Ramadan Fasting Exerts Immunomodulatory Effects: Insights from a Systematic Review

Abstract

Ramadan is the ninth month of the Islamic lunar calendar and is observed by Muslims as a month of fasting. All Muslim adults are expected to fast; nevertheless certain subgroups, including sick, frail subjects, and pregnant women, among others, are exempted. Ramadan fasting has been shown to impact on body systems in different manners. The influence of Ramadan fasting on immune system regulation remains elusive; however, immune system changes, such as the modulation of body response to various infectious, stressful, and other harmful events, are of great interest during fasting. In this paper, we performed an extensive systematic literature review of different scholarly databases (ISI/Web of Science, Scopus, PubMed,/MEDLINE, Google Scholar, Directory of Open Access Journals, EbscoHOST, Scirus, Science Direct, the Cochrane Library, and ProQuest), using the following key words: “fasting,” “Ramadan,” “Islam,” and “immunity.” Conclusions drawn from these findings included: (1) Ramadan fasting has been shown to only mildly influence the immune system and the alterations induced are transient, returning to basal pre-Ramadan status shortly afterward. (2) Ramadan fasting during the second trimester of pregnancy was shown to be safe and did not result in negative fetal outcomes, or maternal oxidative status alterations. (3) In cardiac patients, Ramadan fasting can have beneficial effects including lipid profile improvement and alleviation of oxidative stress. (4) In asthmatic patients as well as in patients with human immunodeficiency virus/acquired immunodeficiency syndrome and autoimmune disorders, fasting was safe. (5) In psychiatric patients, such as those suffering from schizophrenia, fasting could increase immunologic markers. (6) Fasting Muslim athletes who maintain intensive training schedule during Ramadan showed fluctuations of immunologic markers.

Fasting may be an alternative treatment method recommended by physicians

“…Some trials indicate that fasting has positive effects on body weight, glycemia, cardiometabolic risk, inflammation and OS markers ( Table 2). In cardiac patients, Ramadan fasting have beneficial effects such as lipid profile improvement and alleviation of OS (34). It has been identified significant improvement in BMI, serum lipid profiles, and OS parameters by fasting.…”

Fasting Ramadan During COVID-19 Pandemic: Immunomodulatory Effect

“…It has a potential protective role against oxidative stress and inflammation by increasing the expression of three antioxidant genes (TFAM, SOD2, and Nrf2) (29). A systemic review by Adawi et al illustrated a graphical explanation of the mechanism related to Ramadan intermittent fasting and the immune system (6).…”

“…Although following such measures would not eliminate the risk rather than improve the symptoms in case of infection, the recommendations might be misinterpreted to encourage some Muslims to stop fasting during Ramadan. Ramadan fasting is only required of healthy adult Muslims who are physically able to fast (6,7). Therefore, Muslims are legally exempted from fasting if their health status would not enable them to fast.…”

Ramadan Intermittent Fasting and Its Beneficial Effects of Health: A Review Article

“…The review of many literatures on this point concluded that the Ramadan fasting appears to have significant effect on weight loss and LDL cholesterol that could be translated in to significant reductions of cardiovascular diseases, coronary heart disease, myocardial diseases and atherosclerosis [27][28][29][30][31][32].…”