Ramadan Fasting in Health and Disease: A Concise Review of the 2024 Literature

Abstract

The literature on the health implications of Ramadan fasting (RF) is extensive and dispersed across multiple disciplines and journals, which presents accessibility challenges for interested readers. This narrative, nonsystematic review synthesizes international literature published in 2024 on RF, identified through PubMed. Diabetes-focused studies were excluded, as they are reviewed separately. The included studies were thematically grouped to highlight major findings across physiological, clinical, and professional development domains. A total of 66 out of 112 studies were categorized into key thematic areas, including physiology and metabolism; nutrition and gut microbiota; cardiovascular and renal health; endocrine and hormonal regulation; maternal and fetal outcomes; neurology and cognitive function; sports performance; and health care provider and patient perspectives. RF was associated with beneficial effects on several metabolic parameters, such as reductions in body weight, lipid profile, blood pressure, and inflammatory markers. Modulations in circadian rhythms, gut microbial diversity, and autophagy-related gene expression were observed. In individuals with chronic kidney disease or those taking levothyroxine, fasting was generally well tolerated when supported by appropriate clinical oversight. While maternal studies reported no major adverse birth outcomes, subtle long-term developmental changes were suggested. Patient and professional perspectives underscored the need for culturally competent health care and pre-fasting education. Overall, the findings underscore the wide-ranging academic and clinical relevance of RF. This review offers a concise synthesis of the 2024 literature to help clinicians, researchers, and health care professionals remain informed about current evidence and emerging trends.

Keywords

Ramadan fasting - endocrinology - kidney disease - public health - sports medicine

Introduction

Ramadan, the ninth month of the Islamic lunar calendar, is observed by Muslims worldwide through daily fasting from dawn to dusk. This unique form of intermittent fasting is not merely a dietary approach but one intertwined with social, behavioral, and spiritual elements.[1] While Islamic law exempts vulnerable individuals, many with chronic or acute health conditions voluntarily fast, presenting both medical and ethical challenges to practitioners.[2]

The past decade has witnessed a surge in academic interest in the health effects of Ramadan fasting (RF).[3] [4] [5] This trend has been marked by increasingly sophisticated study designs, broader disciplinary coverage, and rising publication volume. Despite this, access to comprehensive and thematic summaries remains limited, as studies are dispersed across diverse specialty journals that use different inclusion criteria, outcome measures, and populations.

Annual narrative reviews since 2017 have been published to address this gap. This 2024 edition compiles and analyzes peer-reviewed studies retrieved from PubMed, presenting them under clinically relevant themes to support evidence-based decision-making.

This review aims to distil the year's evidence, identify emerging trends, identify areas requiring further research, and outline practical applications of the findings. The synthesis is aimed at clinicians, researchers, health care educators, and policy makers seeking a concise yet thorough understanding of the biomedical and psychosocial implications of RF.

Materials and Methods

A narrative review was conducted using PubMed to identify English-language human studies published between January 1 and December 31, 2024. The search term “Ramadan fasting” was used. A total of 146 records were identified. The PubMed database was used, guided by the established peer-review practices required for inclusion in the database. Fifty-six diabetes-related studies were excluded to maintain focus and readability and these were published separately under a different cover.[6] After manual screening, 66 of the studies were identified as relevant and were thematically analyzed. Only full-text articles were included. Letters, case reports, and narrative reviews were excluded unless they introduced very important perspectives. They were manually grouped thematically based on epidemiological, physiological, and clinical criteria. Small and single articles were presented under the miscellaneous group. Multiple rounds of collaborative review and editing were performed among co-authors to refine the manuscript to its final version.

Results and Thematic Discussion

Epidemiology

Kartal et al[7] analyzed mortality rates over 33 years and found no significant overall difference in mortality during Ramadan compared with other months. However, an unexpected increase in female mortality during Ramadan in the winter months was noted, suggesting a need for further investigation into gender-specific and seasonal effects.

