Effects of fasting during ramadan month on cognitive function in muslim athletes

Effects of Ramadan on cognitive functions in young boys

Fasting during Ramadan involves abstaining from food and drink from dawn to sunset, potentially influencing cognitive functions essential for the intellectual development of the youth. Therefore, understanding the effects of fasting on these functions in children/adolescents provides valuable perspectives to enhance education and promote mental well-being. However, studies on children/adolescents in this context are still limited. To evaluate the impact of Ramadan fasting on cognitive functions, including information processing speed, inhibition, decision-making, and auditory attention processes among children and adolescents aged 11 to 15 years. This study was conducted with 24 healthy children/adolescents (aged 12.84 ± 0.69 years). The experimental protocol consisted of two sessions: Before-Ramadan (BR) and at the beginning of the second week of Ramadan (R2). At each session, the boys were randomly tested on simple reaction time (SRT), choice reaction time (CRT), negative priming reaction time (NPRT), and auditory discrimination (P300). The tests were administered and scored by the same person in the different sessions. The study found that Ramadan fasting did not have an effect on various reaction times or on electro-physiological data, including P300 amplitude and latency. The current study, conducted with healthy children/adolescents, indicates that Ramadan fasting had no impact on various reaction times (SRT, CRT, NPRT), suggesting the preservation of information processing speed and decision-making, even in the face of increased task complexity. This is evident, on the one hand, through the maintenance of the ability to react to unexpected events, and, on the other hand, through the mastery of resistance to automatism, thus reflecting the preservation of inhibitory function (NPRT). Regarding P300 data, the absence of changes in latencies and amplitudes suggests that Ramadan fasting did not alter either the evaluation time of auditory stimuli or auditory attention processes.

Individual predictors of vaccine hesitancy in the Italian post COVID-19 pandemic era

A wide range of survey studies have explored vaccination hesitancy/resistance during the COVID-19 pandemic and provided evidence that this can be explained by several individual variables from the ideological, clinical, and socio-affective domain. However, evidence about which individual variables predict vaccine hesitancy in the post-pandemic state of COVID-19 is meager. We administered a battery of questionnaires to a group of 120 Italian participants with high and low scores on the adult vaccine hesitancy scale (aVHS) to investigate the predictive role of ideological (i.e. political orientation), clinical (i.e. anxiety, interoceptive accuracy), and socio-affective (i.e. alexithymia, disgust sensitivity/propensity, empathy) variables on vaccine hesitancy/resistance. This study provides evidence that lower interoceptive awareness and cognitive empathy are predictors of a greater hesitancy to get vaccinated in the post-pandemic COVID-19 state.

The impact of intermittent fasting during Ramadan on psychomotor and cognitive skills in adolescent athletes

Introduction

Intermittent fasting (IF) represents a dietary intervention similar to caloric restriction, characterized by the strategic limitation of food consumption. Among the diverse array of practices for IF, Ramadan IF (RIF), a religious observance in Islam, mandates that healthy adult Muslims abstain from both food and drinks during daylight hours. In sports, researchers have extensively studied IF effects on health, including sleep and physical performance, but its impact on cognitive functions during RIF remains understudied. Therefore, this study was conducted to evaluate the influence of RIF on psychomotor and cognitive performance among young female athletes.

Methods

To achieve this purpose, a cohort of 23 female handball players, aged 17.2 ± 0.5 years, participated in a series of six testing sessions: one conducted prior to Ramadan (R0), and others during the first (R1), second (R2), third (R3), and fourth (R4) weeks of Ramadan, followed by a session in the week after Ramadan (R5). Each session involved assessments using a Simple Reaction Time Test (SRT), Choice Reaction Time Test (CRT), Vigilance Test (VT), and Mental Rotation Test (MRT). Additionally, dietary intake, body composition, and Pittsburgh Sleep Quality Index (PSQI) scores were evaluated during these periods.

