Health Benefits of Islamic Intermittent Fasting

Abstract

Background & Objective:
Islamic fasting is observed by millions of Muslims across the world during the holy month of Ramadan and other specific days of the lunar year. Fasting Muslims abstain from eating and drinking from dawn until sunset. Depending on season and geographical location, Muslims maintain fasting for approximately 13-18 hours per day. The present study aimed to review the benefits of Islamic fasting.

Materials and Methods:
This literature review was conducted via searching in databases like Medline, PubMed, PMC, Google Scholar, ScienceDirect, and reference lists of relevant articles using keywords like health benefits, Islamic fasting, intermittent fasting, alternate-day fasting, time-restricted feeding, and Ramadan intermittent fasting.

Results:
Islamic fasting could be considered as intermittent fasting as it is similar to alternate-day fasting and time-restricted feeding. Intermittent fasting is associated with numerous health benefits.

Conclusion:
According to this review, some of the main health benefits of Islamic fasting include weight loss, attenuation of metabolic markers (e.g., insulin resistance, blood glucose, and blood pressure), improved lipid profile, prevention of chronic problems (e.g., obesity, diabetes, cardiovascular diseases, and cancer), protection against neurodegeneration, and diminished inflammation.

Full text

* Corresponding author: Naina Mohamed Pakkir Maideen, Dubai Health Authority, Dubai, UAE. Tel: +97142164952; Fax:
+97142244302; Email: nmmaideen@dha.gov.ae
© 2017 mums.ac.ir All rights reserved.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.
Health Benefits of Islamic Intermittent Fasting
Naina Mohamed Pakkir Maideen1*, Abdurazak Jumale2, Jamil I.H. Alatrash2, Asali
Ahamed Abdul Sukkur3
1. Pharmacologist, Dubai Health Authority, Dubai, UAE
2. Senior Specialist Registrar, Dubai Health Authority, Duba i, UAE
3. Senior Pharmacist, Ambulatory Healthcare Services – SEHA, Alain, UAE
A R T I C L E I N F O
A B S T R A C T
Article type:
Original article
Introduction: Islamic fasting is observed by millions of Muslims across the world during the holy
month of Ramadan and other specific days of the lunar year. Fasting Muslims abstain from eating
and drinking from dawn until sunset. Depending on season and geographical location, Muslims
maintain fasting for approximately 13-18 hours per day. The present study aimed to review the
benefits of Islamic fasting.
Methods: This literature review was conducted via searching in databases like Medline, PubMed,
PMC, Google Scholar, ScienceDirect, and reference lists of relevant articles using keywords like
health benefits, Islamic fasting, intermittent fasting, alternate-day fasting, time-restricted feeding,
and Ramadan intermittent fasting.
Results: Islamic fasting could be considered as intermittent fasting as it is similar to alternate-day
fasting and time-restricted feeding. Intermittent fasting is associated with numerous health
benefits.
Conclusion: According to this review, some of the main health benefits of Islamic fasting include
weight loss, attenuation of metabolic markers (e.g., insulin resistance, blood glucose, and blood
pressure), improved lipid profile, prevention of chronic problems (e.g., obesity, diabetes,
cardiovascular diseases, and cancer), protection against neurodegeneration, and diminished
inflammation.
Article History:
Received: 18 Mar 2018
Accepted: 13 Jun 2018
Published: 29 Jun 2018
Keywords:
Alternate-day fasting
Health benefits
Intermittent fasting
Islamic fasting
Ramadan fasting
Time-restricted feeding
Please cite this paper as:
Pakkir Maideen NM, Jumale A, I.H. Alatrash J, Ahamed Abdul Sukkur A. Health Benefits of Islamic Intermittent Fasting. J Fasting
Health. 2017; 5(4): 162-171. Doi: 10.22038/jnfh.2018.30667.1111
Introduction
Islam has five pillars including faith, prayers,
alms, fasting, and pilgrimage (1). According to
Prophet Muhammad (PBUH), Islamic fasting is a
shield to protect believers against sins and
lustful desires. Muslims who practice Islamic
fasting abstain from eating, drinking, smoking,
and sexual intercourse from Sahur (predawn
meal) to Iftar (sunset meal). The believers of
Islam, practice fasting during the holy month of
Ramadan and other specific days of the lunar
year as an obligatory task (2).
Islamic fasting is associated with some
health discomforts, like headaches, heartburn,
constipation, dehydration, anemia, and poor
sleep quality (2). Therefore, fasting Muslims
are recommended to follow preventive
measures in order to minimize the adverse
effects of fasting. These individuals must
adhere to a balanced diet containing fruits and
vegetables, pulses, whole grains, meat, fish, and
dairies. In addition, they need to drink fluids
abundantly, such as water, fresh juices, and
soups, during the interval between Iftar and
Sahur. Fasting Muslims are advised to avoid
deep-fried foods , sweets, fatty foods, refined
carbohydrates, salty foods, and caffeinated and
carbonated drinks (2).
Intermittent Fasting
Intermittent fasting (IF) is a dietary pattern,
in which the fasting and feasting periods occur
in a cycle (3). IF may include alternate -day
fasting (ADF) and time-restricted feeding (TRF).
ADF consists of 24 hours of fasting and 24 hours

