Implications of Ramadan Fasting in the Setting of Gastrointestinal Disorders

Abstract

Intermittent fasting is an increasingly popular dieting technique with many well-studied benefits, such as permitting weight loss in obese patients, lowering low-density lipoprotein cholesterol (LDL-C) levels and triglyceride levels, and optimizing circadian rhythms. A special type of intermittent fasting occurs during Ramadan, when Muslims worldwide fast daily from dawn to sunset for a month. Ramadan fasting has demonstrated several health benefits, including improving the gut microbiome, modifying gut hormone levels, and lowering proinflammatory markers such as cytokines and blood lipids. Although fasting has many health benefits, fasting during Ramadan may aggravate chronic medical conditions. We aim to review the literature devoted to Ramadan fasting and its effects on Muslim patients with gastrointestinal (GI) disorders, such as Inflammatory bowel disease (IBD), peptic ulcer disease (PUD), upper GI bleeding (UGIB), gastroesophageal reflux disease (GERD), and liver conditions. We will discuss recommendations for diet and medication compliance during Ramadan in the recommended pre-Ramadan counseling sessions. In this study, we used PubMed to research journals using the key terms "Ramadan," "intermittent fasting," and "gastrointestinal diseases." The current literature studying the impact of Ramadan on gastrointestinal disorders shows that patients with IBD have a minimal risk of disease exacerbation, although older men with ulcerative colitis (UC) were more prone to exacerbation during fasting. Patients with duodenal ulcers were at a higher risk of hemorrhage after Ramadan fasting. Although with mixed results, studies show patients with liver disease demonstrated improvements in liver enzymes, cholesterol, and bilirubin after Ramadan. Physicians should offer pre-Ramadan counseling to educate patients on the risks of fasting and encourage shared decision-making. To facilitate more definitive discussions between the physician and a Muslim patient, clinicians should seek a deeper understanding of how Ramadan fasting affects certain health conditions and offer accommodations, such as diet and medication adjustments.

Patient Care During Ramadan: A Narrative Review

“…Patients suffering from gastroesophageal reflux disease may benefit from fasting as studies have indicated reductions in symptoms, even when accounting for change in meal size and tobacco use. 10 , 37 , 38 Studies using upper endoscopy surveillance during Ramadan did not detect any worsening occurrences of gastritis, gastric ulcers, or gastric bleeding though there were increases in rates of duodenal ulcers and duodenitis. Patients with known duodenal disease should take caution with fasting.…”

“…Decreases in GLP-1 and the improved leptin/adiponectin ratio in time-restricted fasting favor decreased insulin resistance. 9 , 10 These markers are also affected by circadian rhythm, which changes during Ramadan fasting. 9 Low-density lipoprotein, triglycerides, insulin, CRP levels, and endothelial function demonstrate improvement in studies comparing periods before and during Ramadan.…”

“…These findings may positively affect the risk of obesity and gastrointestinal symptoms if sustained. 10 …”

“…Patients with stable Crohn's disease and ulcerative colitis appear to have no significant flares as a result of fasting during Ramadan Though some data suggested an increase flares in elderly patients with ulcerative colitis. 10 …”