Results and discussion

The obtained data illustrated that there was a decrease in SRT, CRT, VT, and MRT performances during R1 in comparison to R0 (all p < .001). This reduction was also observed in R2, R3, R4, and R5. Notably, during the fourth week of Ramadan (R4), these cognitive and psychomotor parameters were significantly lower than during the earlier weeks (R1, R2, R3; all p < .001). Furthermore, a gradual decrease in total PSQI scores, sleep quality, and sleep duration was observed throughout the Ramadan period, reaching the lowest levels during R4. These findings illustrate that RIF has a significantly detrimental impact on neuromuscular and cognitive abilities as well as sleep quality in young female athletes. The study also highlights a fluctuating pattern in cognitive function across the four weeks of Ramadan, with the most pronounced decline observed during the final week of fasting illustrating the importance of conducting similar studies on normal individuals from both genders with larger sample size.

The effect of last meal "Suhoor" timing on diurnal variations in cognitive performance during Ramadan fasting among female athletes

The present study aimed to investigate the effect of the timing of the last meal, "Suhoor", on diurnal variation in cognitive performance during Ramadan intermittent fasting (RIF). In a randomized order, 26 adolescent female athletes (aged 15.9 ± 0.9 y) were tested in three sessions at 7:00 a.m., 12:00 p.m., and 5:00 p.m. across four different conditions: the 10 days preceding Ramadan (PR); the final 12 days of Ramadan (RO): two different conditions: Early Suhoor (SEarly), and Late Suhoor (SLate); and, ultimately, the 10 days immediately after Ramadan (AR) with an in-between recovery period of ≥24 h. During each test session, the oral temperature (OT), simple reaction time test (SRT), choice reaction time test (CRT), attention test (ATT), and mental rotation test (MRT) were evaluated. The Pittsburgh Sleep Quality Index (PSQI) and daily diary intake were assessed across the three periods. Compared to PR, the sleep parameters assessed by the PSQI were significantly lower during the RO and AR periods. However, neither total dietary intake nor OT showed any changes due to RIF. Compared to PR, the afternoon performances of SRT, CRT, ATT, and MRT significantly declined under both the SEarly and SLate conditions. Notably, midday performance decreased only during SLate, while morning performance remained unaffected in both conditions. Additionally, compared to SEarly, these performances were better during SLate in the afternoon and at midday. In summary, nutrient intake timing had a significant effect on the diurnal fluctuations in cognitive functions during Ramadan fasting, particularly around noon and in the afternoon. Our results illustrate the benefits of a late last meal (Suhoor) in preserving optimal morning cognitive abilities and preventing any impairment during the fasted state at midday or in the afternoon, which could affect overall athletic performance.

Effects of fasting during Ramadan month on soccer-specific technical performance, cognitive function, and perceptions in soccer players

We aimed to examine the effects of Ramadan fasting (RF) and high-intensity short-term maximal performance on elite soccer players' shooting accuracy, executive function (EF), and perceptions. Sixteen Muslim elite players fasting during Ramadan underwent assessments before (BR), during (DR), and after Ramadan (AR). Soccer-specific technical performance was evaluated using the Loughborough Soccer Shooting Test (LSST) before and after a 5-metre shuttle run test (5mSRT), conducted at the same time-of-day (17:00 h). Performance metrics recorded included higher distance (HD), total distance (TD), and fatigue index (FI). RPE after a 5-min warm-up and each repetition of the 5mSRT were obtained, and the mean RPE score was calculated. Trail Making Test (TMT Parts A and B) were used after the warm-up and the 5mSRT. Perceived difficulty (PD) was assessed following the LSST. HD, TD, and FI were not affected by RF (p > 0.05). DR, RPE and accuracy scores in the LSST were significantly lower after the 5mSRT compared to BR (1.29 vs. 1.24 AU; 1.29 vs. 1.24, respectively). In conclusion, RF had no adverse effects on physical performance. However, when combined with high-intensity running sessions, RF may impact accuracy and PD, and these adverse effects seem to have been translated into EF.