Health Benefits of Islamic Fasting Pakkir Maideen NM et al
J Fasting Health. 2017; 5(4): 162-171. 163
of feasting (4). In this regard, Islamic fasting is
similar to ADF since the feasting and fasting
periods in Islamic fasting range between 12-18
hours on average depending on the season and
geographical area (5).
TRF is a type of IF, in which the individual
intakes a whole day of calories within
approximately eight hours, while spending the
remaining hours fasting (6). Islamic fasting is
also similar to TRF since the believers of Islam
fast from sunrise to sunset and feast only at
night (approximately eight hours). Therefore,
Islamic fasting could be considered as
intermittent fasting as it is similar to ADF and
TRF.
The present study aimed to review the
health benefits of Islamic fasting in the holy
month of Ramadan.
Material and methods
This literature review was conducted via
searching in databases such as Medline,
PubMed, PMC, ScienceDirect, Google scholar,
and reference lists of relevant articles using
keywords such as health benefits, Islamic
fasting, intermittent fasting, alternate-day
fasting, time-restricted feeding, and Ramadan
intermittent fasting.
Results
Islamic IF has been associated with several
metabolic health benefits, including weight loss,
reduced insulin resistance, decreased blood
glucose, reduced blood pressure, and improved
lipid profile (Table 1). Moreover, Islamic IF
results in the cardiac protection, prevention
and treatment of obesity, diabetes, and
cancer, protection against neurodegeneration,
reduction of inflammation, promotion of health
span, and extension of lifespan (Table 2).
Discussion
Metabolic Health Benefits
Insulin resistance, obesity, hyperglycemia,
hypertension, hypertriglyceridemia, and low
high-density lipoprotein cholesterol (HDLc)
characterize metabolic syndrome (7). Metabolic
syndrome is primarily caused by insulin
resistance and obesity and increases the risk of
cardiovascular disease (CVD), diabetes type II ,
coronary heart disease (CHD), stroke, vascular
dysfunction, polycystic ovary syndrome (PCOS),
fatty liver disease, cholesterol gallstones,
asthma, sleep disturbances, breast cancer,
pancreatic cancer, and colorectal cancer (8-12).
IF consisting of ADF, TRF and Ramadan
fasting exerts positive effects on metabolic
markers (13). Ramadan IF has been reported to
decrease body weight and body mass index
(BMI) and improve insulin sensitivity through
reducing the levels of fasting glucose and insulin
(14). In healthy individuals adhering to ADF,
glucose and leptin levels decrease, and
adiponectin levels increase (15). In addition, IF
Table 1. Metabolic Health Benefits of Islamic Intermittent Fasting
Health Benefit
Author(s)
Proposed Mechanisms
Weight Loss
Ziaee V et al. (26), Fedail
SS et al. (27), and Hallak
MH et al. (28)
Reduced energy intake
Rohin MA et al. (29)
Reduction of total body fluids
Kassab S et al. (30)
Altered serum levels of leptin, insulin, and cortisol due to changes in
sleeping patterns and daily energy consumption
Sweileh N et al. (31)
Absence of fluid intake
Sanders SW et al. (32)
Consuming foods and drinks only at night, which could delay
absorption due to decreased gastric emptying and blood flow
compared to daytime.
Reduced Insulin
Resistance
Boden G et al. (37)
Reduction of serum leptin levels
Reduced Blood Glucose
Kul S et al. (22)
Altered sleep–wakefulness cycle leads to changes in levels of factors
involved in regulation of energy intake and energy expenditure, such
as leptin, neuropeptide-Y, insulin, melatonin, and steroid hormones
(e.g., cortisol and, testosterone).
Reduced Blood
Pressure
Dewanti L et al. (46)
Dehydration
Al-Shafei AI et al. (47)
Decreased ventricular ejection and arterial stiffness
Improved Lipid Profile
Adlouni A et al. (48), Faris
ME et al. (53), and Lamri-
Senhadji MY et al. (54)
Qualitative feeding behavior
Al-Shafei AI (47)
Calorie restriction and timing of food intake

