The purpose of this review was to ascertain the effects on healthy Muslims of fasting during Ramadan. We found some changes such as weight loss, evidence of dehydration, increase in serum uric acid, and nonpharmacological improvement in lipid parameters. We also observed changes in daily lifestyles and mental-health status. Thus, observance of the Ramadan fasting has both positive and adverse effects on healthy individuals. The adverse effects, however, are unlikely to persist after Ramadan or to lead to other complications. Healthy individuals can observe Ramadan without anxiety about their health.
Keywords: Islam, Ramadan, religious fasting, lifestyle, health.
Ramadan is the ninth month of the Islamic lunar calendar. It has significance for Muslims as the month in which the Qur'an was revealed to Mohammed. To express their gratitude to God, during Ramadan Muslims abstain from eating and drinking from dawn to sunset. Apart from this proscription, there is no restriction on the amount or type of nocturnal food and fluid intake. During Ramadan the custom, however, is to consume a large meal after sunset and a relatively light meal before dawn.
Lasting 29 or 30 days, the Ramadan fast is one of the five pillars of Islam. It is believed to teach Muslims self-restraint and to remind them of the feelings of the have-nots. On the other hand, dramatic changes in dietary habits may be expected to cause physiological and psychological effects.
In a previous papef, we suggested that adherence to the religious beliefs of Islam may guide Muslims to live in a more healthy manner (Toda & Morimoto, 2001). In that study, however, considering Ramadan to be out of the ordinary, we did not discuss fasting at length. First of all, it should be known that, according to the Qur'an, children are not expected to fast. In addition, it is acceptable for anyone who is sick or traveling, and for women who are pregnant, lactating, or menstruating, to postpone fasting until another suitable time. To provide a more complete picture of the relationship of Islamic religious observance and health, in this study we investigated the effects of Ramadan fasting on healthy Muslims.
Numerous studies have reported significant weight loss during Ramadan (Adlouni, Ghalim, Benslimane, Lecerf, & Saile, 1997; Adlouni et al., 1998; Fedail, Murphy, Salih, Bolton, & Harvey, 1982; Kayikcioglu, Erkin, & Erakgun, 1999; Ramadan, Telahoun, Al-Zaid, & Barac-Nieto, 1999; Schmahl & Metzler, 1991; Sweileh, Schnitzler, Hunter, & Davis, 1992). The declines may result from water loss early in Ramadan and loss of body fat during the later period (Sweileh et al., 1992). In fact, we did find evidence of dehydration.
Loss of body fat would indicate the use of fat for energy production during Ramadan (Husain, Duncan, Cheah, & Ch'ng, 1987; Ramadan et al., 1999; Sweileh et al., 1992). In addition, researchers have found decreased heart rate and oxygen consumption during Ramadan (Husain et al., 1987; Ramadan et al., 1999; Sweileh et al., 1992). These findings suggest a metabolic adaptation to fasting. It seems that during the Ramadan daylight hours - when no food or water is taken in - to conserve stored energy, the metabolism slows down (Sweileh et al., 1992).
Other studies, however, have reported no change in body weight during Ramadan (El-Ati, Beji, & Danguir, 1995; Finch, Day, Razak, Welch, & Rogers 1998; Maislos et al., 1993; Maislos, Abou-Rabiah, Zuili, Iordash, & Shany, 1998). In fact, one study carried out in Saudi Arabia reported a significant increase in body weight during Ramadan (Frost & Pirani, 1987). Such variations may be attributable to local custom and food quality. In short, in Islamic communities - as elsewhere - food habits vary according to geography, culture, and socioeconomic factors (Musaiger, 1993; Rashed, 1992). Ramadan is a special month and the variety of foods generally increases (Karaagaoglu & Yucecan, 2000) so, during this period, richer meals and special treats are not uncommon in households that can afford them. …