Physiology and Metabolism

Several studies have demonstrated that fasting during Ramadan leads to significant alterations in circadian rhythms and metabolic regulation. Ali and Lessan[8] reported shifts in key hormones, including melatonin, cortisol, ghrelin, and leptin, suggesting a unique chronobiological profile associated with fasting. In the LORANS cohort, Al-Jafar and colleagues[9] observed changes in 14 metabolites, with reductions in cancer-related metabolic scores linked to colorectal, lung, and breast cancer risks. Additional studies revealed improvements in olfactory acuity, reductions in inflammatory biomarkers such as MMP-9 and tumor necrosis factor-α, and modulation of neurotrophic markers, including brain-derived neurotrophic factor (BDNF), which are linked to cognitive function and sleep regulation. Fasting was also associated with changes in zinc and magnesium levels, suggesting a need for supplementation in specific populations. Plasma volume improvements were reported, particularly in individuals with obesity. Moreover, fasting appeared to upregulate genes associated with autophagy, which may contribute to longevity and healthier metabolic profiles.[10] [11] [12] [13] These findings are summarized in [Table 1].

Table 1 Physiological and metabolic effects of Ramadan fasting

Study	Population	Key findings	Implication
Ali & Lessan[8]	General population	Altered melatonin, cortisol, ghrelin, and leptin	Unique circadian profile of RF
Al-Jafar et al[9]	UK cohort (n = 72)	14 altered metabolites; decreased cancer risk markers	Potential long-term metabolic protection and cancer risk modulation.
Paukkonen et al[10]	Systematic review	Increased gut microbial diversity, lower LDL-C	Supports improved gut-lipid health
Bou Malhab et al[11]	Overweight cohort	Increased autophagy gene expression	Potential longevity-promoting effects
Çakan et al[12]	Young adults	Enhanced olfactory sensitivity and identification	Suggests neurosensory modulation via fasting
Khalfoun et al[13]	Mixed body types	Improved plasma volume, especially in obese participants	May enhance thermoregulation and exercise capacity

Abbreviations: LDL-C, low-density lipoprotein cholesterol; RF, Ramadan fasting; UK, United Kingdom.

Nutrition, Gut, and Liver

RF influenced nutrient intake, body composition, and dietary behavior. Increased sugar intake and reduced starch consumption were common.[14] Changes in micronutrients, such as lutein and betaine, partially explained shifts in blood pressure and body mass index (BMI). Khan et al documented variable weight change in Indian Muslims, influenced by urban residence, employment status, and altered eating habits.[15] Comparative studies showed that RF led to greater reductions in abdominal fat and liver steatosis than traditional 16-hour intermittent fasting models.[16] Systematic reviews confirmed reduced energy, carbohydrate, and protein intake during Ramadan. Shifts in meal timing were more influential than changes in nutrient quantity on metabolic changes.[17] The gut microbiota was significantly modulated by RF, improving microbial diversity and lipid profiles.[10] However, results varied across studies, and further work is needed to clarify implications for human health.

Endocrinology

The impact of RF on endocrine and metabolic function is summarized in [Table 2].[18] [19] [20] [21] [22] [23] RF yielded modest effects on thyroid hormones and sex steroids. Morning cortisol was consistently reduced, indicating circadian disruption.[18] [19] For patients on levothyroxine, dose timing adjustments improved outcomes without overt dysfunction.[20] [21] Studies on adrenal insufficiency demonstrated that converting patients to once-daily prednisolone at predawn was safe and preserved quality of life, but doses below 5 mg risked adrenal symptoms.[22] [23] Limited studies on polycystic ovarian syndrome showed mixed results regarding hormonal and metabolic improvements, underscoring the need for more trials.[24] Intermittent fasting (including RF) was generally as effective as continuous energy restriction for weight loss, though evidence on insulin and lipid metabolism remained mixed.