Pakkir Maideen NM et al Health Benefits of Islamic Fasting
164 J Fasting Health. 2017; 5(4): 162-171.
Table 2.Other Health Benefits of Islamic Intermittent Fasting
Health Benefit
Author(s)
Proposed Mechanisms
Cardiac Protection
Wan R et al. (57), Gonon
AT et al. (58), and
Shinmura K et al. (59)
Reduction of inflammation and apoptosis of myocardial cells
Mattson MP et al. (60)
Reduction of oxidative damage and increased cellular stress resistance
Obesity Prevention
Norouzy A et al. (62)
Increased adiponectin and decreased leptin levels
Diabetes
Prevention
Brown JE et al. (68)
Decreased insulin resistance and fasting insulin levels, increased insulin
sensitivity and glucose uptake, decreased lipolysis and assistance in
weight loss
Krizova E et al. (71)
Decreased lipolysis and circulating concentrations of free fatty acids
Cancer Prevention
and Treatment
Rogozina OP et al. (74), and
Rogozina OP et al. (75)
Reduced serum insulin-like growth factor-1 (IGF-1), which regulates
cellular proliferation, growth, and apoptosis.
Marinac CR et al. (76)
Prolonged nightly fasting decreases the risk of breast cancer recurrence
by improving glucoregulation and sleep.
Descamps O et al. (77)
Decreased generation of mitochondrial reactive oxygen species.
Protection against
Neurodegeneration
Arumugam TV et al. (81)
Stimulation of neuroprotective and neurotrophic pathways through
elevation of antioxidant defense and BDNF and suppressing inflammation
through reducing pro-inflammatory cytokines (TNF-α, IL-1β, and IL-6)
Lee J et al. (82)
Stimulation of production of new neurons from neural stem cells
(neurogenesis) and synapse formation by increasing expression of BDNF
and neurotrophin-3 to restore damaged nerve cell circuits
Reduction of
Inflammation
Kacimi S et al. (83)
Reduction of expression of proinflammatory cytokines like Interleukin-6
(IL-6) and Tumor necrosis factor α (TNF α).
Aksungar FB et al (84)
Decreased levels of other inflammatory markers (e.g., homocysteine and
C-reactive protein)
Promotion of
Health Span
Johnson JB et al. (87)
Reduction of asthma-related symptoms and oxidative stress markers
Teng NI et al. (88)
Decreased episodes of depression
Akuchekian S et al. (89)
Reduction of cravings by elevating plasma levels of endogenous opioids
(e.g., β-endorphin)
Zangeneh F et al. (90)
Decreased serum levels of stress hormones in women with polycystic
ovary syndrome
Extension of
Lifespan
Mattson MP et al. (60) and
Sohal RS et al. (92)
Anti-ageing effects (reduction of metabolic markers of diabetes,
cardiovascular diseases and cancer, reduced oxidative damage, and
increased cellular stress resistance)
Fontana L et al. (93)
Anti-ageing effects by reducing levels of hormones regulating
thermogenesis and cellular metabolism (e.g., thyroid hormones and
catecholamines) and anabolic hormones (e.g., testosterone, estradiol,
insulin and leptin) and increasing levels of hormones suppressing
inflammation (e.g., glucocorticoids, adiponectin, and ghrelin)
Heilbronn LK et al. (39)
Delayed onset of age-related declines in size, number, and function of
mitochondria
Fontana L et al. (94) and
Blüher M et al. (95)
Activation of anti-ageing pathways through down-regulation of
insulin/IGF-1 and mTOR pathways
has been shown to decrease the levels of insulin
(16, 17), glucose, and triglycerides (18).
In young, healthy individuals adhering to
TRF, glucose and triglycerides reduce, and the
level of high-density lipoprotein increases (19).
On the other hand, IF has been reported
to decrease body weight, increase insulin
sensitivity, and reduce the resting heart rate and
blood pressure in rats (20). According to the
studies conducted on animal models and human
volunteers, IF effectively reduces the risk of
chronic conditions, such as cardiovascular
diseases, diabetes, and cancer (4).
Weight Loss
Islamic fasting could achieve and maintain
significant weight loss (21). According to the
clinical trials in this regard, Islamic fasting could
induce a statistically significant weight loss in
fasting individuals (22-25). Furthermore, it has
been postulated that Islamic IF may induce
weight loss through various mechanisms,
including reduced energy intake (26-28),
reduction of total body fluids (29), changes in
the serum levels of leptin, insulin, and cortisol
due to the altered sleeping patterns and daily
energy consumption (30), absence of fluid

