The Impact of Fasting the Holy Month of Ramadan on Colorectal Cancer Patients and Two Tumor Biomarkers: A Tertiary-Care Hospital Experience

Abstract

Background: Fasting during the holy month of Ramadan is a religious ritual practiced by the majority of Muslims around the globe. This daytime fasting is short-term or intermittent fasting, which may be associated with valuable health benefits, particularly in cancer patients.Methods: A prospective cohort study of pre-and post-fasting evaluation of 37 colorectal cancer (CRC) patients was conducted at King Abdulaziz Medical City (KAMC) and King Abdullah Specialized Children's Hospital (KASCH)-oncology outpatient clinics. The study aimed to assess the impact of fasting during the holy month of Ramadan on the tolerability of chemotherapy side effects and to assess changes in the levels of carcinoembryonic antigen (CEA) and lactate dehydrogenase (LDH) tumor biomarkers, which are primarily associated with certain types of carcinomas, including CRC.Results: A total of 33 patients (89.2%) had fasted at least part of the month of Ramadan. Twenty-seven patients (73%) reported "Serenity" after fasting during Ramadan with improved tolerability of chemotherapy side effects. However, the results did not reveal any significant difference in the measured laboratory variables between pre-fasting values and by the end of the 30 days of Ramadan. Although statistically insignificant, the levels of CEA and LDH were reduced in 46.9% and 55.6% of patients, respectively. The mean level of CEA in the fasting group was substantially reduced by more than 40%, attributed to the highly significant decline of CEA levels in three patients (p=0.0283). Moreover, there were no significant differences between pre-and post-fasting blood creatinine levels or estimated glomerular filtration rates, ruling out any possible adverse effects of fasting on renal function. Conclusion:The current study confirms the safety and tolerability of intermittent fasting in CRC patients actively receiving chemotherapy, which is consistent with several reports. Nonetheless, the results did not reveal a significant decrease in CEA and LDH tumor biomarkers.

Fasting and Cancer: Practice and Patients’ Quality of Life during Ramadan

“…However, patients reported a significant improvement in emotional functioning which may be related to spiritual well-being, as the patient felt more active by being involved in religious activities and less depressed and isolated [8]. However, this is consistent with a number of studies that have reported no significant change during fasting, Kanan Alshammari and colleagues [9] showed that most CRC patients (73%) reported "serenity" after fasting during the holy month of Ramadan with improved tolerance. Moreover, this is consistent with a pilot trial [10] to study the feasibility and effects on quality of life (QOL) and well-being of short-term fasting during chemotherapy in gynecological cancer patients whose results showed that fasting during chemotherapy is well tolerated and appears to improve QOL and fatigue.…”

Take metabolic heterogeneity into consideration when applying dietary interventions to cancer therapy: A review

“…A third method, time-restricted eating (TRE), requires limiting the intake of all foods to a 4- to 12-h window [ 60 ]. Finally, some forms of fasting advocated by Christianity, Judaism, Buddhism, and Islam also showed benefits in patients with cancer [ 60 , 61 ].…”