DR KHALID DHANSAY points out that apart from the spiritual rewards, fasting has many medical benefits.
FASTING during Ramadaan is considered an essential part of Islam for practicing Muslims. It is an ancient practice that was always considered as an efficient approach to wellness.
As early as the 5th Century CE, the Greek physician Hippocrates considered fasting as a treatment for both acute and chronic diseases, following the empirical observation that infection is frequently accompanied by a loss of appetite. Similarly, Plato, Aristotle and Pythagoras were all advocates of fasting.
Most of the major religious traditions include fasting as an integral ritual thereof, although the form of such fasting may vary substantially. Religions and philosophies that practice fasting include Buddhism, Christianity, Islam, Judaism, Taoism, Jainism and Hinduism.
While the duration, practice, and specific reasons of fasting may differ, all fasts have similar goals including personal sacrifice, increasing self-control and purifying oneself both physically and spiritually. This is confirmed in the Qur’an: ‘Oh you who believe, fasting is prescribed for you as it was prescribed for those before you, that you may develop God-Consciousness.’ (Sura Al Baqarah, 2:183)
Whilst there may be many individual spiritual benefits for the fasting person, only recently have the many health benefits and associated mechanisms of intermittent fasting been elucidated. As a result, intermittent fasting has become a popular dietary approach to help people lose weight and has also been promoted as a way to reset metabolism, control chronic disease, slow ageing and improve overall health.
Intermittent fasting may take various forms but essentially consists of short periods of calorie restriction where food intake is limited for 12 to 16 hours per day followed by periods of normal food intake. The compulsory fasting of Ramadaan, as well as non-obligatory Sunnah fasts, closely resemble intermittent fasting regimens.
The 2016 Nobel Prize in Physiology or Medicine was awarded to Yoshinori Ohsumi, who discovered and elucidated mechanisms underlying autophagy. Autophagy is a fundamental process for destroying and recycling cellular components. Ohsumi’s discoveries opened the path to understanding the crucial importance of autophagy in many physiological processes, such as in the adaptation to starvation, response to infection and ageing. Disrupted autophagy has been linked to multiple illnesses like Parkinson’s disease, Alzheimer’s Disease, type two diabetes, cancer and even autoimmune diseases. Autophagy genes have since also been identified, and mutations in these can also cause genetic disease.
Intermittent fasting, via promoting autophagy, has been found to have therapeutic potential with a focus on cancer, autoimmune diseases, neurodegeneration (in being neuroprotective), metabolic and cardiovascular disease. It can reduce the risk for cardiovascular disease with studies showing improvement in weight, hypertension, dyslipidaemia & diabetes.
Disturbances in the autophagic machinery in cells have also been linked to cancer. Intense research is now ongoing to develop drugs that can target autophagy in various diseases in which autophagy may play a role.
Intermittent fasting may exert its effects through multiple pathways including reducing cellular stress, gene regulation, optimisation of circadian rhythms and ketogenesis. Ketogenesis is the biochemical process through which cells produce ketone bodies by breaking down fatty acids and normally occurs after about 12 hours of fasting. Possible benefits of ketogenesis include weight loss, improved blood sugar management, and reduced seizures in children with epilepsy.
Psychologically, intermittent fasting is also associated with increased levels of vigilance and improvements in anxiety and mood symptoms such as tranquility and subjective well-being.
Ramadaan fasting is also about aiming to improve good moral character and habits and can thus be used as an impetus to strengthen personal virtues like patience, discipline, willpower, gratitude, restraint, self-control, and personal growth and renewal. These factors are associated with psychological well-being and resilience which are becoming increasingly important due to the ongoing negative trends in mental health in both developed and developing countries.
During Ramadaan, almost a billion people worldwide are engaged in the same activity at a similar time, leading to a strong sense of social identity and belonging. This increases social connectedness, which refers to a term broadly encompassing the quantity, quality, frequency, type and network structure of one’s relationships with friends, family, and the community. Social connectedness reduces levels of social isolation which has protective effects on loneliness, thus reducing subsequent associated anxiety and depressive symptoms. Communal fasting may thus be considered to be a health promoting factor in communities with a potential advantage of not requiring excessive funding.
In conclusion, although fasting has been around for centuries, fasting in the Islamic tradition is similar to current intermittent fasting regimens. In an increasingly secular world, modern science is starting to elucidate the multiple potential scientific benefits and mechanisms associated with the various medical, psychological and social benefits of intermittent fasting.
- Dr Khalid Dhansay is a specialist psychiatrist practicing in the Melomed Group.
