . It encompasses almost all the pillars of lifestyle medicine with the exception of sleep and maybe movement but then the act of prayer forces one to move, squat, kneel and stand five times a day and these principles have embodied this month representing the now tenets of lifestyle medicine since over fourteen hundred years ago.
There are exceptions to fasting such as pregnancy, illness, children and the elderly and while travelling.
The month of Ramadan offers an opportunity to enter upon a journey of lifestyle modification especially in the South Asian population where the incidence of chronic disease such as diabetes, hypertension , high cholesterol etc. are higher.(1) There is a model on the British Islamic Medical Association and is a compendium of expert evidence and consensus to risk stratify patients with these chronic conditions. This also draws upon the guidelines from the IDF-DAR guidelines (2) and the Ramadan Rapid review produced in 2020 to allow a patient led discussion regarding their ability to fast safely and without issues based on their risk.
A few whole foods mentioned in the Quran are olives, figs, grapes, onions, cucumber and pulses such as lentils and the Prophet Muhammad’s(PBUH) favourite foods were dates, milk, mutton and lamb although meat was rarity in his house. In view of mindful eating , he said, a third of your stomach should be for food, a third for drink and a third for air.(3) Wasting of food is frowned upon and so is overfeeding .The underlying principle is the body is entrusted to us and we should nourish it both for physical and mental wellbeing. This is one of the key principles to apply when opening the fast. Unfortunately many do the opposite and open the fast with fried, fatty foods which defeats the point altogether.
This month allows many addictions such as caffeine and tobacco to be overcome. This in turn is beneficial if sustained beyond this month and therefore it is crucial that patients be offered all the help available to give up smoking if they are finding that they are scrambling for a cigarette as soon as a fast is opened.
Physiological changes in the Ramadan fast:
On sleep and circadian rhythm: this recent meta-analysis has shown that total sleep time is reduced by only an hour with an increase in daytime sleepiness.4
There is usually a shift delay in the circadian rhythm with lower morning cortisol and higher evening cortisol ratio which is reversed by week 3 of Ramadan, along with reduction in ghrelin by last week of Ramadan.5
A meta-analysis showed on average weight loss of 1.24 kg with regaining of 0.72 kg following Ramadan but there is considerable variability in weight changes with Ramadan fasting .6
A small Turkish study has shown favourable effects on the gut microbiota. 7
No surprise, that Ramadan fasting upregulates the anti-inflammatory genes via epigenetics 8
Favourable effects on lipids in a meta-analysis showing significantly reduced LDL 9
In conclusion, Ramadan is an important teachable moment to introduce and implement lifestyle medicine principles in your patients to nudge them towards their optimum physical and mental wellbeing.
1.British Islamic Medical Association (BIMA). Ramadan compendium. December 11, 2021. Accessed November 29, 2022. https://britishima.org/ramadan/compendium/
2.International Diabetes Federation; Diabetes and Ramadan International Alliance (IDF-DAR). Diabetes and Ramadan: practical guidelines 2021. Accessed November 29, 2022. https://www.daralliance.org/daralliance/idf-dar-practical-guidelines-2021
3.Ramadan health guide (mcb.org.uk)
4.Faris, M.A.E., et al., Effect of diurnal fasting on sleep during Ramadan: a systematic review and meta-analysis. Sleep Breath, 2020. 24(2): p. 771-782.
5.Al-Rawi, N., et al., Effect of diurnal intermittent fasting during Ramadan on ghrelin, leptin, melatonin, and cortisol levels among overweight and obese subjects: A prospective observational study. PLoS One, 2020. 15(8): p. e0237922
6.Patterson, Ruth E., and Dorothy D. Sears. “Metabolic effects of intermittent fasting.” Annual review of nutrition 37 (2017).
7.Ozkul, C., M. Yalinay, and T. Karakan, Structural changes in gut microbiome after Ramadan fasting: a pilot study. Beneficial Microbes, 2020. 11(3): p. 227-233
8.Madkour, M.I., et al., Ramadan diurnal intermittent fasting modulates SOD2, TFAM, Nrf2, and sirtuins (SIRT1, SIRT3) gene expressions in subjects with overweight and obesity. Diabetes Res Clin Pract, 2019. 155: p. 107801
9.Kul, S., et al., Does Ramadan fasting alter body weight and blood lipids and fasting blood glucose in a healthy population? A meta-analysis. J Relig Health, 2014. 53(3): p. 929-42