Advertisement

American Society for Metabolic and Bariatric Surgery review on fasting for religious purposes after surgery

      This review article is issued by the American Society for Metabolic and Bariatric Surgery (ASMBS) in response to numerous inquiries made to ASMBS by patients, physicians, ASMBS members, hospitals, health insurance payors, the media, and others regarding the safety and recommendations for fasting for religious purposes after undergoing metabolic and bariatric surgery. In this article, a summary of published, peer-reviewed scientific evidence spanning the years from 2000 to 2020 and a recently published 2021 Delphi Consensus and expert opinion is presented. The intent of issuing such a review is to provide available objective information about this topic. Unfortunately, there is a lack of published research on the effects of religious fasting on metabolic and bariatric surgery (MBS); therefore, the majority of the reviewed literature covers the effects of religious fasting on adults who have not undergone MBS. For the purpose of this review, guidance is given for religious fasting for spiritual, health, and safety benefits after bariatric surgery but not for using fasting as a weight loss strategy in the adult population. In addition, because of the absence of research on adolescents and children undergoing MBS and fasting, this review focuses on summarizing literature regarding adults and making recommendations for adults who underwent MBS and desire to fast. This review is not intended as and should not be construed as stating or establishing a local, regional, or national standard of care. This review article will be revised in the future as additional evidence becomes available.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Surgery for Obesity and Related Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Trepanowski J.F.
        • Bloomer R.J.
        The impact of religious fasting on human health.
        Nutr J. 2010; 9: 57-66
        • Al-Ozairi E.
        • Al Kandari J.
        • Al Haqqan D.
        • AlHarbi O.
        • Masters Y.
        • Syed A.A.
        Obesity surgery and Ramadan: a prospective analysis of nutritional intake, hunger and satiety and adaptive behaviours during fasting.
        Obes Surg. 2015; 25: 523-529
        • Sarri K.O.
        • Tazanakis N.E.
        • Lanardakis M.K.
        • Mamalakis G.D.
        • Kafatos A.G.
        Effects of Greek Orthodox Christian church fasting on serum lipids and obesity.
        BMC Public Health. 2003; 3: 16
        • Bloomer R.J.
        • Kabir M.M.
        • Canale R.E.
        • et al.
        Effect of a 21-day Daniel fast on metabolic and cardiovascular disease risk factors in men and women.
        Lipids Health Dis. 2010; 9: 94
        • Tabatabaie O.
        • Matin N.
        • Mohammadinejad P.
        • Zeinoddini A.
        A comment on: “Obesity surgery and Ramadan: a prospective analysis of nutritional intake, hunger, and satiety and adaptive behaviours during fasting.”.
        Obes Surg. 2015; 25: 2426-2427
        • Kermansaravi M.
        • Omar I.
        • Mahawar K.
        • et al.
        Religious fasting of Muslim patients after metabolic and bariatric surgery: a modified Delphi Consensus.
        Obes Surg. 2021; 31: 5303-5311
        • Dagan S.S.
        • Goldenshluger A.
        • Globus I.
        • et al.
        Nutritional recommendations for adult bariatric surgery patients: clinical practice.
        Adv Nutr. 2017; 8: 382-394
        • Sadiq A.
        Managing the fasting patient: sacred ritual.
        in: Sheikh A. Gatrad A.R. Caring for Muslim patients. 2nd ed. Radcliff Publishing, Oxford, UK2008
        • Gaborit B.
        • Dutour O.
        • Ronsin O.
        • et al.
        Ramadan fasting with diabetes: an interview study of inpatients’ and general practitioners’ attitudes in the south of France.
        Diabetes Met. 2010; 37: 395-402
        • Mygind A.
        • Kristiansen M.
        • Wittrup I.
        • Nørgaard L.S.
        Patient perspectives on type 2 diabetes and medicine use during Ramadan among Pakistanis in Denmark.
        Int J Clin Pharm. 2013; 35: 281-288
        • Salti I.
        • Bénard E.
        • Detournay B.
        • et al.
        A population-based study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries: results of the Epidemiology of Diabetes and Ramadan 1422/2001 (EPIDIAR) study.
