What Every Clinician Should Know about Ramadan & Intermittent Fasting

Further, fasting activates autophagy and defense mechanisms against oxidative and metabolic stress and suppresses inflammation.^5-8 These effects of intermittent fasting are similar to those of aerobic exercise.⁹

Macrophages infiltrate hypertrophied adipose tissue and produce proinflammatory cytokines, including interleukin (IL) 6 and tumor necrosis factor-alpha (TNF-α), which induce insulin resistance and atherosclerosis and are linked to the systemic inflammation that we are familiar with in rheumatic and autoimmune conditions. Systemic inflammation is linked to the pathogenesis of type 2 diabetes mellitus, cardiovascular diseases, cancers and rheumatic autoimmune conditions. Thus, systemic inflammatory markers may predict the development of these metabolic disorders.³

Body weight reduction decreases adipose tissue macrophages, reduces proinflammatory cytokines, and improves insulin resistance and systemic inflammatory states. Several clinical trials have shown that intermittent fasting intervention improves inflammatory status in obese subjects, demonstrating a reduction in C-reactive protein, and mixed results regarding reduction in plasma levels of IL-6, TNF-α and interferon-γ, markers that rheumatologists have been targeting with both biologic disease-modifying anti-rheumatic drugs (DMARDs) and conventional DMARDs to treat autoimmune conditions.¹¹

Your Muslim Patients

Ramadan is a month of introspection, prayer and self-improvement, and it is safe to assume the majority of Muslim patients will be observing fasting in some capacity this year. Some may observe fasting the entire month, as recommended. Others may miss fast days for various reasons and make them up at a later time in the year.¹⁰

Pregnant (or nursing) women, menstruating women, post-partum women (who are still bleeding), children, the elderly, travelers on a long journey, those with chronic diseases (e.g., diabetes, autoimmune disease) and the mentally ill are exempt from the fasting requirement.

Ramadan is the largest Muslim celebration of the year. As a result, there is a strong desire to participate in all activities even when exceptions can be made due to chronic disease. Thus, many individuals choose to fast and do not necessarily disclose this information to their healthcare professionals unless they are specifically asked.

Caring for patients during this time will require their healthcare team, including rheumatology professionals and pharmacists, to play an active role.