Ramadan Fasting in Health and Disease
Ramadan fasting, an annual alternate day event, is characterized by repeated cycles of fasting and refeeding (fast and feast) periods generally separated by a 12 h interval. During the fast period, the subject refrains from eating, drinking, medicating, a
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Adel E. Berbari, Najla A. Daouk, Samir G. Mallat and Abdo R. Jurjus
26.1
Introduction
Fasting is defined as partial or complete abstinence from food and drink, and may be associated with restriction of calorie intake, certain food items, mainly macronutrients, or both [1]. Fasting can be practiced continuously over a prescribed period or on alternate days. Alternate day fasting consists of succeeding periods of abstinence (fast period) and nutrition (feast period) over a 24 h cycle [1]. During the fast period, food and fluid intake is discontinued completely, while during the feast period, those who fast resume food and fluid intake ad libitum [1]. Fasting may be partaken for health reasons or for religious or spiritual purposes. Although it may elicit favorable effects on several health-related outcomes, fasting may also impact negatively on the health of the individual. The aim of this chapter is twofold: (1) a review of the studied effects of Ramadan fasting, a form of alternate day fasting, on the biochemical, hemodynamic, and cardiorenal parameters in healthy individuals and in those suffering
A. E. Berbari (&) N. A. Daouk S. G. Mallat Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon e-mail: [email protected] N. A. Daouk e-mail: [email protected] S. G. Mallat e-mail: [email protected] A. R. Jurjus Anatomy, Cell Biology and Physiological Sciences, American University of Beirut, Beirut, Lebanon e-mail: [email protected] A. E. Berbari and G. Mancia (eds.), Special Issues in Hypertension, DOI: 10.1007/978-88-470-2601-8_26, Ó Springer-Verlag Italia 2012
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from one or more of the high cardiovascular risk conditions such as hypertension, diabetes mellitus, and or chronic kidney disease; and (2) to offer therapeutic recommendations for safe fasting under various conditions.
26.2
Ramadan Fasting
26.2.1 Definition Ramadan fasting, a fundamental requirement of the Islamic religion, is a form of annual alternate day fasting that is characterized by periods of fasting and feasting, generally separated by a 12 h interval [2, 3]. During the fast period, which generally lasts about 12 h, the individual must refrain from eating, drinking, smoking, sexual intercourse, and medicating from sunrise (Suhoor) to sunset (Iftar). On breaking the fast, the individual consumes a large meal at sunset and one lighter meal before dawn [2, 3]. An additional meal may be consumed before sleeping. Ramadan differs from total fasting as refeeding is essential once or twice within 24 h and as there is no restriction in the nature and extent of the food consumed between sunset and dawn [2]. While the abstinence period during Ramadan may be about 12 h, several factors modify the length of the daytime fast. Since the Islamic Calendar (Hijra) is a lunar calendar, the first day of Ramadan, which advances by 11 days each year in relation to the Gregorian calendar, falls in different days of the seasonal year over a 33 year cycle [1, 2]. This can result in Ramadan fasting being unde
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