Doctor studying health benefits of Ramadan fasting.
Doctor studying overall benefits of dawn-to-dusk religious practice
When you eat could be just as important as what you eat, according to a recent study out of Baylor College of Medicine. Recently published research, led by Dr. Ayse Mindikoglu, associate professor of medicine and surgery, centers on intermittent fasting — with a twist.
She looked specifically at fasting that follows circadian rhythms, lasting from dawn to dusk.
This type of fasting is practiced during the month of Ramadan, when Muslims around the world abstain from food and drink every day.
“Muslims believe that through fasting, they are able to strengthen their relationship with God, practice willpower and empathize with the less fortunate,” said Imam Rihabi Mohamed from Al-Ansaar Masjid in The Woodlands.
Two meals — suhoor, served before dawn, and iftar, served after sunset — unite families and friends each day.
The timing of these two meals and the fast itself may hold the key to a healthier life, said Mindikoglu, who is board certified in internal medicine, gastroenterology and transplant hepatology.
The study, led by Mindikoglu, found that dawnto-sunset fasting was associated with proteins protective against cancer, as well as obesity, diabetes, metabolic syndrome, inflammation and some neurological disorders.
“Intermittent fasting has become very popular in the treatment of many chronic diseases, including cancer,” said Mindikoglu, who began designing the research in 2014.
But the problem with intermittent fasting is the multitude of interpretations — suggesting how, when and for how long to abstain from eating to reap health benefits.
Mindikoglu and her team wondered if the answer could lie in circadian rhythms.
“All living organisms — plants, animals and humans — have an internal clock,” she said. “Our biological clock helps regulate feeding patterns and hormone release.”
There are a number of reasons humans struggle to stick to their circadian rhythm, Mindikoglu explained. Jet lag, working the night shift and the constant presence of cellphones can all disrupt schedules.
At the same time, many people eat randomly and often throughout the day, which means they have stopped relying on any clock for mealtime.
“Previous research indicates that disrupted circadian rhythm can lead to diabetes, high cholesterol, insulin resistance and elevated blood pressure,” Mindikoglu said.
She compares the phenomena to a computer malfunction.
“You need a reset,” she said. “By time-restricted eating, you can reset the clock.”
Mindikoglu had studied research in animals, which she was not involved in, but wanted to know if the same could be true in humans. And she wanted to know, “Can we prevent cancer by resetting our circadian clocks?”
Individuals who fast during Ramadan follow the ideal timeline for Mindikoglu’s research. In 2018, she began following 14 subjects who were all fasting for Ramadan. Each participant had to commit to fasting for more than 14 hours a day and follow a dawn-tosunset timeline. They also had to eat both at suhoor and iftar.
Outside of that, there were no calorie or diet restrictions. Participants were able to eat as much or as little as they wanted for their two daily meals.
Having suhoor, the predawn breakfast, was particularly important, Mindikoglu explained. It protects participants against dangerous increases in blood pressure and sugar levels. Mindikoglu’s team took blood samples before fasting began, to use as a baseline. A second set of samples were taken at the end of the fourth week, followed by a third, one week after fasting ended.
Researchers conducted untargeted proteomic profiling, or the study of proteins, on the samples.
“We compared the blood samples to determine if there was any change,” Mindikoglu said.
By focusing on the proteins, researchers could understand the specific mechanism behind health benefits during Ramadan. The study showed an increase in specific proteins that are down regulated in several cancers and other disorders.
Mindikoglu explained down regulation is a process that decreases the quantity of its cellular component, like RNA or protein, for example, in response to a variable. For example, a tumor suppression protein or gene would be down regulated in someone with cancer, allowing for the proliferation of cancer cells.
In study participants, researchers found those types of proteins were present at increased levels, which could lead to protection against illness and even cancer.
The research was published in the Journal of Proteomics and funded by the National Institutes of Health.
“Our study is just the beginning,” Mindikoglu said. “We have to replicate all the results. We would like to proceed with more patients. There are so many questions that need to be answered.”
For example, she wants to learn how long and how often fasting should occur for optimal health benefits.
“When a person eats a predawn meal and fasts until sunset, it optimizes resetting of their metabolic circadian rhythm,” said Dr. John Vierling, director of Baylor Liver Health at Baylor College of Medicine. “The excitement and importance at the scientific level are the actual metabolic and anti-cancer benefits of this type of intermittent fasting.”
He pointed to the particular proteins that are inhibited, the suppression and the change in gene expression.
He agreed that the next step would be to answer how often such fasting cycles are required to achieve a positive change to health. Can periodic fasting during the year achieve sustained benefits? In addition, would the results be the same if fasting occurred at other times of day?
“There are many questions that can be asked — and should be answered,” Vierling said. “Dr. Mindikoglu has an extraordinary appreciation of what needs to be studied. Intermittent fasting represents a promising pathway toward better health.”
Imam Dr. Basem Hamid at the Shadow Creek Muslim Center in Pearland is well aware of the health benefits of Ramadan. He is the founder and president of the Wasat Institute in Houston, which is dedicated to improving health and wellness in the Muslim community.
Hamid believes that health has physical, mental and spiritual aspects. He explained that in the oral tradition, Prophet Muhammad says that “fasting is a protection.”
He said that another translation is “Fast, you become healthy.”
“This is a deeply rooted belief in Islamic culture, that fasting leads to better health,” Hamid said. “Now science is coming in with real evidence.”
Being healthy is an important part of worship of God, the imam added.
He believes that the fast can serve as a restart button for wellness — both physically and spiritually. “Ramadan is all about rebooting the brain,” he said.