The impact of continuous calorie restriction and fasting on cognition in adults without eating disorders

Research into the effects of calorie restriction continues to intrigue those interested in whether it may allow humans to live longer and healthier lives. Animal studies of continuous calorie restriction (CCR) and fasting have demonstrated substantial advantages to health and longevity. However, concerns remain about the impact of restricting calorie intake on human health and cognition. Given the emerging evidence of cognitive impairments in eating disorders, studies investigating restricted calorie intake in healthy humans (in an ethical way) may also have implications for understanding restrictive eating disorders. In this review, the published literature on the impact of CCR and fasting on cognitive function in healthy human participants is synthesized. Of the 33 studies of CCR and fasting in humans identified, 23 demonstrated significant changes in cognition. Despite variation across the cognitive domains, results suggest CCR benefits inhibition, processing speed, and working memory, but may lead to impairments in cognitive flexibility. The results of fasting studies suggest fasting is associated with impairments in cognitive flexibility and psychomotor abilities. Overall, the results of these studies suggest the degree (ie, the severity) of calorie restriction is what most likely predicts cognitive improvements as opposed to impairments. For individuals engaging in sustained restriction, this may have serious, irreversible consequences. However, there are mixed findings regarding the impact of CCR and fasting on this aspect of human functioning, suggesting further research is required to understand the costs and benefits of different types of calorie restriction.

Effects of intermittent fasting on cognitive health and Alzheimer's disease

OBJECTIVE

Caloric restriction by intermittent fasting produces several metabolic changes, such as increased insulin sensitivity and use of ketone bodies as energy sources. In humans, intermittent fasting has been studied in hypertension, diabetes, and related conditions, but, to date, not as a strategy to reduce the risk of emergent dementia. In this scoping review, the relevance of intermittent fasting as a potential preventive intervention for Alzheimer's dementia is explored.

BACKGROUND

The beneficial effects of calorie restriction have been documented in animals and humans. Decreased oxidative stress damage and attenuated inflammatory responses are associated with intermittent fasting. These changes have a favorable impact on the vascular endothelium and stress-induced cellular adaptation.

RESULTS

Physiological alterations associated with fasting have profound implications for pathological mechanisms associated with dementias, particularly Alzheimer's disease. Compared with ad libitum feeding, caloric restriction in animals was associated with a reduction in β-amyloid accumulation, which is the cardinal pathological marker of Alzheimer's disease. Animal studies have demonstrated synaptic adaptations in the hippocampus and enhanced cognitive function after fasting, consistent with these theoretical frameworks. Furthermore, vascular dysfunction plays a crucial role in Alzheimer's disease pathology, and intermittent fasting promotes vascular health.

CONCLUSIONS

These observations lead to a hypothesis that intermittent fasting over the years will potentially reverse or delay the pathological process in Alzheimer's disease.

Effects of Ramadan fasting on the diurnal variations of physical and cognitive performances at rest and after exercise in professional football players

Introduction

Ramadan fasting (RF) is characterized by daily abstinence from food and fluid intake from dawn to sunset. The understanding of the Ramadan effects on the diurnal variations of athletic and cognitive performance is crucial for practitioners, coach and researchers to prepare sport events and optimize performance. The aim of the present study was to reveal the effects of RF on the diurnal variation of physical and cognitive performances at rest and after exercise.

Method

In a randomized order, 11 male football players (age: 19.27 ± 0.9; height: 1.79 ± 0.04 cm; body mass: 70.49 ± 3.97 kg; BMI: 21.81 ± 1.59 kg/m2) completed a 30-s Wingate test [i.e., mean (MP) and peak powers (PP)] at 07:00, 17:00, and 21:00 h on five occasions: 1 week before Ramadan (BR); the second (R2); the third (R3); the fourth (R4) week of Ramadan; and 2 weeks after Ramadan (AR), with an in-between recovery period of ≥72 h. Simple (SRT) and choice (CRT) reaction times, mental rotation test (MRT) and selective attention (SA) test were measured before and after Wingate test. Rating of perceived exertion (RPE), body composition, dietary intake, profile of mood states (POMS) and Pittsburgh Sleep Quality Index (PSQI) were assessed over the five periods.