Table 2 Endocrine and hormonal effects of Ramadan fasting

Study	Population	Hormones/markers	Key findings	Conclusion
Poursalehian et al[18]	(Meta-analysis, n = 1,107); healthy adults	T3, T4, TSH, FT3, FT4, cortisol, testosterone, LH, FSH, prolactin	No significant change in most hormones; significant decrease in morning cortisol.	RF is hormonally safe for healthy individuals, but it impacts circadian cortisol rhythms
Şentürk et al[19]	Healthy Turkish men (n = 19)	Melatonin, Cortisol, Serotonin	↑ In serotonin, no change in melatonin or cortisol	RF may improve mood via serotonin, but does not disturb cortisol/melatonin balance significantly
Belal et al[20]	Hypothyroid patients on levothyroxine (systematic review)	TSH, T3, T4	RF requires adjustment in medication timing; most remained euthyroid	Safe if monitored, especially with medication timing adjustments
Mok et al[22] Hee et al[23]	Patients with adrenal insufficiency (X2 trials)	Cortisol	Replacing short-acting hydrocortisone with prednisolone	Prednisolone may be used during RF in patients with AI
Kalsekar et al[24]	Women with PCOS (n = 75)	LH, FSH, testosterone, insulin	Mixed results; some showed decreased insulin resistance, others no effect	More high-quality trials are needed to confirm the effect of RF on PCOS

Abbreviations: FT3, free triiodothyronine; FSH, follicle-stimulating hormone; LH, leutinizing hormone; PCOS, polycystic ovarian syndrome; T3, triiodothyronine; T4, thyroxine.

Cardiovascular and Renal Health

RF was associated with reductions in BMI, systolic blood pressure, and total cholesterol across multiple systematic reviews and trials.[25] [26] [27] [28] [29] [30] For instance, Gholampoor et al[25] confirmed cardiometabolic improvements with various religious fasting practices, including RF, which positively affects blood pressure reduction. Abdulkadir et al[26] observed reductions in weight, blood pressure, and BMI among healthy Nigerian Muslims during Ramadan, supporting its potential role in reducing cardiovascular risk; however, over 80% of the study's small sample had a healthy lifestyle and exercised regularly before Ramadan.

The key studies published in 2024 on kidney health are summarized in [Table 3].[27] [28] [29] [30] With appropriate monitoring, many patients with chronic kidney disease (CKD) stages 1 to 3 can safely fast during Ramadan. Individualized hydration and dietary plans were recommended. Meta-analyses revealed no significant deterioration in renal function among stable CKD or transplant patients, though high heterogeneity calls for caution.[27] Studies reported no significant changes in lipid profile, HbA1c, or uric acid among fasting CKD patients.[28] [29] Adverse effects were rare, and renal parameters remained stable when pre-Ramadan assessments and post-Ramadan monitoring were implemented, especially in patients with stable CKD.[30] Boobes et al[31] published updated consensus recommendations for CKD patients, emphasizing individualized risk assessment and shared decision-making.

Table 3 The impact of Ramadan fasting on kidney health

Study	Population	Key parameters	Findings	Conclusion
Bello et al (meta-analysis, 32 studies, n = 2,592)[27]	CKD and transplant patients	SCr, eGFR, proteinuria, BP	No significant deterioration in renal function across groups	RF appears safe in stable CKD and KTR with appropriate monitoring
Haroon et al[28]	CKD patients in Pakistan (n = 68)	SCr, eGFR, uric acid, BP	Statistically significant improvement in BP, SCr, and uric acid (p < 0.0001)	RF did not worsen renal function, even in diabetics
Ashkbari et al (meta-analysis)[29]	CKD patients	Lipid profile, HbA1c, uric acid	No significant change in lipids, uric acid, or HbA1c	RF shows metabolic neutrality in CKD—safe with monitoring
Alobaidi (narrative review)[23]	CKD patients (non-dialysis)	Hydration, BP, metabolic markers	Highlights individual variability and the importance of education	Pre-fasting planning and post-fasting monitoring are essential

Abbreviations: BP, blood pressure; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; HbA1c, glycosylated hemoglobin; KTR, kidney transplant; RF, Ramadan fasting; SCr, serum creatinine.

