Lt Col Nazmul Huda Khan, MPhil, MPH :
Ramzan is one of the five pillars of Islam. It is a time of spiritual reflection, self-improvement, heightened devotion and worship. The fast begins at dawn and ends at sunset. In addition to abstaining from eating and drinking during this time, we abstain from physical relations, sinful speech and behaviour. Through this temporary deprivation of food, we renew our awareness of and gratitude for everything the Almighty has provided in our lives. The act of fasting is said to redirect the heart away from harmful activities, its purpose being to cleanse the soul by freeing it from harmful impurities. We believe that Ramzan teaches us to practice self-discipline, self-control, sacrifice, empathy for those who are less fortunate. Muslims also believe fasting helps instill compassion for the food-insecure poor. During Ramzan, we aim to grow spiritually and become closer to Allah. Ramzan is also a time for unity and spiritual reflection and Muslims spend time through praying, reciting the Quran and doing good deeds. We use to donate to charity, avoid lying, gossiping and fighting.
Physiologically, there are various health effects of fasting in Ramzan. It has number of positive effects on a number of health outcomes. Amongst those,increase longevity, maintaining glucose homeostasis, reduction in glucose levels,changes in blood components, maintenance of body weight, protective influence in blood lipid profile, decrease risk of cardiovascular diseases, improve kidney functions and boost immune system etc. are few.
Increase longevity: Ramzan fasting is a healthy non pharmacological means for minimizing all physical, mental, social and spiritual risk factors and improving health; thereby increasing longevity.
Glucose homeostasis: Glucose homeostasis occurs amongst individuals by which blood sugar primarily glucose is maintained, together with reduction in percentage body fat and in HbA1c. Fasting in Ramzan decrease in intake of total fat, saturated fatty acid, cholesterol and polyunsaturated fatty acid during Ramzan month thereby regulate the mechanism easily.
Reduction in glucose levels: During Ramzan fasting, the sleep-wakefulness cycle is altered. This leads to changes in the levels of various hormones like leptin, neuropeptide-Y and insulin, all playing important role in the long-term regulation of energy intake and energy expenditure. The outcome is the reduction of glucose level and decrease risk of diabetes.
Maintenance of body weight: Fasting causes weight loss and maintenance among overweight and obese people. It has been revealed that, body weight, body mass index and body fat have a significant reduction in 3rd week of Ramzan.
Decrease harmful but increase protective lipid components: A trend of reduction in very low-density lipoprotein is observed after Ramzan month which is harmful for health; but on the other hand, increase HDL concentration that is considered to be protective for body. It reduces fat mass, total cholesterol and LDL cholesterol. There is a reduction in serum triglycerides, markers of oxidative stress and inflammation.
Changes in blood cell components: Ramzan Fasting increases the Red Blood Cells (RBCs), White Blood Cells (WBCs), platelet (PLT) count. It has role to decrease the inflammation, pro-inflammatory cytokines IL-1b, IL-6, tumour necrosis factor, a cancer risk component.
Decrease cardiovascular diseases: Fasting have beneficial effects on endothelial function and can modulate cardiovascular risks. There are decrease in resting heart rate, equivalent reduction in blood pressure, insulin, circulating levels of glucose which are favorable with regards to the risk of cardiovascular diseases. In addition, it reduces systolic and diastolic blood pressure and anxiety levels.
Reduction risk of cancer: Effects on a number of cancer risk biomarkers occur e.g., insulin, cytokines, and the inflammation-related molecules leptin and adiponectin which are thought to mediate the effects of adiposity and excessive energy intake on the development and growth of cancers in humans. Ramzan fasting decrease the concentration of IL-6, IL-1ß, TNF-a which are known as risk factor for cancers. Ramzan fasting also results in oxidative stress reduction, therefore lower level of reactive oxygen species and decrease chance of cancer.
Kidney function: It is estimated that glomerular filtration rate (GFR) is improved; proteinuria and urinary sodium are decreased during Ramzan. Suggested mechanism for this improvement in renal function is a reduction in blood pressure and body weight and decline in dietary protein and creatinine intake.
StrengtheningImmune system: The concentration of interleukin 6 (IL-6), IL-1ß and tumor necrosis factor-a (TNF-a) and the number of total leukocytes, granulocytes, lymphocytes and monocytes are significantly decreased during Ramzan thereby strengthen against developing cancer.
Protective against neuron disorders: Ramzan fasting protects neurons against aging disorders e.g., Alzheimer’s disease and stroke.
Provision of alternative fuel for vital organs: Circulating ketone levels are elevated on the fasting days. During starvation, ketone bodies are used as fuel in the heart, brain and muscle.
Decrease risk of Diabetes: It has been shown that alterations in sleep patterns and psychological/ social habits during Ramzan induce changes in the rhythmic pattern of a number of hormonal variables, that is, melatonin, steroid hormones, pituitary hormones and thyroid hormones. These hormones are related to energy metabolism and regulation of energy intake. These hormonal changes could explain decreases in blood glucose levels, thereby reduce the risk to develop diabetes.
Protective for health indirectly: Smoking is forbidden during the daylight hours of Ramzan; therefore, a large number of smokers conceivably experience changes in health-related biomarkers simply by virtue of smoking less. Thus, reducing the number of cigarettes may result in positive changes health.
According to latest definition of health by World Health Organization (WHO); health has three main components namely physical, mental and social well-being. Ramzan has worthwhile effects in all three elements. Ramzan fasting is considered safe for all healthy individuals; however it may pose risks for individuals with certain pre-existing ailments. Fasting is not required for those who are ill,if there is further chance of deterioration of health status. Pregnant or lactating women, travelers are also exempted from fasting during Ramzan according to some authorities.
(Lt Col Nazmul Huda Khan, MPhil, MPH is Public Health Specialist and Assistant Director, Kurmitola
General Hospital).
