Effects of Ramadan Fasting on the Regulation of Inflammation

Effects of Ramadan Fasting on the Regulation of Inflammation Safieh Ebrahimi1, Farzad Rahmani1, Amir Avan2, Mohsen Nematy3, Seyyed Mostafa Parizadeh4, Mahdi Hasanian-Mehr1,5‫٭‬, Seyed Mohammad Reza Parizadeh1,3 1. 2. 3. 4. 5. Department of Medical Biochemistry, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Department of Modern Sciences and Technologies, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Biochemistry and Nutrition Research Center, School of Medicine, Mashhad University of Medical Science, Mashhad, Iran School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Microanatomy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran ARTICLE INFO ABSTRACT Article type: Review article As a model of intermittent fasting, the month of Ramadan is a valuable opportunity to investigate the effects of dietary modifications on human metabolism. Fasting improves insulin sensitivity, while reducing the risk of atherogenesis, oxidative stress, and inflammation. Inflammation plays a pivotal role in the pathogenesis of different disorders, including atherosclerosis, metabolic syndrome, and cardiovascular diseases. Ramadan fasting could positively modulate cardiovascular risks and improves the features of metabolic syndrome through the suppression of inflammatory responses. This review aimed to explore recent studies evaluating the regulatory role of the nutritional status of fasting in the regulation of inflammation in patients with inflammatory diseases. According to the literature, fasting has significant anti-inflammatory effects and could be a complementary therapeutic approach in the treatment of inflammatory disorders. Article History: Received: 20 Jan 2016 Accepted: 15 Mar 2016 Published: 20 Mar 2016 Keywords: Cardiovascular disease Inflammation Metabolic syndrome Ramadan fasting Please cite this paper as: Ebrahimi S, Rahmani F, Avan A, Nematy M, Parizadeh SM, Hasanian-Mehr M, Parizadeh SMR. Effects of Ramadan Fasting on the Regulation of Inflammation. J Fasting Health. 2016; 4(1): 32-37. Introduction Fasting in the month of Ramadan, the ninth month in the lunar Islamic year, is the religious duty of all healthy adult Muslims. While fasting from sunrise (Sahur) to sunset (Iftar), Muslims refrain from eating, drinking liquids, smoking, and sexual activity (1). Fasting is recommended as a medical treatment for various conditions, including weight control (2,3), resting the digestive tract, and reducing lipid levels (4-7). A constant dietary restriction could positively influence the biochemical and physiological functions, as well as the inflammatory state of the body (6, 8). Inflammatory status of the body, which is characterized by the up-regulation of cytokines, chemokines, and other inflammatory mediators, contributes to the pathogenesis of some proinflammatory disorders, such as atherosclerosis (9), insulin resistance (10), cardiovascular diseases (11), and cancer (12). Several experimental studies have confirmed the numerous health benefits of fasting in Ramadan. According to the literature, Ramadan fasting could enhance insulin sensitivity (13), while reducing the risk of atherogenesis, oxidative stress, and inflammation (14, 15). Furthermore, it has been suggested that fasting attenuates the inflammatory status of the body through inhibiting the expression of proinflammatory cytokines and chemokines (16, 17). The majority of the studies in this regard have focused on the effect of fasting on inflammation through investigating the serum levels of inflammatory markers, such as C-reactive protein (CRP), leukocyte count, cytokines, and chemokines. These markers could be used to differentiate between healthy individuals and those with * Corresponding author: Mahdi Hasanian-Mehr, Department of Medical Biochemistry, Mashhad University of Medical Sciences, Azadi Sq. Medical School, Mashhad, Iran. Email: © 2016 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. Ramadan Fasting and Regulation of Inflammation inflammatory diseases. Studies in this regard have suggested that Ramadan fasting through downregulation of the expression of proinflammatory molecules could beneficially affect inflammation and decrease the destructive symptoms of inflammatory diseases in the patients. This review aimed to update recent findings regarding the regulatory effects of Ramadan fasting on inflammation and the safety of this practice for patients with inflammatory disorders. Fasting and inflammation Extensive research has been conducted to investigate the effects of Ramadan fasting on inflammation. For instance, in one report by Aksungar et al., it was demonstrated that inflammatory biomarkers, such as interleukin-6 (IL-6) and CRP, had a significant reduction after the month of Ramadan in male and female fasting individuals compared to the basal values (one week before Ramadan). Therefore, they concluded that prolonged intermittent fasting in Ramadan could positively affect the inflammatory state of the body (15). These findings are in line with the results obtained by Faris et al., who stated that Ramadan fasting led to a significant reduction in the circulating levels of proinflammatory cytokines, including IL-1β, IL-6, and tumor necrosis factor alpha (TNF-α) (16). Low level of reactive oxygen species and down-regulation of nuclear factor κB (NF-κB) signaling may result in the reduction of cytokine levels during Ramadan fasting (18). NFκB is a major proinflammatory signaling pathway, which regulates the expression of proinflammatory cytokines, such as IL-1β, IL-6, and TNF-α (19). In another study, Unalacak et al. reported that some inflammatory mediators, such as IL-2, IL-8, and TNF-α, decreased after fasting (6). Furthermore, Mohajeri F et al. stated that during Ramadan fasting, serum levels of CXC chemokines (CXCL1, CXCL10, and CXCL12) decreased (17), which is suggestive of the fact that through the suppression of inflammatory chemokines, fasting could inhibit inflammatory responses in individuals. Moreover, fasting has been shown to reduce oxidative stress and inflammation in different body tissues, including the brain (18). In an animal model of stroke, Arumugam et al. indicated that the production of TNF-α and IL-6, the J Fasting Health. 2016; 4(1):32-37. Ebrahimi S et al cytokines involved in neuronal degenerative processes, was suppressed through intermittent fasting in young mice, resulting in the protection of neurons against ischemic injury. In rats, intermittent fasting and calorie restriction were observed to improve cardiovascular complications and protect the myocardium against ischemiainduced cell damage and inflammation (...truncated)