Results

Compared to BR, RF decreased MP at 17:00 h (p &lt; 0.05, d = 1.18; p &lt; 0.001, d = 2.21, respectively) and PP at 17:00 h (p &lt; 0.05, d = 1.14; p &lt; 0.001, d = 1.77, respectively) and 21:00 h (p &lt; 0.01, d = 1.30; p &lt; 0.001, d = 2.05, respectively) at R3 and R4. SRT (p &lt; 0.001,d = 1.15; d = 1.32, respectively), number of correct answers (MRTE; p &lt; 0.05, d = 1.27; d = 1.38, respectively) and SA (p &lt; 0.01, d = 1.32; d = 1.64, respectively) increased during R2 and R3 in the evening before exercise compared to BR. Short term maximal exercise enhanced SRT (p &lt; 0.01, d = 1.15; p &lt; 0.001, d = 1.35, respectively), MRTE (p &lt; 0.001, d = 2.01; d = 2.75 respectively) and SA (p &lt; 0.05, d = 0.68; d = 1.18, respectively) during R2 and R3 in the evening. In comparison to BR, sleep latency and sleep duration increased during R3 (p &lt; 0.001, d = 1.29; d = 1.74, respectively) and R4 (p &lt; 0.001, d = 1.78; d = 2.19, respectively) and sleep quality increased in R2, R3 and R4 (p &lt; 0.01, d = 1.60; p &lt; 0.001, d = 1.93; d = 2.03, respectively).

Conclusion

During RF, anaerobic and cognitive performances were unaffected in the morning but were impaired in the afternoon and evening. Short-term maximal exercise mitigates the negative effects of fasting on cognitive performance. Maximal exercise could thus partially counteract the effect of fasting on cognitive function.

Temporary Self-Deprivation Can Impair Cognitive Control: Evidence From the Ramadan Fast

During Ramadan, people of Muslim faith fast by not eating or drinking between sunrise and sunset. This is likely to have physiological and psychological consequences for fasters, and societal and economic impacts on the wider population. We investigate whether, during this voluntary and temporally limited fast, reminders of food can impair the fasters' reaction time and accuracy on a non-food-related test of cognitive control. Using a repeated measures design in a sample of Ramadan fasters (N = 190), we find that when food is made salient, fasters are slower and less accurate during Ramadan compared with after Ramadan. Control participants perform similarly across time. Furthermore, during Ramadan performances vary by how recently people had their last meal. Potential mechanisms are suggested, grounded in research on resource scarcity, commitment, and thought suppression, as well as the psychology of rituals and self-regulation, and implications for people who fast for religious or health reasons are discussed.

Sporadic fasting reduces attentional control without altering overall executive function in a binary classification task

Diets with intermittent fasting are an efficient method for producing clinically significant weight loss and preventing the development of obesity. However, individuals following intermittent fasting must face the difficulty of avoiding eating when experiencing the feeling of hunger. In this study, we investigated which aspects of executive function were affected following a prolonged period of food deprivation in participants that have never previously undergone intermittent fasting. Twenty-six participants with normal weight performed two binary classification tasks (Stop Signal (SST) and Go/NoGo) after either a 12 h fasting or a nonfasting period in separate sessions. We measured their performance in several underlying decision-making processes, such as response inhibition and attentional control. In line with previous studies, our results revealed that decision-making processes to resolve the classification task were unaffected by fasting. Response inhibition, as indexed by the stop signal reaction time in the SST, remained as well unaltered after food deprivation. Rather, we observed a higher error rate in NoGo trials following a fasting period, which was associated with disrupted attentional control. Overall, these results indicate that when a hunger feeling reaches consciousness, it induces deficits over certain aspects of attentional control. Our findings hint at the importance of structured behavioral change strategies to cope with fasting-induced difficulties in attentional control, to help achieve weight management goals through successful self-monitoring of food intake.

Diabetes, Ramadan, and driving - Ensuring patient safety while respecting religious autonomy: A qualitative study

BACKGROUND AND AIMS

Hypoglycaemia due to fasting during Ramadan may affect the ability to perform complex activities among people with type 2 diabetes mellitus (T2D), but it is unclear how this affects one's ability to drive. This study aims to explore driving experiences and coping strategies to ensure safe driving among people with T2D who fast during Ramadan.