Health Benefits of Islamic Fasting Pakkir Maideen NM et al
J Fasting Health. 2017; 5(4): 162-171. 165
intake (31), and food and drink consumption at
night only, which could delay the absorption due
to lower gastric emptying and blood flow
compared to daytime (32). However, the
findings of a study performed on eight healthy
men adhering to IF indicated no significant
weight changes in the participants (15). The lost
weight during Ramadan IF could be regained
quickly (33); consequently fasting Muslims
should adopt structured and consistent
lifestyle modifications for long-lasting weight
maintenance (34, 35).
Reduction of Insulin Resistance
Overweight and obese individuals often have
a high plasma leptin/adiponectin ratio due to
high leptin and low adiponectin secretion from
the hypertrophic adipocytes, which leads to
insulin resistance (36). IF could reduce serum
leptin levels (37), thereby decreasing the
leptin/adiponectin ratio and insulin resistance.
According to a randomized clinical trial
conducted on young, overweight women, levels
of fasting insulin and insulin resistance
decreased as a result of IF (38).
Reduction of Blood Glucose
ADF is associated with the elevation of
insulin-mediated glucose uptake (15) and
improved insulin sensitivity (39). Sleep-
wakefulness cycle is altered during Islamic IF,
leading to changes in the levels of the factors
regulating energy intake and expenditure, such
as leptin, neuropeptide-Y, insulin, melatonin,
and steroid hormones (cortisol and
testosterone) (22).
In a research performed on eight men and
eight women, ADF was reported to cause no
significant changes in the blood glucose level
(16).
On the other hand, previous findings have
indicated that ADF could decrease the fasting
glucose concentration in animal models
(40, 41).
Reduction of Blood Pressure
Fasting could employ as an effective non-
pharmacological measure to diminish
hypertension (42, 43). Ramadan fasting has
been reported to reduce the systolic and
diastolic blood pressures significantly (44,
45). Additionally, the dehydration associated
with Islamic fasting could lower the blood
pressure (46), ventricular ejection, and
arterial stiffness (47).
Improvement of Lipid Profile
Ramadan IF has been reported to decrease
triglyceride levels and increase HDLc significantly
(47-51). HDLc levels increase during Ramadan
fasting and could be maintained for a minimum
of one month after Ramadan (51, 52).
Qualitative feeding behaviors (48, 53, 54),
calorie restriction, and timing of food intake
(47) contribute to the improvement of the lipid
profile associated with Islamic IF.
Cardiovascular Health Benefits
Ramadan IF is associated with improved
cardiovascular risk factors, including low-
density lipoprotein cholesterol (LDLc), very
low-density lipoprotein cholesterol, trigly-
cerides, systolic blood pressure, BMI, waist
circumference, and elevated HDLc levels (4,
55). In obese individuals, calorie restriction has
been shown to reduce the risk of CVD (56).
Hypoadiponectinemia induced by IF could
protect the heart against ischemic injury (57).
Adiponectin activates the cyclic 5' adenosine
monophosphate-activated protein kinase
pathway and protect the myocardial cells
against ischemic injury through reducing the
inflammation and apoptosis of myocardial cells
(57-59). Moreover, IF provides cardiac
protection through reducing oxidative damage
and increasing cellular stress resistance (60).
Islamic IF could be an effective dietary strategy
to decrease the risk of CHD (61).
Obesity Prevention
Ramadan IF has been reported to decrease
body weight, waist and hip circumferences, and
BMI significantly in the majority of study
subjects (62-64). Obesity is characterized by
adipocyte hypertrophy. Adipocytes produce
adipocytokines and adipokines, including leptin,
adiponectin, resistin, tumor necrosis factor-α
(TNF-α), interleukin-6 (IL-6), adipsin, and
visfatin.
Adipocyte hypertrophy leads to the
dysregulated production of adipokines and
development of the metabolic syndrome (65).
Adiponectin is an adipokine with anti-
atherogenic, insulin-sensitizing, and anti-

