Ramadan fasting linked to favorable metabolic changes and reduced chronic disease risk

By Hugo Francisco de SouzaReviewed by Susha Cheriyedath, M.Sc.Feb 4 2024

In a recent study published in The American Journal of Clinical Nutrition, researchers carried out a metabolomics investigation to elucidate the impacts of Ramadan fasting on health and metabolism. Their study group comprised 72 participants who provided blood shortly before and after Ramadan fasting, based on which researchers generated metabolic scores. Study findings, obtained by comparing participants' metabolic scores against those maintained by the UK Biobank, reveal that Ramadan fasting significantly reduced the risks of lung, colorectal, and breast cancers.

Study: Metabolomics of Ramadan fasting and associated risk of chronic diseases. Image Credit: Odua Images / Shutterstock

Can depriving your body of food make you healthier?

Fasting, the intentional abstention from consuming food and sometimes liquids, is practiced for clinical, religious, political, and fitness reasons, the latter of which is rapidly growing in popularity. Reports reveal that globally, many health-conscious individuals are gravitating toward 'time-restricted fasting,' an approach that restricts daily eating to a predetermined period each day (usually six to eight hours). Popularized by the term' intermittent fasting,' this trend promises general health improvements, weight loss, and fitness benefits.

Unfortunately, apart from observational evidence for weight loss, comprehensive metabolic and cohort-based studies into the other benefits of time-restricted fasting remain lacking. Ramadan, the Muslim month of fasting, reflection, prayer, and community, shares every trait of time-restricted fasting except its intent (Ramadan is religious fasting). This provides a 'natural experiment' to quantify the positive or negative impacts of time-restricted fasting.

Two previous works have investigated the impacts of Ramadan fasting on health. However, these studies were small-scale (n = 11, 25) and used dated analytical tools focused on overweight and obese individuals not representative of the fitness-oriented. This presents the need for an updated study using the latest metabolomics techniques and a larger, more generalized sample cohort, the results of which will inform the billions of Muslims and health-minded people worldwide.

About the study

In the present study, researchers recorded the metabolomics alterations following Ramadan fasting. Their study cohort was the London Ramadan Study (LORANS), an observational cohort comprising 140 Muslims who observe the Ramadan fast. Study data collection included demographic data, medical records, and two blood samples provided a few days before and a few days following initiation of the fast. Additionally, blood pressure and body composition were recorded during routine blood collection.

Study inclusion criteria comprised age (above 18 years), intended duration of fast (20 days or more), and completed data records. Pregnant women were excluded from the study. Following exclusions due to unmet criteria requirements, 72 participants were included for data analyses, all providing written informed consent to participate in the study.

Blood samples were processed to separate and isolate the plasma, which in turn was subjected to high-throughput Nuclear Magnetic Resonance (NMR) spectroscopy using the Nightingale platform. The Nightingale platform was chosen due to its ability to identify and quantify 169 lipids and metabolites. It was also selected because the United Kingdom's (UK) Biobank dataset includes Nightingale platform readings. The UK Biobank is a country-wide large-cohort prospective study comprising 500,000 English citizens representative of the nation.

Linear mixed-effects models were used to compare NMR readings from blood samples provided before and after fasting, allowing a one-to-one comparison of the metabolite changes arising as outcomes of the fasting process. Additionally, UK Biobank Nightingale platform metabolite readings were used to compute metabolic risk scores for common chronic diseases, including cancers and cardiometabolic disorders. These values were then applied to NMR readings from this study to measure the relative change in chronic disease risk as a consequence of Ramadan (and, by extension, intermittent) fasting.

Study findings

Demographic analyses revealed that the mean age of the 72-strong study cohort was 45.7 years, 48.6% (n = 35) of whom were male. Body assessments during blood collection visits showed that, on average, participants lost 1.7 kg and 1.1% of their body fat in the two to three weeks between measurements. Nightingale platform analyses show that of the 169 measured metabolites, 14 were observed to change significantly when comparing blood collections.

These included one inflammation marker, one amino acid, two glycolysis-related metabolites, two ketone bodies, two triglycerides, and six lipoprotein subclasses. The most significant differences before/after Ramadan were observed for lactate (β = -0.31, P <0.001), acetate (β= -0.22, P <0.001), tyrosine (β= - 0.10, P=0.019) (all inverse) and acetone (β= 0.10, P=0.019) (direct).

For establishing the metabolic risk scores, baseline characteristics of 117,981 UK Biobank participants were used to establish seven scores, including diabetes (using 46 metabolites), coronary heart disease (16), hypertension (25), renal failure (12), lung cancer (nine), colorectal cancer (two), and breast cancer (one). Applying these scores to present study participants reveals that the relative risk of lung, colorectal, and breast cancers decreased by 9.6%, 2.4%, and 1.1%, respectively. In contrast, the other measured outcomes observed no changes in metabolic risk scores.

Conclusions

The present study uses Ramadan fasting as a natural experiment to investigate the effects of time-restricted fasting on people's health and chronic illness risk. It used cutting-edge, high-throughput NRM spectroscopy via the Nightingale platform to compute chronic disease metabolite risk scores.

When applied to the 72 included study participants, the metabolic risk scores highlight the beneficial role of Ramadan fasting in reducing the risk of certain cancers such as lung (-9.6%), colorectal (-2.4%), and breast (-1.1%), while having no measurable effects on cardiovascular disease risk.

Ramadan fasting is associated with short-term favorable changes in the metabolic profile concerning the risk of some chronic diseases. These findings should be further investigated in future, larger studies of longer follow-up with clinical outcomes.