METHODS

We conducted an exploratory qualitative study and purposefully selected people with T2D who drove and fasted during the past Ramadan period in 2019. In-depth face-to-face interviews were conducted and transcribed verbatim. Data were analysed thematically using a constant comparative method until saturation was achieved (n = 16).

RESULTS

Two major themes were identified, namely: (1) knowing oneself and (2) voluntary self-restriction. Participants described the importance of understanding how Ramadan fasting affected them and their level of alertness. As such, participants often adjusted their daily activities and tested their blood glucose levels to prevent experiencing hypoglycaemia. Other coping strategies reported include adjusting their medications and driving restrictions or driving in the mornings when they were more alert. Findings from this study shed light on participants' experiences and coping mechanisms while driving during Ramadan.

CONCLUSION

Given the risks and effects of hypoglycaemia among those who fast, there is a need to provide appropriate and focused patient education during Ramadan to people with T2D to ensure they can perform complex activities such as driving safely, especially in Muslim majority countries.

Time-restricted feeding and cognitive function in sedentary and physically active elderly individuals: Ramadan diurnal intermittent fasting as a model

Objectives

This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals.

Methods

A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan (n = 32) and a physically active group (n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters.

Results

Compared to before Ramadan, performance in executive function (p = 0.035), attention (p = 0.005), inhibition (p = 0.02), associative memory (p = 0.041), and recognition memory (p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased (p = 0.041), whilst performances in the remaining domains remained unchanged during Ramadan. Global PSQI, ISI, and ESS scores indicated both groups suffered from poor sleep quality and excessive daytime sleepiness, with significantly higher negative effects of RDIF observed in the sedentary group.

Conclusion

Older adults who continue to train at least three times per week during Ramadan may improve their cognitive performance, despite the impairment of sleep quality. Future studies in older adults during Ramadan including objective measures of sleep (e.g., polysomnography, actigraphy) and brain function (e.g., functional magnetic resonance imaging) are warranted.

Global Research Trends of Health-Related Publications on Ramadan Fasting from 1999 to 2021: A Bibliometric Analysis

Ramadan fasting is one of the five pillars of Islam. The current study aims to examine, analyze, and identify trends of health-related publications on Ramadan fasting. In total, 1468 documents retrieved from Scopus were analyzed. The mean number of authors per document was 3.7, with an average of 13.3 citations per document. The UK ranked first (12.3%, n = 181) regarding the number of documents, followed by Iran (10.4%, n = 153) and then Saudi Arabia (9.8%, n = 144). The most active journal was "Diabetes Research and Clinical Practice" (4.9%, n = 72). Publications related to diabetes and fasting constituted around 29.7% (n = 436) of the literature. The research volume on Ramadan fasting has been noticeably growing. More reliable research is required to aid healthcare professionals in providing patient-specific care.

Anthropometric, Psychosocial, Physiological, and Postural Observances During Ramadan in Men With Chronic Obstructive Pulmonary Disease

This study aimed to carry out a Ramadan observance (RO) on anthropometric, psychosocial, physiological, and postural characteristics of patients with chronic obstructive pulmonary disease (COPD). Twenty COPD patients were evaluated. Tests performed 1 week before Ramadan (C), and during the second (R-2) and the fourth weeks of Ramadan (R-4) included standard anthropometry, spirometry, a quality of life questionnaire (VQ11), a 6-minute walking test (6MWT), measurement of maximal voluntary contraction force of the quadriceps (MVC), Timed Get Up and Go (TUG), Berg Balance Scale (BBS), and Unipedal Stance (UST). During R-2, there were significant decreases in forced vital capacity and forced expiratory volumes, 6MWT distance, MVC, BBS, and UST, with significant increases in TUG and significant changes in VQ11. During R-4, there was some recovery, but all variables remained significantly different from initial control data. To conclude, RO adversely affects pulmonary function, exercise performance, postural balance, and quality of life in COPD, with some recovery by the R-4. Although a number of functional consequences remain to be elucidated, functional losses were insufficient to limit daily living in our sample, but further studies are recommended in those with more severe COPD, paying particular attention to postural disturbances and a possible increase in the risk of falls.

