Oxidative stress and Ramadan observance; a possible influence of associated dieting

Introduction: The effects of Ramadan observance and any associated dietary restriction upon oxidative stress are not well known. The topic has thus been examined in a brief systematic review of available literature concerning non-athletic but otherwise healthy subjects, patients with selected clinical conditions, and in athletes. Methods: Ovid/Medline and Google searches were supplemented by a perusal of reference lists in papers thus identified. Results: Ramadan observance and associated dietary restrictions are generally associated with a decrease of body mass in non-athletic adults, and in patients with conditions such as obesity, metabolic syndrome, diabetes mellitus and hypertension. During Ramadan, measures of oxidative stress (particularly malondialdehyde and F2 isoprostanes) are consistently decreased, antioxidant status (particularly levels of peroxidases, uric acid and reduced glutathione) are enhanced and inflammatory reactions (particularly c-reactive protein, IL-6 and TNF-a) are decreased in association with decreases in body mass. Perhaps because of lower initial body weights and greater dietary control during Ramadan, changes of oxidant status are more variable in athletes; in 3 of 7 studies, Ramadan observance had little effect on oxidant status, and in 2 reports there was some deterioration. In 3 of 4 studies where athletes underwent short-term dieting, there was also no improvement of antioxidant status. Conclusion: Ramadan observance and any associated dieting reduce oxidative stress in non-athletic individuals, apparently in association with decreases of body mass. In athletes, oxidant levels are generally unchanged during Ramadan, and if food intake is maintained they may even increase. More information is needed upon possible adverse health consequences, but chronic risks are probably small because any changes are limited to one month per year.