Possible gastrointestinal disorders for athletes during Ramadan: an overview

Ramadan intermittent fasting and its association with health-related indices and exercise test performance in athletes and physically active individuals: an overview of systematic reviews

OBJECTIVE

To systematically review, summarise and appraise findings of published systematic reviews, with/without meta-analyses, examining associations between Ramadan fasting observance (RO), health-related indices and exercise test performances in athletes and physically active individuals.

DESIGN

Overview of systematic reviews with assessment of reviews' methodological quality.

DATA SOURCES

PubMed, Web of Science, Scopus, Cochrane Database of Systematic Reviews, SPORTDiscus, ProQuest, PsycINFO and SciELO.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Systematic reviews with/without meta-analyses examining associations of RO with health-related indices and exercise performances in athletes and physically active individuals.

RESULTS

Fourteen systematic reviews (seven with meta-analyses) of observational studies, with low-to-critically-low methodological quality, were included. Two reviews found associations between RO and decreased sleep duration in athletes and physically active individuals. One review suggested athletes may experience more pronounced reductions in sleep duration than physically active individuals. One review found associations between RO and impaired sleep quality in athletes and physically active individuals. RO was associated with decreased energy, carbohydrate and water intake in adult-aged athletes, but not adolescents. One review suggests RO was associated with athletes' increased feelings of fatigue and decreased vigour. No association was found between RO and athletes' lean mass or haematological indices. RO was unfavourably associated with changes in athletes' performance during high-intensity exercise testing.

CONCLUSION

Continuance of training during RO could be associated with athletes' mood state disturbances, decreased sleep duration and performance decline during high-intensity exercise testing, while preserving lean mass. However, careful interpretation is necessary due to the low-to-critically-low methodological quality of the included reviews.

Does observance of Ramadan affect sleep in athletes and physically active individuals? A systematic review and meta-analysis

The purpose of this systematic review and meta-analysis is to provide an accurate description of the effect of Ramadan observance on sleep duration, sleep quality, daily nap duration, and daytime sleepiness in athletes and physically active individuals. Five electronic databases (PubMed, Web of Science, Scopus, Wiley, and Taylor and Francis) were used to search for relevant studies conducted with athletes or physically active individuals during Ramadan, published in any language, and available before May 23, 2021. Studies that included assessments of sleep quantity and/or quality, and/or daytime sleepiness, and/or daily naps in athletes and physically active individuals were included. The methodological quality of the studies was assessed using "QualSyst". Of the 18 papers included in this study (298 participants in total), 14 were of strong quality, two were moderate, and the remaining two were rated as weak. Individuals who continued to train during Ramadan experienced a decrease in sleep duration (number of studies, K = 17, number of participants, N = 289, g = -0.766, 95% confidence interval [CI] -1.199 to -0.333, p = 0.001). Additionally, the global score of the Pittsburgh Sleep Quality Index increased from 4.053 (K = 5, N = 65, 95% CI 3.071-5.034) pre-Ramadan, to 5.346 (95% CI 4.362-6.333) during Ramadan, indicating a decrease in sleep quality. The duration of daytime naps increased during compared to pre-Ramadan (K = 2, N = 31, g = 1.020, 95% CI 0.595-1.445, p = 0.000), whereas Epworth Sleepiness Scale scores remained unchanged during versus pre-Ramadan (K = 3, N = 31, g = 0.190, 95% CI -0.139-0.519, p = 0.257). In conclusion, individuals who continued to train during Ramadan experienced a decrease in sleep duration, impairment of sleep quality, and increase in daytime nap duration, with no change in daytime sleepiness levels.