        Diabetes Care. 2004; 27: 2306-2311
        • Hui E.
        • Devendra D.
        Diabetes and fasting during Ramadan.
        Diabes Metab Res Rev. 2010; 26: 606-610
        • Al-Arouj M.
        • Assaad-Khalil S.
        • Buse J.
        • et al.
        Recommendations for management of diabetes during Ramadan: update 2010.
        Diabetes Care. 2010; 33: 1895-1902
        • Hui E.
        • Bravis V.
        • Hassanein M.
        • et al.
        Management of people with diabetes wanting to fast during Ramadan.
        BMJ. 2010; 340: c3053
        • Kannan S.
        • Mahadevan S.
        • Seshadri K.
        • Sadacharan D.
        • Velayutham K.
        Fasting practices in Tamil Nadu and their importance for patients with diabetes.
        Indian J Endocrinol Metab. 2016; 20: 858-862
        • Bravis V.
        • Hui E.
        • Salih S.
        • Mehar S.
        • Hassanein M.
        • Devendra D.
        Ramadan Education and Awareness in Diabetes (READ) programme for Muslims with type 2 diabetes who fast during Ramadan.
        Diabet Med. 2010; 27: 327-331
        • M’guil M.
        • Ragala M.A.
        • El Guessabi L.
        • et al.
        Is Ramadan fasting safe in type 2 diabetic patients in view of the lack of significant effect of fasting on clinical and biochemical parameters, blood pressure, and glycemic control?.
        Clin Exp Hypertens. 2008; 30: 339-357
        • Khaled B.M.
        • Belbraouet S.
        Effect of Ramadan fasting on anthropometric parameters and food consumption in 276 type 2 diabetic obese women.
        Int J Diabetes Dev Ctries. 2009; 29: 62-68
        • Vasan S.K.
        • Karol R.
        • Mahendri N.V.
        • Arulappan N.
        • Jacob J.J.
        • Thomas N.
        A prospective assessment of dietary patterns in Muslim subjects with type 2 diabetes who undertake fasting during Ramadan.
        Indian J Endocrinol Metab. 2012; 16: 552-557
        • Karatoprak C.
        • Yolbas S.
        • Cakirca M.
        • et al.
        The effects of long term fasting in Ramadan on glucose regulation in type 2 diabetes mellitus.
        Eur Rev Med Pharmacol Sci. 2013; 17: 2512-2516
        • Bethancourt H.J.
        • Kratz M.
        • O’Connor K.
        A short-term religious “fast” from animal products has a minimal impact on cardiometabolic health biomarkers irrespective of concurrent shifts in distinct plant-based food groups.
        Am J Clin Nutr. 2019; 110: 722-732
        • Kul S.
        • Savaş E.
        • Öztürk Z.A.
        • Karadağ G.
        Does Ramadan fasting alter body weight and blood lipids and fasting blood glucose in a healthy population? A meta-analysis.
        J Relig Health. 2014; 53: 929-942
        • Shehab A.
        • Abdulle A.
        • El Issa A.
        • Al Suwaidi J.
        • Nagelkerke N.
        Favorable changes in lipid profile: the effects of fasting after Ramadan.
        PLoS One. 2012; 7e47615
        • Lamri-Senhadji M.Y.
        • El Kebir B.
        • Belleville J.
        • Bouchenak M.
        Assessment of dietary consumption and time-course of changes in serum lipids and lipoproteins before, during and after Ramadan in young Algerian adults.
        Singapore Med J. 2009; 50: 288-294
        • Rahman M.
        • Rashid M.
        • Basher S.
        • Sultana S.
        • Nomani M.Z.
        Improved serum HDL cholesterol profile among Bangladeshi male students during Ramadan fasting.
        East Mediterr Health J. 2004; 10: 131-137
        • Mazidi M.
        • Rezaie P.
        • Chaudhri O.
        • Karimi E.
        • Nematy M.
        The effect of Ramadan fasting on cardiometabolic risk factors and anthropometrics parameters: a systematic review.
        Pak J Med Sci. 2015; 31: 1250-1255
        • Salahuddin M.
        • Sayed Ashfak A.H.
        • Syed S.R.
        • Badaam K.M.