Neurology

The neurological effects of fasting were mixed and context-dependent. Several studies reported increased BDNF levels and corresponding improvements in cognition, particularly in adolescents. Conversely, other research documented decreased BDNF levels, reflecting variability in methodology and population. A systematic review by Alkurd et al[32] found that three of five Ramadan studies reported increased BDNF levels, while the remaining two showed reductions. Fasting headaches were commonly reported in the early days of Ramadan. In a clinical trial, extended-release paracetamol demonstrated modest efficacy in preventing headache. Alwhaibi et al[33] identified elevated CGRP (calcitonin gene-related peptide) levels in individuals with fasting-induced headaches, suggesting its potential as a therapeutic target. Emergency department records indicated increased presentations of dehydration-related delirium and cardioembolic strokes during Ramadan, although causality remains unclear.

Furthermore, a randomized trial found that “modified” RF (with prior lifestyle advice) improved well-being, mindfulness, and some biometric markers, such as BMI and blood pressure.[34] Conversely, hospital data showed a rise in seizures and cardioembolic strokes during Ramadan, possibly due to dehydration or medication non-adherence.[35] In children, cognitive functions and event-related potentials remained stable during Ramadan.[36] Additionally, case reports suggest that RF may trigger idiopathic intracranial hypertension or exacerbate headaches in sensitive populations.[37] [38] A randomized clinical trial evaluated the role of paracetamol in preventing headache during the first week of Ramadan.[39]

Maternal and Fetal Health

A few articles addressed maternal and fetal health during Ramadan ([Table 4]). The long-term effects of fasting during pregnancy remain unclear.[40] [41] [42] [43] Pradella et al's meta-analysis of 31 studies found no significant effect on birth weight or prematurity.[41] However, there were small but statistically significant adverse impacts on childhood cognition, stature, and hearing disability in adulthood. Kasap et al[42] found reduced antioxidant status among fasting pregnant women, but no observable fetal harm based on ultrasound parameters. Guilfoyle[43] demonstrated a dose–response relationship between fasting days and colostrum cortisol levels, suggesting possible endocrine effects on neonates.

Table 4 Highlights of the maternal and fetal effects of Ramadan fasting

Study	Population	Outcome measures	Main findings
Pradella et al[41]	31-study meta-analysis	Birth weight, prematurity, cognition, and hearing	No birth risk; mild adverse cognitive/hearing outcomes
Kasap et al[42]	100 pregnant women	TAS, fetal ultrasound	↓ Antioxidant status; no fetal harm
Guilfoyle[43]	Moroccan cohort	Colostrum cortisol	↑ Cortisol with more fasting days

Furthermore, a systematic review concluded that RF—as a form of time-restricted eating—may be associated with long-term adverse outcomes in offspring, such as lower body size and cognitive effects, particularly in low-income settings.[44] Meanwhile, a study in Lebanon found that pregnant women's intention to fast was shaped more by family influences (especially mothers) and perceived physical ability than by medical or religious authorities.[45]

Sports Medicine and Athletes' Well-Being

Research on the effects of RF on athletes' physical performance, cognitive function, metabolism, and lived experiences was abundant.[46] [47] [48] [49] [50] [51] [52] [53] The results are summarized in [Table 5]. Multiple studies show that Ramadan intermittent fasting (RIF) can impair mental and psychomotor performance, especially later in the fasting period, and is often linked to reduced sleep quality.[46] The timing of the Suhoor meal also influences cognitive performance throughout the day. A systematic review by Trabelsi et al[47] found that RIF is associated with decreased sleep, energy intake, and performance during high-intensity exercise, despite low-quality evidence. Elghoul et al[48] reported that while sprint performance remained stable, fasting reduced shooting accuracy and executive function in soccer players after intense exertion. Triki et al[49] demonstrated that resistance training is safe during fasting, but evening (fed-state) sessions yielded better strength gains and hormonal responses. Almuraikhy et al[44] [50] found that combined exercise and fasting reduced lipid metabolites linked to inflammation and aging. Amjad et al[51] highlighted the spiritual significance of Ramadan for Muslim collegiate athletes while identifying physical, emotional, and social challenges. The findings emphasize the need for tailored support and cultural understanding in athletic settings during RF. Bougrine et al[52] studied 26 adolescent female athletes to investigate the impact of Suhoor timing on diurnal cognitive performance. They found that late Suhoor helped preserve cognitive performance, especially in the afternoon and noon. Finally, Özbay et al[53] observed no significant differences in sprint performance or energy metabolism between fasted and non-fasted states, though slight performance declines were noted.