Ramadan Observance Is Associated with Impaired Kung-Fu-Specific Decision-Making Skills

The aim of the present study is to evaluate the effect of Ramadan observance (RAM) on decision-making in Kung-Fu athletes. Fourteen male Kung-Fu athletes (mean age = 19 ± 3 years) completed two test sessions: before Ramadan (BR) and at the end of Ramadan (ER). In the afternoon of each session (between 16:00 h and 18:00 h), participants completed: Epworth Sleepiness Scale (ESS), Profile of Mood States (POMS), and Pittsburg Sleep Quality Index (PSQI). Subjects also reported subjective fatigue, alertness, and concentration. Additionally, all participants performed video-based decision-making tasks (i.e., reaction time and decision-making). Results indicated that reaction time decreased by 30% at ER vs. BR (p < 0.01). However, decision-making decreased by 9.5% at ER vs. BR (p < 0.05). PSQI results indicated sleep quality score, sleep duration, and sleep efficiency were negatively affected at ER compared to BR (p < 0.05). ESS was higher at ER compared to BR (p < 0.05). In addition, fatigue scores, estimated by the POMS and current subjective feelings (i.e., fatigue, concentration, and alertness), were also negatively affected at ER compared to BR (p < 0.05). In conclusion, Ramadan observance was associated with an adverse effect on sleep and decision making, as well as feelings of fatigue, alertness, and concentration.

Research gaps in Ramadan fasting studies in health and disease

BACKGROUND AND AIM

Ramadan fasting is a religious fasting of Muslims and has many effects on health and disease. This study aim was to analyze Ramadan fasting research output during the past five years and identify research gaps in this field.

MATERIALS AND METHODS

A systematic search was performed in Web of Science, pubmed, Scopus, EMBASE and Cochrane databases by appropriate keywords. Documents published between January 2015 and January 2020 with English language were included. After removing duplicates, remained documents were screened and classified.

RESULTS

Finally, after screening, 393 documents remained and were classified. Of these documents, 53 were review article and 338 original articles. More than 96% of studies were clinical study while basic science studies were too limited. Among the study topics, diabetes mellitus with 31% was the most common topic followed by metabolic disorders and nutrition, respectively.

CONCLUSION

Ramadan fasting is an important religious issue that needs more attention. Research should be directed to clinical and basic studies in different health and disease conditions other than nutrition and metabolic disorders.

Effect of Acute Ramadan Fasting on Muscle Function and Buffering System of Male Athletes

The aim of this study was to investigate the effect of acute Ramadan fasting (RF) on the muscle function and buffering system. Twelve male athletes with 8 years of professional sports experience (age, 23.2 ± 1.3 years, body mass index: 24.2 ± 2.2 kg/m²) participated in this study. The subjects were tested twice, 3 weeks after the beginning of RF and 2 weeks after the end RF. Muscle function, buffering capacity, and rating of perceived exertion (RPE) were measured during and after RF by using the Biodex isokinetic machine, blood gas analyzer, and RPE 6–20 Borg scale, respectively. Venous blood samples for pH and bicarbonate (HCO₃⁻) were measured during and after RF by using the Biodex isokinetic machine, blood gas analyzer, and RPE 6–20 Borg scale, respectively. Venous blood samples for pH and bicarbonate (HCO₃⁻) were taken immediately after 25 repetitions of isokinetic knee flexion and extension. Measures taken during isokinetic knee extension during RF were significantly lower than those after RF in extension peak torque (t = −4.72, p = 0.002), flexion peak torque (t = −3.80, p = 0.007), extension total work (t = −3.05, p = 0.019), extension average power (t = −4.20, p = 0.004), flexion average power (t = −3.37, p = 0.012), blood HCO₃⁻ (t = −2.02, p = 0.041), and RPE (Z = −1.69, p = 0.048). No influence of RF was found on the blood pH (t = 0.752, p = 0.476). RF has adverse effects on muscle function and buffering capacity in athletes. It seems that a low-carbohydrate substrate during RF impairs muscle performance and reduces the buffering capacity of the blood, leading to fatigue in athletes.