        Effect of Ramadan fasting on body weight, BP and biochemical parameters in middle aged hypertensive subjects: an observational trial.
        J Clin Diagn Res. 2014; 8: 16-18
        • Nematy M.
        • Alinezhad-Namaghi M.
        • Rashed M.M.
        • et al.
        Effects of Ramadan fasting on cardiovascular risk factors: a prospective observational study.
        Nutr J. 2012; 11: 69
        • Dewanti L.
        • Watanabe C.
        • Sulistiawati Ohtsuka R.
        Unexpected changes in blood pressure and hematological parameters among fasting and nonfasting workers during Ramadan in Indonesia.
        Eur J Clin Nutr. 2006; 60: 877-881
        • Sezen Y.
        • Altiparmak I.H.
        • Erkus M.E.
        • et al.
        Effects of Ramadan fasting on body composition and arterial stiffness.
        J Pak Med Assoc. 2016; 66: 1522-1527
        • Yeoh E.C.
        • Zainudin S.B.
        • Loh W.N.
        • et al.
        Fasting during Ramadan and associated changes in glycaemia, caloric intake and body composition with gender differences in Singapore.
        Ann Acad Med Singap. 2015; 44: 202-206
        • Sinaga M.
        • Teshome M.S.
        • Kidane R.
        • et al.
        Metabolic effects of fasting and animal source food avoidance in an Ethiopian adult cohort.
        Sci Rep. 2019; 9: 16964
        • Harder-Lauridsen N.M.
        • Rosenberg A.
        • Benatti F.B.
        • et al.
        Ramadan model of intermittent fasting for 28 d had no major effect on body composition, glucose metabolism, or cognitive functions in healthy lean men.
        Nutrition. 2017; 37: 92-103
        • McNeil J.
        • Mamlouk M.M.
        • Duval K.
        • Schwartz A.
        • Nardo Junior N.
        • Doucet E.
        Alterations in metabolic profile occur in normal-weight and obese men during the Ramadan fast despite no changes in anthropometry.
        J Obes. 2014; 2014: 482547
        • Ziaee V.
        • Razaei M.
        • Ahmadinejad Z.
        • et al.
        The changes of metabolic profile and weight during Ramadan fasting.
        Singapore Med J. 2006; 47: 409-414
        • Kassab S.
        • Abdul-Ghaffar T.
        • Nagalla D.S.
        • Sachdeva U.
        • Nayar U.
        Interactions between leptin, neuropeptide-Y and insulin with chronic diurnal fasting during Ramadan.
        Ann Saudi Med. 2004; 24: 345-349
        • Alsubheen S.A.
        • Ismail M.
        • Baker A.
        • et al.
        The effects of diurnal Ramadan fasting on energy expenditure and substrate oxidation in healthy men.
        Br J Nutr. 2017; 118: 1023-1030
        • Pallayova M.
        • Zaghloul H.B.
        • Arora T.
        • et al.
        Investigating physiological glucose excursions before, during, and after Ramadan in adults without diabetes mellitus.
        Physiol Behav. 2017; 179: 110-115
        • Al-Hourani H.M.
        • Atoum M.F.
        Body composition, nutrient intake and physical activity patterns in young women during Ramadan.
        Singapore Med J. 2007; 48: 906-910
        • Sadiya A.
        • Ahmed S.
        • Siddieg H.H.
        • Babas I.J.
        • Carlsson M.
        Effect of Ramadan fasting on metabolic markers, body composition, and dietary intake in Emiratis of Ajman (UAE) with metabolic syndrome.
        Diabetes Metab Syndr Obes. 2011; 4: 409-416
        • Karaagaoglu N.
        • Yucecan S.
        Some behavioural changes observed among fasting subjects, their nutritional habits and energy expenditure in Ramadan.
        Int J Food Sci Nutr. 2000; 51: 125-134
        • Shadman Z.
        • Akhoundan M.
        • Poorsoltan N.
        • et al.
        Nutritional education needs in relation to Ramadan fasting and its complications in Tehran, Iran.
        Iran Red Crescent Med J. 2016; 18e26130
        • Norouzy A.
        • Salehi M.
        • Philippou E.
        • et al.