Table 5 Impact of Ramadan fasting on athletes' health and performance

Study	Participants	Focus	Key measures	Main findings
Bougrine et al[46]	23 female handball players	Effects of RF on cognitive and psychomotor performance	SRT, CRT, MRT, PSQI, body composition, diet	Significant decline in performance and sleep quality during RF, especially in Week 4
Trabelsi et al[47]	Systematic reviews (14 total)	Effects of RF on health and exercise in athletes	Sleep duration, energy intake, mood, lean mass, performance	Decreased sleep, energy intake, and performance; results from reviews had low methodological quality
Elghoul et al[48]	16 elite soccer players	Impact of RF and high-intensity exercise on performance	LSST, 5mSRT, TMT A & B, RPE, FI, PF, TD, HD,	No effect on physical performance; reduced accuracy and perceived difficulty during high-intensity sessions
Triki et al[49]	40 physically active males	Timing of resistance training during RF	1-RM, PSQI, serum cortisol, serum testosterone, serum IGF-1	Fed-state training is more effective than fasted-state training for strength; hormonal adaptations varied by time of training
Almuraikhy et al[50]	29 young, healthy females	Exercise + RF vs. exercise alone on metabolism and aging	Untargeted metabolomics, telomere length	Significant lipid metabolite reductions (e.g., ceramides) in the fasting group; implications for inflammation and aging
Amjad et al[51]	12 Muslim collegiate athletes (4F, 8M)	Lived experiences of athletes during Ramadan fasting	Semi-structured interviews	Themes: spiritual meaning, physical/mental challenges, lack of support, need for more inclusive athletic environments
Bougrine et al[52]	26 adolescent female athletes	Timing of Suhoor on diurnal cognitive performance	SRT, CRT, ATT, MRT, OT, PSQI	Late Suhoor helped preserve cognitive performance, especially in the afternoon and at noon
Özbay et al[53]	14 active male athletes	Performance and metabolism during repeated sprints in RF	Sprint time, bioenergetics (PCr-LA-O2), energy expenditure	No significant performance or bioenergetic differences between fasting and non-fasting; trends favor the non-fasting state

Abbreviations: ATT, attention test; CRT, choice reaction time test; FI, fatigue index; IGF-1, insulin-like growth factor 1; HD, higher distance; LSST, Loughborough Soccer Shooting Test; MRT, mental rotation test; OT, oral temperature; PD, perceived difficulty; PF, perceived fatigue; PSQI, Pittsburgh Sleep Quality Index; RF, Ramadan fasting; RPE, rating of perceived exertion; SRT, simple reaction time test; TMT Parts A and B, Trail Making Test (TMT Parts A and B); 1-RM, one-repetition maximum; 5mSRT, 5-m shuttle run test; TD, total distance.

Miscellaneous Clinical Issues

Recent studies on RF have explored its implications across diverse domains, including regenerative medicine, surgery, neurology, sleep, dermatology, and clinical practice.[50] [54] [55] [56] [57] [58] [59] [60] [61] [62] [63] [64]

Regenerative Medicine

RF combined with exercise was associated with increased telomere length and reduced lipid metabolites (notably ceramides), suggesting potential anti-aging effects.[50] Similarly, intermittent fasting during Ramadan increased circulating progenitor stem cells in healthy males, with enhanced migration capacity, indicating a possible regenerative response to fasting stress.[54]

