Ramadan intermittent fasting and immunity: An important topic in the era of COVID-19

Abstract

WITH the growing pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome (SARS)-related coronavirus (SARS-CoV-2) infection, a parallel growing interest arose concerning potential preventive and adjunct therapies, dietary and lifestyle modifications, and remedies that may boost the immunity against SARS-CoV-2 infection. Furthermore, as Ramadan intermittent religious fasting that is practiced by about one and a half billion Muslims throughout the globe is coincide this year with COVID-19 pandemic, a growing debate rose concerning the expected impact of fasting during Ramadan month and the associated dietary and lifestyle behaviors on the body's immunity against the pandemic infection. Published literature was searched to find out how intermittent fasting (IF) and its model of Ramadan affect the various aspects related to the body's immunity against microbial infections. IF was found to impact immunity by changing different related elements, including oxidative stress and inflammation, metabolism, body weight, and body composition. Dietary and lifestyle modifications during Ramadan month and their impact on immunity, such as water intake and hydration status, sleep duration and timing, caloric intake and mealtime, and social and spirtual activities, were addressed. Further research is warranted to figure out how IF during ramadan affects immunity against SARS-CoV-2 infection.

Fasting Ramadan During COVID-19 Pandemic: Immunomodulatory Effect

“…Of interest is that diurnal intermittent fasting and its model of Ramadan affect the immunity by changing the body's response toward infection, inflammation, and oxidative stress (23). For instance, Ramadan fasting reduces the pathogenicity of Mycobacterium tuberculosis by increasing the macrophage number and INF-γ secretion in fasting volunteers (23). It was demonstrated to be safe for patients infected with HIV and on antiretroviral therapy (23).…”

“…It should be noted that the beneficial effects of Ramadan intermittent fasting on immunity might be reduced by the sleep pattern practiced in the blessed month of Ramadan. Several studies showed that total sleep time significantly decreased by about 1 h in Ramadan nights, while daytime sleepiness increased (23,36). Partial sleep deprivation is associated with increased susceptibility to viral infections (23,37).…”

“…For instance, Ramadan fasting reduces the pathogenicity of Mycobacterium tuberculosis by increasing the macrophage number and INF-γ secretion in fasting volunteers ( 23 ). It was demonstrated to be safe for patients infected with HIV and on antiretroviral therapy ( 23 ). It decreases C-reactive protein, pro-inflammatory cytokines such as IL-1β, TNF-α, IL-6, and IL-8 ( 24 – 27 ), and pro-inflamatory CXC chemokines such as CXCL1, CXCL10, and CXCL12 ( 27 ).…”

“…Several studies showed that total sleep time significantly decreased by about 1 h in Ramadan nights, while daytime sleepiness increased ( 23 , 36 ). Partial sleep deprivation is associated with increased susceptibility to viral infections ( 23 , 37 ). It impairs the immune functions, decreases cytokine release, and reduces the infection-fighting antibodies and cells ( 38 ).…”

Switching Host Metabolism as an Approach to Dampen SARS-CoV-2 Infection

“…In the absence of current treatment for SARS-CoV-2, a strong interest has emerged regarding the optimization of the intake of dietary factors, specifically lipids, to effectively reduce inflammation and oxidative stress, thus strengthening the immune response during the COVID-19 crisis. Besides, metabolic changes accompanied by IF that trigger antiviral mechanism has been suggested elsewhere [ 25 , 26 ].…”