Pakkir Maideen NM et al Health Benefits of Islamic Fasting
166 J Fasting Health. 2017; 5(4): 162-171.
inflammatory properties. Obese individuals
have low levels of adiponectin, which increase
following weight loss (66).
Leptin is another adipokine that is involved
in the regulation of food intake and energy
expenditure. Excessive body weight and
metabolic syndrome induce Leptin resistance by
increasing the plasma levels of leptin. Leptin
resistance may be present in pathophysiological
conditions, such as obesity, insulin resistance,
hypertension, hyperlipidemia, inflammation,
atherosclerosis, ischemic heart disease, and
heart failure (67).
Diabetes Prevention
Islamic IF may decrease the incidence of
diabetes through decreasing insulin resistance
and fasting insulin levels, increasing insulin
sensitivity and glucose uptake, decreasing
lipolysis, and assisting in weight loss (41, 68).
Insulin resistance is the major cause of diabetes
type II, prediabetes, and gestational diabetes.
Insulin resistance could be reduced by IF
through the reduction of serum leptin levels
(69) and elevation of adiponectin levels (70).
Insulin levels have been reported to decrease
by IF in non-obese volunteers (16). Furthermore,
IF could improve insulin sensitivity by decreasing
the ectopic accumulation of intracellular lipid in
animals (71). Insulin-mediated glucose uptake
has been shown to elevate in human volunteers,
and animal studies have demonstrated that
fasting glucose and insulin concentrations may
decrease by ADF (4). IF could also reduce the risk
of diabetes indirectly through decreasing
lipolysis and the circulating concentrations of
free fatty acids (72).
Cancer Prevention and Treatment
Islamic IF reduce the levels of insulin-like
growth factor-1 (IGF-1), insulin, and glucose to
protect cells against DNA damage through
diminished cell growth and augmented
apoptosis of damaged cells (73). In addition, IF
could decrease the incidence of breast cancer
possibly through reducing the serum IGF-1
levels (74, 75), which regulates cellular
proliferation, growth, and apoptosis.
Prolonged nightly fasting has been reported
to decrease the risk of breast cancer recurrence
by improving glucoregulation and sleep patterns
(76). Furthermore, ADF could decrease
mitochondrial reactive oxygen species (ROS)
generation which results in significant reduction
of incidence of age-associated lymphoma in
mice (77). Fasting and chemotherapy could
synergistically promote the DNA breaks in
cancer cells (78). Moreover, fasting results
in the reduction of chemotherapy-induced
complications (79).
Protection against Neurodegeneration
Fasting induces neuroprotection by
stimulating the production of brain-derived
neurotrophic factor (BDNF), through increased
neuronal network activity. BDNF is also
involved in the improvement of cognitive
function, food intake inhibition, and energy
expenditure acceleration (80). IF may protect
the neurons against tissue injury by stimulating
the neuroprotective and neurotrophic pathways
through the elevation of antioxidant defense and
BDNF levels, as well as the suppression
of inflammation through reducing pro-
inflammatory cytokines such as IL-6, IL-1β, and
TNF-α (81). IF could also stimulate the
production of new neurons from the neural
stem cells (i.e., neurogenesis) and synapse
formation by increasing BDNF and
neurotrophin-3 levels, to restore damaged nerve
cell circuits (82).
Reduction of Inflammation
Elevated levels of pro-inflammatory
cytokines may increase the risk of
inflammatory diseases, such as insulin
resistance, diabetes, atherosclerosis, and
cardiovascular diseases (83). In healthy
individuals, Ramadan IF has been shown to
decrease the expression of pro-inflammatory
cytokines, including TNF-α and IL-6 leading to
decreased inflammatory status of the body
(83). Moreover, Ramadan IF has been reported
to decrease the levels of other inflammatory
markers (e.g., homocysteine, C-reactive protein,
and IL-6 in healthy subjects (84).
Promotion of Health Span
IF has been shown to attenuate the risk
of chronic conditions such as diabetes,
cardiovascular diseases, cancer, and neurode-
generation (85). The incidence of conditions like
cardiovascular diseases, cancer, osteoporosis
and Alzheimer's disease decreased by calorie