        Effect of fasting in Ramadan on body composition and nutritional intake: a prospective study.
        J Hum Nutr Diet. 2013; 26: 97-104
        • Lessan N.
        • Ali T.
        Energy metabolism and intermittent fasting: the Ramadan perspective.
        Nutrients. 2019; 11: 1192
        • Persynaki A.
        • Karras S.
        • Pichard C.
        Unraveling the metabolic health benefits of fasting related to religious beliefs: a narrative review.
        Nutrition. 2017; 35: 14-20
        • Fahrial Syam A.
        • Suryani Sobur C.
        • Abdullah M.
        • Makmun D.
        Ramadan fasting decreases body fat but not protein mass.
        Int J Endocrinol Metab. 2016; 14e29687
        • Angelova R.
        • Utermohlen U.
        Culture-specific influences on body image and eating distress in a sample of Bulgarian women: the roles of faith and traditional fasting.
        Eat Behav. 2013; 14: 386-389
        • Savas E.
        • Ozturk Z.
        • Tanriverdi D.
        • Kepekci Y.
        Do Ramadan fasting restrictions alter eating behaviors in obese women?.
        J Relig Health. 2014; 53: 135-140
        • Lessan N.
        • Saadane I.
        • Alkaf B.
        • et al.
        The effect of Ramadan fasting on activity and energy expenditure.
        Am J Clin Nutr. 2018; 107: 54-61
        • Bahammam A.
        • Nashwan S.
        • Hammad O.
        • Sharif M.
        • Randi-Perumal S.
        Objective assessment of drowsiness and reaction time during intermittent Ramadan fasting in young men: a case-crossover study.
        Behav Brain Funct. 2013; 9: 32
        • Sadeghirad B.
        • Motanghipisheh S.
        • Kolahdooz F.
        • Zahedi M.
        • Haghdoost A.
        Islamic fasting and weight loss: a systemic review and meta-analysis.
        Public Health Nutr. 2014; 17: 396-406
        • Hajek P.
        • Myers K.
        • Dhanji A.
        • West O.
        • McRobbie H.
        Weight change during and after Ramadan fasting.
        J Public Health (Oxf). 2012; 34: 377-381
        • Bakhotmah B.A.
        The puzzle of self-reported weight gain in a month of fasting (Ramadan) amoung a cohort of Saudi families in Jeddah, Western Saudi Arabia.
        Nutr J. 2011; 10: 1-8
        • Suriani I.
        • Shamsuddin K.
        • Abdul-Latif K.
        • Saad H.
        The effect of the Malaysian Food Guideline guidance on a group of overweight and obese women during Ramadan.
        Saudi Med J. 2015; 36: 40-45
        • Kiyani M.
        • Memon A.
        • Amjad M.
        • Ameer M.
        • Sadiq M.
        • Mahmood T.
        Study of human biochemical parameters during and after Ramadan.
        J Relig Health. 2017; 56: 55-62
        • Fernando H.
        • Zibellini J.
        • Harris R.
        • Seimon R.
        • Sainsbury A.
        Effect of Ramadan fasting on weight and body composition in healthy non-athlete adults: a systematic review and meta-analysis.
        Nutrients. 2019; 11: 478-502
        • Lopez Bueno M.
        • Gonzalez-Jimenez E.
        • Navarro-Prado S.
        • Montero-Alonso M.
        • Schmidt-RioValle J.
        Influence of age and religious fasting on the body composition of Muslim women living in a Westernized context.
        Nutr Hosp. 2015; 31: 1067-1073
        • Rohin M.
        • Rozano N.
        • Hadi N.
        • Nor M.
        • Abdullah S.
        • Venkateshaiah
        Anthropometry and body composition status during Ramadan among higher institution learning centre staffs with different body weight status.
        Scientific World Journal. 2013; 2013: 308041
        • Ramadan J.
        Does fasting during Ramadan alter body composition, blood constituents, and physical performance?.
        Med Princ Pract. 2002; 11: 41-46
        • Celik A.
        • Saricicek E.
        • Saricicek V.
        • et al.
        Effect of Ramadan fasting on serum concentrations of apelin-12 and new obesity indices in healthy adult men.
