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Relation
Su J, Wang Y, Zhang X, et al. Conversion of the intestinal microbioma during the Ramadan-associated intermittent fasting.I'm jlin nutr. 2021;113:1332-1342.
Objective
Analysis of the biological effects of a one-month Ramadan-associated intermittent fasting on the intestinal microbioma
Draft
Prospective study of 2 separate cohorts during Ramadan fasting
Participant
There were 2 cohorts: a young adult cohort and a middle-aged cohort. The middle-aged cohort had 10 nonfasting participants who served as controls; there was no control group within the young adult cohort:
- Kohorte 1 (jung, gesund) Ramadan 2016: Alter 18,63±1,75; n=30 nüchtern
- Kohorte 2 (mittleres Alter, gesund) Ramadan 2018: Alter 39,9±6,4; n=27 nüchtern, n=10 nicht nüchtern
All volunteers observed an overnight fast lasting approximately 16 hours to celebrate Ramadan, the 9th month of the Muslim year in which those who practice the Islamic faith fast from sunrise to sunset for 30 days. All participants in the young cohort were male, and 70% of participants in the middle-aged cohort were male. Due to regional differences in the diet of the 2 cohorts, it was reported that the young cohort had rice as a staple in their diet, while the staple for the middle-aged cohort was wheat.
Exclusion criteria were obesity, diabetes, high blood pressure, arthritis, chronic respiratory diseases and gastrointestinal diseases. Taking prescription antibiotics a month before Lent was also excluded.
Results measured
The primary outcome was to analyze the composition of the gut microbiome before and after Ramadan. Gut microbiota was analyzed for composition, diversity and taxonomic abundance in both cohorts using next-generation sequencing and 16s ribosomal RNA gene sequencing and data processing techniques.
Healthy, young cohort: Only fecal samples were used for comparison. There were 3 time points: day one of Ramadan (T1), day 15 (T2), and day 30 (T3).
Given these far-reaching effects, it makes sense that changes in microbial composition could be a key factor in the diverse health benefits of intermittent fasting.
Healthy middle -aged cohorts: stool samples were analyzed in the same way as with the young cohort. The times for the middle -aged cohort were the beginning of the Ramadan (T1), end of the Ramadan (T2) and 1 month after the end of the Ramadan (T3). In addition to stool samples, the researchers assessed the body composition as well as several blood parameters (comprehensive metabolic profile, hemoglobin A1C, lipid panel and uric acid). This cohort also filled out a Food Frequency Questionnaire (FFQ).
Secondary endpoints were blood parameters, body composition and food intake.
Key insights
During the fasting period, both cohorts experienced major changes in the composition of the microbiome, which were similar to each other, while the non -fast control in the middle -aged group did not experience any significant changes in the composition of the microbiome. In particular, both cohorts showed an enrichment of butyric acid productionLachnospiraceae. The authors point out that high concentrations ofLachnospiraceaeare associated with a reduced risk of cancer, improved inflammatory bowel disease, better mental health, less allergies and improved cardio -piratory health.
The young cohort had an increase in overall gut microbiota diversity (Shannon-Weaver Index), while the middle-aged cohort did not. In the middle-aged cohort, microbial composition largely returned to baseline for most taxa 1 month after fasting, while shifts persisted in some.
The fasting groups also experienced weight loss and had improved liver enzyme activity.
Practice implications
More than 24% of the world's population is Muslim.1Ramadan provides a convenient opportunity to assess the physiological changes of a 16-hour fast in large populations. It is expected that fasting during Ramadan, like fasting in general, should provide health benefits, and so far this appears to be the case. According to a 2014 analysis of 21 different studies, Ramadan fasting resulted in positive metabolic effects and weight loss.2This analysis, as well as a 2021 study, showed that Ramadan fasting can reduce inflammation and boost immunity.3
2020,Journal of naturopathypublished a peer-reviewed paper on this topic that discussed mechanisms of action and clinical applications of intermittent fasting.4A review of 12 different studies from 2019 showed that intermittent fasting lowered the BMI and that glycemic control, insulin resistance and obocin concentration improved compared to adults who did not make intermittent fasting.5A 2020 review found that intermittent fasting not only reduces the risk of cardiovascular disease but also improves cognition in both obese and non-obese individuals.6
Shortly after the study discussed here, another small pilot study showed that fasting during Ramadan led to significant changes in the intestinal microbioma.7General fasting, i.e. a very early dinner and/or a late breakfast, has already established itself as a means of changing the intestinal microbiota.8These studies on Ramadan fasting imply that the time of day at which fasting occurs (daytime vs. nighttime) does not alter the overall effect of increasing diversity and shifting microbiota composition. The ability to alter the composition of the microbiota has broad clinical significance, as everything from depression to diabetes, cardiovascular disease to cancer and more can be traced, at least in part, to the gut microbiome.9Given these far-reaching effects, it makes sense that changes in microbial composition could be a key factor in the diverse health benefits of intermittent fasting.
Intervall fasting is not suitable for all patients because it is a burden on the body. As part of religious observations such as Ramadan, many population groups are encouraged to avoid fasting. This includes pre -pubertal children, older people, frail and pregnant women, to name just a few.10
Fasting as a means of improving health is perhaps one of the simplest and most economical tools we have in integrative medicine. However, as with any therapy, caution should be exercised in frail individuals, those with acute illnesses, and those for whom skipping meals is considered contraindicated.
Study Restriction
A limitation of the study was the fact that there was no control group in the young male cohort, which affects the results of the young male cohort group. However, the control group in the middle-aged cohort confirmed that the microbial composition of the intestine hardly changes without fasting.