Health Benefits of Islamic Fasting Pakkir Maideen NM et al
J Fasting Health. 2017; 5(4): 162-171. 167
restriction through the reduction of chronic
inflammation (86). In overweight individuals
with asthma, ADF reported to decrease
oxidative stress markers and asthma-related
symptoms (87). On the other hand, episodes of
depression have been shown to reduce by two
days of fasting per week in elderly males (88).
Fasting could also elevate the plasma levels of
endogenous opioids (e.g., β-endorphin), thereby
diminishing cravings (89). Ramadan IF could
significantly lower the serum levels of stress
hormones in the women with PCOS (90).
Extension of Lifespan
The aging process is associated with the
gradual loss of the function of various organs
and increased vulnerability to diseases.
Evidence suggest that IF significantly
contributes to the extension of lifespan (85, 91)
through exerting anti-aging effects, such as the
reduction of diabetic metabolic markers,
cardiovascular diseases, cancer, and oxidative
damage and increasing cellular stress
resistance (60, 92). Calorie restriction may
enhance the levels of hormones suppressing
inflammation (e.g., adiponectin and ghrelin)
and decrease the levels of the hormones
regulating thermogenesis and cellular
metabolism (e.g., thyroid hormones and
catecholamines) and anabolic hormones (e.g.,
testosterone, estradiol, insulin, and leptin) to
exhibit anti-aging effects (93).
According to animal studies, ADF could
extend lifespan by delaying the onset of age-
related decreases in the size, number, and
function of mitochondria (39). Calorie
restriction has also been shown to activate the
anti-ageing pathways through the down-
regulation of insulin/IGF-1 and mTOR pathways
(94, 95).
Conclusion
Muslims practicing Islamic IF enjoy various
health benefits, including weight loss, reduced
insulin resistance, blood glucose, and blood
pressure, improved lipid profile, prevention of
obesity, diabetes, cardiovascular diseases, and
cancer, protection against neurodegeneration,
and diminished inflammation. Islamic IF could
also improve health span and extend life span.
Therefore, it is generally considered safe for
healthy individuals (96). However, the patients
having chronic health conditions, like diabetes
(97-99), hypertension (100, 101), active ulcers
(102-104), urolithiasis (105), and chronic
kidney disease (106, 107) should consult
healthcare professionals, before initiating
fasting. Moreover, certain individuals are
exempt from Islamic fasting, including patients,
travelers, menstruating women, pregnant
women, and breastfeeding mothers (108).
Islamic fasting is associated with common
health problems, including dehydration,
headaches, heartburn, constipation, anemia, and
poor sleep quality, which could be minimized by
preventive measures (2). Therefore, fasting
individuals are recommended to adhere to a
balanced diet containing fruits and vegetables,
whole grains, pulses, meat, fish, and dairies. In
addition, they need to drink fluids abundantly,
such as water, fresh juices, and soups during
Islamic IF. Fasting Muslims are advised to avoid
deep-fried foods, sweets, and fatty foods (2).
According to the results of the current
review, the health benefits of Islamic IF could be
sustained by leading a healthy lifestyle and
practicing optional fasting regularly after the
holy month of Ramadan twice a week on
Mondays and Thursdays.
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