Evaluation of Self-Perceived Changes in Gastrointestinal Symptoms During Ramadan Fasting

Abstract

Little is known regarding the effects of Ramadan fasting on common gastrointestinal symptoms. The aim of this study was to assess the alterations of these symptoms in a healthy Iranian adult population during Ramadan. In a cross-sectional study, self-administered questionnaires were used to evaluate the alterations in seven groups of gastrointestinal symptoms (esophageal symptoms, dyspeptic symptoms, bloating and abdominal distension, constipation, diarrhea, abdominal pain, and nausea) after Ramadan. A total of 900 individuals participated in the study. Almost 87 % of participants reported to fast for at least 2 weeks during Ramadan. After adjusting for potential confounders, we found no relationship between alteration in frequency of gastrointestinal symptoms and Ramadan fasting, except for constipation which increased significantly after Ramadan fasting (odds ratio 1.99, 95 % confidence interval 1.05-3.80, P < 0.05). In addition, those who fasted for at least 2 weeks reported to experience severe or very severe constipation-related symptoms three times more in comparison with those who fasted for less than 2 weeks (P < 0.05). There was no relationship between severity of other gastrointestinal symptoms and Ramadan fasting. We found that Ramadan fasting does not increase frequency and severity of common gastrointestinal symptoms in the general population except for constipation that may be experienced more frequently and severely among those who fast for 2 weeks or more.

Impact of Ramadan Fasting on Dietary Intakes Among Healthy Adults: A Year-Round Comparative Study

“…In this study, the increased intake of dietary fibers, vitamin C, beta-carotene, and vitamin A (expressed as retinol equivalent) during Ramadan compared to the non-fasting remainder of the year could be explained by a higher intake of vegetables, and dried fruit during Ramadan night hours. This increased intake of fiber-rich foods could be looked at as a prophylactic measure for the anticipated and frequently experienced constipation during the fasting hours, which is exaggerated with the lack of water intake and reduced physical activity during Ramadan (68). Besides, fresh and dried fruits and vegetable salads are principal ingredients in many dishes during and out of Ramadan in the traditional Lebanese cuisine, which is part of the Mediterranean diet pattern (42).…”

Disruption of Circadian Rhythms and Gut Motility

“…[38][39][40][41][97][98][99] Studies have indicated that patients with disrupted circadian rhythms present with gastrointestinal symptoms/ disorders, most notably constipation, and IBS. [48][49][50]53,62 Some studies of circadian rhythms in the gastrointestinal system have been hampered by the inability to adequately control external cues, such as light-dark cycles or food intake in many clinical studies. 77 Nevertheless, constipation has been associated with circadian rhythm-dependant differences in colonic transit following waking or food consumption, and frequency of bowel movements compared to nonconstipated patients.…”

“…A questionnaire measured the rate of constipation in 900 individuals and found that those who fasted for > 14 days reported more "severe" or "very severe" constipation than those who fasted for <14 days. 62 However, alimentation is a confounding factor, affected by the increased volume of food intake and, in some cases, the introduction of traditional dishes. 24,25 There are conflicting reports on MMC duration, ie, shorter vs. no difference 37,38 Colon Normal colonic motility follows a circadian rhythm, with minimal activity during the night and increased activity during the day HAPCs are more prevalent in the morning 36 LAPCs increase after meals and during the day 10 Antegrade propagating sequences are more frequent and of greater amplitude during daytime hours 39 Retrograde propagation sequences are less frequent and have lower amplitude during daytime hours 42 Postprandial distal colonic activity consists primarily of retrograde propagating sequences following a meal in healthy persons 43…”

Effect of High Fiber Cereal Intake on Satiety and Gastrointestinal Symptoms during Ramadan

“…Likewise, a recent systematic review of interventions studying the effect of high fiber cereal on bowel function indicated that wheat fiber promotes healthy bowel function as it improves total stool weight, dry stool weight, intestinal transit time, and stool frequency [38]. In addition, other studies conducted on Ramadan fasting individuals reported constipation as the most frequent gastrointestinal symptom experienced by the end of Ramadan [39,40]. Therefore, recommending high fiber cereal to reduce symptoms of constipation and improve bowel function for fasting individuals during Ramadan should be taken into consideration.…”