        Med Sci Monit. 2014; 20: 337-342
        • Faris M.
        • Madkour M.
        • Obaideen A.
        • et al.
        Effect of Ramadan diurnal fasting on visceral adiposity and serum adipokines in overweight and obese individuals.
        Diabetes Res Clin Pract. 2019; 153: 166-175
        • Mushtaq R.
        • Akran A.
        • Mushtaq R.
        • Khwaya S.
        • Ahmed S.
        The role of inflammatory markers following Ramadan fasting.
        Pak J Med Sci. 2019; 35: 77-81
        • Yucel A.
        • Degirmenci B.
        • Acar M.
        • Albaryrak R.
        • Haktanir A.
        The effect of fasting month of Ramadan on the abdominal fat distribution: assessment by computed tomography.
        J Exp Med. 2004; 204: 179-187
        • Faris M.
        • Kacimi S.
        • Al-Kurd R.
        • et al.
        Intermittent fasting during Ramadan attenuates proinflammatory cytokines and immune cells in healthy subjects.
        Nutr Res. 2012; 32: 947-955
        • Keshteli A.H.
        • Sadeghpour S.
        • Feizi A.
        • Boyce P.
        • Adibi P.
        Evaluate of self-perceived changes in gastrointestinal symptoms during Ramadan fasting.
        J Relig Health. 2017; 56: 1620-1627
        • Wolfe B.M.
        • Kvach E.
        • Eckel R.H.
        Obesity, diabetes, and cardiovascular diseases compendium. Treatment of obesity: weight loss and bariatric surgery.
        Circulation Res. 2016; 118: 1844-1855
        • Parrott J.
        • Frank L.
        • Rabena R.
        • Craggs-Dino L.
        • Isom K.
        • Greiman L.
        American Society for Metabolic and Bariatric Surgery integrated health nutritional guidelines for the surgical weight loss patient 2016 update: Micronutrients.
        Surg Obes Relat Dis. 2017; 13: 727-741
        • Mechanick J.
        • Apovian C.
        • Brethauer S.
        • et al.
        Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures 2019 update—cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologist.
        Surg Obes Relat Dis. 2020; 16: 175-247
        • Abbas Z.
        Gastrointestinal health in Ramadan with special reference to diabetes.
        J Pak Med Assoc. 2015; 65: S68-71
        • Antwi Ch
        • Krahulec B.
        • Michalko L.
        • Strbova L.
        • Hlinstakova S.
        • Balazovjech I.
        Does diabetic autonomic neuropathy influence the clinical manifestations of reflux esophagitis.
        Bratisl Lek Listy. 2003; 104: 139-142
        • Iraki L.
        • Bogdan A.
        • Hakkou F.
        • Amrani N.
        • Abkari A.
        • Touitou Y.
        Ramadan diet restrictions modify the circadian time structure in humans: a study on plasma gastrin, insulin, glucose, and calcium and on gastric pH.
        J Clin Endocrinol Metab. 1997; 82: 1261-1273
        • Gokakin A.K.
        • Kurt A.
        • Akgol G.
        • et al.
        Effects of Ramadan fasting on peptic ulcer disease as diagnosed by upper gastrointestinal endoscopy.
        Arab J Gastroenterol. 2012; 13: 180-183
        • Chong V.H.
        Impact of Ramadan on upper gastrointestinal endoscopy referrals in Brunei Darussalam.
        Singapore Med J. 2009; 50: 619-623
        • Zahra B.E.
        • Shoaib S.
        • Iqbal R.K.
        An overview of effects of carbonated drinks.
        Nat J Health Sci. 2019; 4: 80-84
        • Hamoui N.
        • Lord R.V.
        • Hagen J.A.
        • Theisen J.
        • Demeester T.R.
        • Crookes P.F.
        Response of the lower esophageal sphincter to gastric distention by carbonated beverages.
        J Gastrointest Surg. 2006; 10: 870-877
        • Cuomo R.
        • Sarnelli G.
        • Savarese M.F.
        • Buyckx M.
        Carbonated beverages and gastrointestinal system: between myth and reality.
        Nutr Metab Cardiovasc Dis. 2009; 19: 683-689