A Thirty-Five-Minute Nap Improves Performance and Attention in the 5-m Shuttle Run Test during and Outside Ramadan Observance

Ramadan observance is characterized by several changes in behaviors, such as food and sleep, which could affect physical and cognitive performance. The aim of the present study was to investigate the effects of a 35-min nap (N35) opportunity on physical performance during the 5-m shuttle run test (5mSRT); attention; feelings; mood states; and perceptual measures of stress, fatigue, and muscle soreness during Ramadan observance. Fourteen physically active men (22 ± 3 years, 177 ± 4 cm, 76 ± 5 kg) were tested after a no-nap condition (N0), N35 15 days before Ramadan (BR), the last 10 days of Ramadan (DR), and 20 days after Ramadan (AR). Measures included the digit cancellation test (attention estimation), the profile of mood state (POMS), and the Hooper questionnaires. After a 5-min standard warm-up, participants performed the 5mSRT (6 × 30 s with 35 s in between; best distance (BD), total distance (TD), and fatigue index (FI) were recorded), along with the rating of perceived exertion (RPE) after each test repetition. After the 5mSRT test, participants responded to the feeling scale (FS). The results showed that TD and FI during the 5mSRT were not affected by Ramadan observance. However, BD was significantly lower than DR compared to AR after N0 (∆ = -4.3 ± 1.3%; p < 0.01) and N35 (∆ = -2.6 ± 1.0%; p < 0.05). After N0, attention decreased significantly at DR in comparison with BR (p < 0.05) and AR (p < 0.001). BD and TD improved after N35 compared to N0 at BR (∆ = +4.4 ± 2.1%, p < 0.05 for BD and ∆ = +4.8 ± 1.6%, p < 0.01 for TD), DR (∆ = +7.1 ± 2.2%, p < 0.05 for BD and ∆ = +5.1 ± 1.6%, p < 0.01 for TD), and AR (∆ = +5.5 ± 1.5%, p < 0.01 for BD and ∆ = +5.2 ± 1.2%, p < 0.001 for TD). A significant increase in attention was observed after N35 in comparison with N0 at DR (p < 0.01) and AR (p < 0.01). However, no changes were found for the perception of mood states, stress, sleep, muscle soreness, and the FI during the 5mSRT. Also, N35 was better than N0 for RPE at DR (p < 0.05), feelings at AR (p < 0.05), and fatigue estimation at AR (p < 0.01). A 35-min nap opportunity may have beneficial effects on physical and cognitive performances before, during, and after Ramadan.

Religion, Food Choices, and Demand Seasonality: Evidence from the Ethiopian Milk Market

The impact of religious behavior on food systems in developing economies has been understated in scholarly studies. With its different Christian, Islamic, and traditional faiths, Ethiopia emerges as a suitable country to investigate the impact of religious practices on demand. The inclusion of livestock products in Ethiopian diets is extremely low, even by African standards, a phenomenon often explained by supply and marketing problems combined with low income levels. We deviate from this dominant narrative and single out the impact of religion. We show how fasting practices of Orthodox Christians, the largest religious group, affect milk intake decisions and channels through which consumed milk is sourced. Employing country-wide data collected by the Living Standards Measurement Studies, we find, as expected, that Orthodox fasting adversely affects milk consumption and decreases the share of milk sourced from own production in Orthodox households, an effect we quantify in this paper. Moreover, we observe spillover effects of Orthodox fasting on other religious groups in dominant Orthodox localities. Our findings improve understanding of the broader societal implication of religiously inspired consumption rituals and underscore the challenges resulting from religion-induced demand cycles to design policies that aim at developing the livestock sector.

The effects of Ramadan intermittent fasting on the underlying mechanisms of force production capacity during maximal isometric voluntary contraction

