Intermittent fasting may worsen clinical disease activity in UC patients
Intermittent fasting during the month of Ramadan was associated with deterioration of clinical parameters in a small group of patients with ulcerative colitis, according to research published in BMC Gastroenterology.
“Fasting during Ramadan is one of the [intermittent fasting (IF)] regimens that mimics several protocols used frequently for weight loss and other health benefits, especially time-restricted eating. [Ramadan intermittent fasting (RIF)] entails a complete abstinence from food and liquids from dawn to sunset,” Mohamed Negm, of the Integrated Clinic and Research Center for Intestinal Disorders at Cairo University, and colleagues wrote. “Counseling patients with inflammatory bowel disease on whether fasting will benefit or harm their bowel condition remains difficult due to the lack of studies on this issue.”
In a prospective, observational cohort study, Negm and colleagues analyzed 80 patients (median age, 32 years; 41 men) with IBD (UC = 60, Crohn’s disease =20) who observed RIF during the lunar month of Ramadan 2021. They assessed the impact of RIF on serum C-reactive protein, fecal calprotectin, partial Mayo score, Harvey Bradshaw Index (HBI), Simple IBD questionnaire (SIBDQ) score and Hamilton depression scale questionnaire score; data was recorded and compared before and at the end of Ramadan.
According to study results, there was no significant difference before vs. after fasting in serum CRP (median 0.53 mg/dl vs. 0.5 mg/dl, respectively), fecal calprotectin (163 mcg/g vs. 218 mcg/g), HBI in patients with CD (4 vs. 5), SIBDQ score (43 vs. 40) and Hamilton depression scale score (18 vs. 18).
However, Negm and colleagues noted a significant rise after fasting in partial Mayo score among patients with UC (mean 1.79 vs. 2.33; P = 0.02), which was associated with older age, male sex, lower baseline Mayo score and higher baseline fecal calprotectin levels. Further multiple linear regression analysis revealed older age (P = 0.02) and higher baseline fecal calprotectin (P = 0.01) significantly associated with a rise in partial Mayo score after fasting.
“IF for 14 to 15 hours during the month of Ramadan did not seem to significantly affect CRP and fecal calprotectin levels in patients diagnosed with IBD. However, in UC patients, especially older ones, and those with a higher baseline fecal calprotectin, RIF was associated with a deterioration in their clinical activity indices,” Negm and colleagues concluded. “Larger studies are required to confirm our initial findings, but for now, it seems prudent to counsel patients diagnosed with IBD that intermittent (Ramadan) fasting is allowed but with caution and vigilance.”