Ramadan fasting during COVID-19: Experts weigh in on immunity research

15 Apr 2021 --- The month of Ramadan has begun, in which the majority of the world’s 1.8 billion Muslims are expected to abstain from consuming foods or fluids during daylight hours. 

Fasting during the COVID-19 pandemic brings new considerations, but a recent research review from the University of Doha, Qatar, suggests fasting during Ramadan may have a positive impact on immunity strength. 

The study, now published in Frontiers in Nutrition, finds evidence that the Ramadan fasting pattern could produce a number of immunological benefits, which could potentially bolster the body against susceptibility and symptoms of SARS‐CoV‐2.

The effects of fasting on immunity include changing the body’s response toward infection, inflammation and oxidative stress. Decreases in C-reactive proteins and pro-inflammatory cytokines have also been noted. 

However, Dr. Tricia Psota, managing director of US-based firm Nutrition on Demand, tells NutritionInsight the evidence of Ramadan’s beneficial impact on immunity is insufficient to warrant these claims. 

“While there is some interesting research in this area, it is still too soon to tell if fasting can improve immune response. Most of the studies have been conducted among animal models, and the data among humans is limited.”

Studies show early signs of Ramadan fasting’s beneficial impact on inflammatory cytokines.Fighting inflammatory cytokines
Among the research reviewed in the study are a number of findings suggesting that fasting can reduce the harmful effects of inflammatory cytokines, which are strongly associated with severe outcomes in COVID-19 patients. 

Ramadan-style fasting was shown to have a modulatory effect on macrophages in young mice, rendering them to produce low amounts of cytokines – something previously proven to benefit asthma patients. 

Another finding was that fasting restored the balance of the renin-angiotensin system, which is crucial to reducing angiotensin II, pro-inflammatory cytokines and fibrosis in the lung tissue. 

Ramadan intermittent fasting also notably reduces inflammatory cytokines IL-6, IL-1β, and pro-inflammatory chemokines CXCL1, CXCL10, and CXCL12, which might alleviate lung tissue damage, says the study.

“Taken together, these findings suggest that Ramadan diurnal intermittent fasting might have a favorable effect against COVID-19,” claims the study. 

Ramadan and COVID-19 
The study authors assert that despite World Health Organization (WHO) advice, which stresses adult people must get a balanced diet and drink plenty of water throughout the day to protect themselves against COVID-19, healthy adult Muslims should not see this as a reason to refrain from fasting. 

“Although following such [WHO] measures would not eliminate the risk rather than improve the symptoms in case of infection, the recommendations might be misinterpreted to encourage some Muslims to stop fasting during Ramadan,” reads the study. 

Experts caution it is too early to determine whether Ramadan fasting can boost immunity.However, Bridget Benelam, nutrition communications manager for the British Nutrition Foundation, tells NutritionInsight the basis of the studies reviewed in the research are inadequate. 

“It is interesting to look at the potential effects of fasting on immunity, however, the research is currently at an early stage, with many studies in cell cultures or mice. So, more research on different types of fasting in humans is needed to clarify.”

The right way to fast?
In order to remain healthy during Ramadan, consumers with health conditions or pregnancy should usually refrain from fasting, Benelam supports. 

“For people with health conditions such as diabetes, medical advice should be taken about managing their condition if they are planning to fast – Islamically, people whose health would be affected by fasting are exempt.”

“Eating during Ramadan should be about balance, getting a range of healthy foods and drinks – of course, it’s also about celebrating the month, but it’s a good idea not to go overboard on fatty and sugary foods or sugary drinks,” she continues. 

While intermittent fasting is a popular practice in varying forms, Muslims’ requirement to abstain from drinking water during Ramadan is relatively unique and raises particular health concerns. 

“Staying hydrated is vital,” remarks Psota. 

“When breaking fast after sunset, drinking plenty of fluids, as well as consuming fluid-rich foods, such as fruits, vegetables, yogurt, soups and stews, is very important. These items can replace fluids lost during the day and help start the next day of fasting well hydrated.”

Personalizing Ramadan
Psota further emphasizes that, as with most nutrition areas, personalization is highly important in approaching fasting. 

“Every person is unique and may feel best with different ways of nourishment when breaking fast. So, it is important to trust how one’s body feels and talk with a dietitian or other healthcare provider for individualized advice based on their health and situation.”

Innova Market Insights recently pegged “Tailored to Fit” as a top trend for 2021, noting research and technological developments are encouraging consumers to adopt a more individualized approach to nutrition. 

By Louis Gore-Langton