Surgery

Surgical literature indicates mixed outcomes. A prospective cohort from Egypt showed that many patients who underwent laparoscopic sleeve gastrectomy were able to fast safely, especially beyond 12 months post-surgery. However, symptoms such as reflux and dehydration were common.[55] In renal health, a 10-year case–control study found no increase in renal colic admissions during Ramadan among fasting Muslims. However, a rise was noted post-Ramadan, suggesting a delayed impact.[56] Other studies noted that fasting could be safe after bariatric or liver transplant surgery, but patient-specific risk assessment remains essential.[57] [58] The recurring question of the interplay between RF and the rates of trauma has been revisited in a new systematic review.[59]

Sleep Medicine

Multiple studies noted reduced sleep duration, increased insomnia, and excessive daytime sleepiness, especially among student-athletes and adults during COVID-19. Structured interventions to improve sleep timing may mitigate these effects.[60] [61] [62] [63]

Dermatology

RF was associated with improvements in acne severity and reductions in inflammatory and oxidative stress markers, suggesting a possible therapeutic role.[64]

Professional and Cultural Aspects

Several studies explored RF's implications for health education and clinical practice. Patients' willingness to fast often persisted despite medical risks.[65] [66] [67] [68] [69] [70] [71] Health care providers emphasized the need for personalized, culturally sensitive counseling and pre-Ramadan planning. Some advocated using the fasting period for health promotion and preventive interventions. For example, Hillier et al[65] found that health care professionals in Western countries often lacked sufficient knowledge to support fasting Muslim patients. Barriers included limited cultural training, language discordance, and insufficient educational resources. Also, Zagloul et al[66] stressed the need for culturally competent care and highlighted systemic gaps that affect Muslim patients' experiences.

Furthermore, fasting was linked to reduced risky behaviors (e.g., smoking) among Turkish nursing students, particularly among those with stronger spiritual beliefs.[67] A cross-sectional study also evaluated the effect of RF on changes in smoking and vaping behaviors and the severity of withdrawal symptoms.[68] A narrative review emphasized the importance of culturally sensitive patient care during Ramadan, especially regarding drug timing, hydration, and pre-fasting counselling.[69] [70] Even a specific risk-assessment tool among patients with chronic liver diseases interested in intermittent fasting has been called for.[71]

This narrative review provides a snapshot of the research productivity on RF in 1 year. This year-in-review article needs to be considered together with the authors' previous series, which spans from 2017 to the present. However, while comprehensive, it is limited by its nonsystematic methodology, potential publication bias, and heterogeneity in study designs, populations, and outcome measures among the included literature. Although it has been shown before that most of the RF work was published in English, the exclusion of non-English studies and gray literature may further narrow the scope of evidence considered. Also, the exclusion of non-PubMed indexed sources excluded many of the indexed emerging journals. Although it can be a more labor-intensive task, including Google Scholar's carefully selected articles may enhance the content. Additionally, many studies lacked long-term follow-up, randomized designs, or adequate sample sizes, particularly in emerging fields such as regenerative medicine.

Conclusion

The 2024 body of literature underscores the breadth and depth of research on RF across multiple disciplines. The findings demonstrate that RF affects physiological systems, metabolic parameters, chronic disease management, cognition, physical activity, maternal and fetal health, and health equity.

Most importantly, RF is generally well tolerated by individuals with stable chronic conditions when managed with clinical oversight and patient education. Studies have begun to explore fasting's impact on cellular aging, hormonal regulation, and mental health, offering new directions for translational research.

Future studies should focus on longitudinal designs, explore population-specific needs, and prioritize culturally competent health care delivery. This review provides a comprehensive reference for clinicians, researchers, and public health professionals committed to supporting the health and well-being of individuals during Ramadan.

Conflict of Interest

None declared.

Authors' Contributions

All authors contributed to the drafting and revision of the manuscript and approved the final version.

Compliance with Ethical Principles

No ethical approval is required.

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Publication History

Article published online:
15 December 2025