The aim of the present study was to investigate the effects of Ramadan intermittent fasting (RIF) on the underlying mechanisms of force production capacity during maximal voluntary isometric contraction (MVIC) using the superimposed twitch technique. Ten healthy male physical education students performed three MVIC of the knee extensor superimposed with nerve electrical stimulation during four testing phases: one week before Ramadan (BR), at the end of the first week of Ramadan (R-1), during the fourth week of Ramadan (R-4) and two weeks after Ramadan (AR). This study was performed during Ramadan 2016. MVIC values, voluntary activation level (VAL), potentiated resting twitch and electromyography signals were recorded during each MVIC. The French version of the Profile of Mood States questionnaire (POMS-f) was used to evaluate the subjective mood states in each testing session. The results showed that MVIC values (890.57 ± 67.90 vs. 816.46 ± 54.72 N) and VAL (87.73 ± 3.27 vs. 77.32 ± 7.87%) decreased at R-1 compared to BR (p < 0.001). However, the neuromuscular efficiency and the potentiated resting twitch remained unchanged during Ramadan (R). Results showed that depression (p < 0.01; 6.3 ± 1.57 vs. 4.7 ± 1.25), fatigue (p < 0.001; 9.2 ± 1.93 vs. 4.6 ± 2.01) and anxiety (p < 0.001; 6.4 ± 1.51 vs. 11.8 ± 1.23) scores of POMS-f were higher during R-1 compared to BR. In conclusion, RIF-related impairment of maximal muscle force seems to be related to nervous alterations of the VAL, whereas the RIF did not adversely affect peripheral mechanisms. Abbreviations' List: ANOVA: Analysis of variance; AR: After Ramadan; BMI: Body-mass index; BR: Before Ramadan; EMG: Electromyography; ER: End of Ramadan; MF: Mean frequency; M_max: Peak-to-peak M-wave amplitudes; MVIV: Maximal voluntary isometric contraction; NES: Nerve electrical stimulation; NME: Neuromuscular efficiency; POMS-f: French version of the Profile of Mood States questionnaire; R: Ramadan; R-1: First week of Ramadan; R-4: Fourth week of Ramadan; RF: Rectus femoris; RIF: Ramadan intermittent fasting; RMS: Root mean square; VAL: Voluntary activation level; VL: Vastus lateralis; VM: Vastus medialis.

Effect of Ramadan fasting on feelings, dietary intake, rating of perceived exertion and repeated high intensity short-term maximal performance

The present study was designed to investigate the effect of Ramadan fasting on feelings, dietary intake, rating of perceived exertion (RPE) and repeated high-intensity short-term maximal performance. Thirteen physically active men (age: 21.2 ± 2.9 years, height: 175.6 ± 5.6 cm, body-mass: 72.4 ± 8.6 kg) performed a 5-m shuttle run test (6 × 30-s + 35-s of recovery in-between) during five experimental periods: fifteen days before Ramadan (BR), the first ten days of Ramadan (FR), the last ten days of Ramadan (ER), ten days after Ramadan (AR10) and 20 days after Ramadan (AR20). The study was carried out in Tunisia during the 2016 Ramadan month. During the 5-m shuttle run test, higher distance (HD), total distance (TD) and fatigue index (FI) were recorded. RPE was determined after a 5-min warm-up and after each repetition of the 5-m shuttle run test (the mean RPE score during the test was calculated). Moreover, a feelings scale (FS) was used after the warm-up and after the end of the 5-m shuttle run test. During the five experimental periods, dietary intake was assessed. The results showed that HD, TD and FI during the 5-m shuttle run test were not affected by Ramadan observance (p > 0.05). Likewise, FS scores recorded after the warm-up and the 5-m shuttle run test were not affected by Ramadan fasting (p > 0.05). However, mean RPE scores during the 5-m shuttle run test were significantly lower at ER (4.06 UA), AR10 (3.86 UA) and AR20 (3.71 UA) in comparison to BR (4.51 UA) (p < 0.05). The results showed also that Ramadan fasting has no adverse effect on energy intake, protein (g and %), fat (g and %) and carbohydrate (g). However, the fractional contribution of carbohydrate was significantly higher AR10 than FR (53.1% vs. 45.8%) and ER (53.1% vs. 46.5%) and AR20 than FR (5.92% vs. 45.8%) (p < 0.05). In conclusion, Ramadan fasting has no adverse effect on feelings, dietary intake, and short-term maximal performance. However, the RPE during repeated high intensity short-term maximal exercise was reduced AR20 in comparison to ER. Abbreviations: AR: After Ramadan; AR10: Ten days after Ramadan; AR20: Twenty days after Ramadan; BR: Fifteen days before Ramadan; ER: Last ten days of Ramadan; FI: Fatigue index; FR: First ten days of Ramadan; FS: Feelings scale; HD: Higher distance; PSQI: The Pittsburgh Sleep Quality Index; RPE: Rating of Perceived Exertion Scale; TD: Total distance.