Ramadan Fasting in the Covid-19 Era: Researchers Try to Answer Questions

The start of the Covid-19 pandemic last year prompted a debate on social media about the safety of fasting during Ramadan, with one Algerian politician going so far as to call for it to be banned altogether.

Ramadan 2021 has started this week and continues through May 11 or 12. For Muslims, Ramadan fasting means abstaining from eating and drinking from dawn till sunset throughout the holy month.

Public concern that a lack of daytime food and water might make people more susceptible to Covid-19 motivated Hatem Zayed, an assistant professor of biomedical sciences at Qatar University’s College of Health Sciences, to publish an article summing up the scientific evidence on the impact of fasting on immunity to infection.

Published in November last year, it concluded that fasting can improve body wellness and performance of the immune system of healthy adult Muslims, and is expected to accelerate the healing process for patients with Covid-19.

“It is very important for academics to confront misconceptions that circulate among the public about fasting and its negative effect on Covid-19 infection,” said Taghreed Abunada, co-author of the article and a teaching assistant at the College of Health Sciences.

But, she said, “while fasting by itself is proven to boost immunity, the beneficial effects … might be reduced by the sleep pattern practiced in the blessed month of Ramadan,” when people often stay up late or eat heavy meals at night.

Calls for Additional Studies

A study published in October 2020 reached similar conclusions. It reviewed available literature on the effects of Ramadan fasting and intermittent fasting in general on human health and linked them to Covid-19.

It demonstrated that fasting reduces levels of pro-inflammatory cytokines  that are associated with severe Covid-19, and concluded that Ramadan fasting is not a cause of concern for healthy people who adopt a balanced diet, drink plenty of fluids, and engage in regular physical activity.

However, another study published in 2020 said the volume of scholarly work on Ramadan fasting and health remains modest and that greater improvements in both quality and quantity of research are needed to identify high-risk individuals.

Shahrad Taheri, a professor of medicine and integrative medicine at Weill Cornell Medicine-Qatar, agrees that more work needs to be done in terms of understanding Ramadan fasting and its benefit or risk for particular individuals in general, not just in relation to Covid-19.

“The Muslim population is a significant population in the world in terms of health, and giving them the right information to identify people who could benefit from fasting or are at risk of fasting is an important area of research,” he said.

Taheri said the scientific community is open to new ideas, including religious fasting, but researchers need to beware of saying that because it is related to Ramadan, it has to be good.

Ramadan Fasting and Minority Populations

Ramadan last year saw a surge in Covid-19 infections in Qatar, which local health authorities blamed on the social gatherings that are common in this month.

However, a study assessing the impact of Ramadan fasting on Covid-19 mortality in the United Kingdom found that the practices associated with Ramadan did not exacerbate the country’s death toll, the highest in Europe.

The study noted that inequalities in living and working conditions in the United Kingdom increased the exposure of minority communities to the pandemic and that attention should focus on these conditions rather than on the communities’ cultural behavior and practices.

“We need research to understand what happens in the population, and this research includes biological as well as social circumstances and how we manage Ramadan, Iftar gatherings and things like that,” Taheri said. (See a related article, “Patterns of Disease Are Changing in the Arab World.”)

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It is also important, according to Taheri, to understand how Ramadan fasting may affect coronavirus vaccine response or rate of infection, although it might be difficult to separate the biological and social causes in this regard.

Until such research becomes available, Taheri says people should use Ramadan to pay attention to their mental and physical health and avoid gatherings as much as possible.

“Ramadan is a really good time for reflection,” he said. “People can use it to think about diet, lifestyle and mental health and to reduce weight, for people who are overweight, because that has benefits in terms of improving metabolic and immune function.”