Nutritional Impact on Metabolic Homeostasis and Brain Health

Aging in modern societies is often associated with various diseases including metabolic and neurodegenerative disorders. In recent years, researchers have shown that both dysfunctions are related to each other. Although the relationship is not fully understood, recent evidence indicate that metabolic control plays a determinant role in neural defects onset. Indeed, energy balance dysregulation affects neuroenergetics by altering energy supply and thus neuronal activity. Consistently, different diets to help control body weight, blood glucose or insulin sensitivity are also effective in improving neurodegenerative disorders, dampening symptoms, or decreasing the risk of disease onset. Moreover, adapted nutritional recommendations improve learning, memory, and mood in healthy subjects as well. Interestingly, adjusted carbohydrate content of meals is the most efficient for both brain function and metabolic regulation improvement. Notably, documented neurological disorders impacted by specific diets suggest that the processes involved are inflammation, mitochondrial function and redox balance as well as ATP production. Interestingly, processes involving inflammation, mitochondrial function and redox balance as well as ATP production are also described in brain regulation of energy homeostasis. Therefore, it is likely that changes in brain function induced by diets can affect brain control of energy homeostasis and other brain functions such as memory, anxiety, social behavior, or motor skills. Moreover, a defect in energy supply could participate to the development of neurodegenerative disorders. Among the possible processes involved, the role of ketone bodies metabolism, neurogenesis and synaptic plasticity, oxidative stress and inflammation or epigenetic regulations as well as gut-brain axis and SCFA have been proposed in the literature. Therefore, the goal of this review is to provide hints about how nutritional studies could help to better understand the tight relationship between metabolic balance, brain activity and aging. Altogether, diets that help maintaining a metabolic balance could be key to both maintain energy homeostasis and prevent neurological disorders, thus contributing to promote healthy aging.

The Implication of Physiological Ketosis on The Cognitive Brain: A Narrative Review

Optimal cognitive functions are necessary for activities of daily living and self-independence. Cognitive abilities are acquired during early childhood as part of progressive neurodevelopmental milestones; unfortunately, regressive changes can occur as part of physiological aging, or more ominously, pathological diseases, such as Alzheimer’s disease (AD). Cases of AD and its milder subset, mild cognitive impairment (MCI), are rising and would impose a burdensome impact beyond the individual level. Various dietary and nutritional approaches have potential for promising results in managing cognitive deterioration. Glucose is the core source of bioenergy in the body; however, glucose brain metabolism could be affected in aging cells or due to disease development. Ketone bodies are an efficient alternate fuel source that could compensate for the deficient glycolytic metabolism upon their supra-physiologic availability in the blood (ketosis), which, in turn, could promote cognitive benefits and tackle disease progression. In this review, we describe the potential of ketogenic approaches to produce cognitive benefits in healthy individuals, as well as those with MCI and AD. Neurophysiological changes of the cognitive brain in response to ketosis through neuroimaging modalities are also described in this review to provide insight into the ketogenic effect on the brain outside the framework of purely molecular explanations.

Parents' perceptions of quality of life of their children and adolescents with type 1 diabetes during Ramadan fasting in Riyadh

This study aimed to assess parents' perceptions of the quality of life (QoL) of their children with type 1 diabetes (T1D) during Ramadan fasting (RF). In this cross-sectional study, an Arabic-translated version of the standard diabetes-specific QoL questionnaire (PedsQL™ version 3.0) was used to compare perceptions of QoL during Ramadan month (Rm) versus non-Rm (NRm) of parents of children/adolescents with T1D from two tertiary hospitals in Riyadh. We used regression analysis to compare proxies (parents' reports) of their perceptions on their children/adolescents' QoL during Rm compared to NRm. A sample of 61 proxies (parents') of two age groups T1D offspring: 8-12 years (41%) and 13-18 years (59%) who reported their perceptions of their children/adolescents QoL during Rm were matched by children/adolescents' age and gender of 61 proxies in NRm. QoL scores of all domains were significantly lower in Rm compared to NRm; p < 0.0001, however, worries domain showed no statistical differences p = 0.052 in a regression analysis. The total aggregate median (IQR) in Rm was 850 (612-1,062) compared to 1,750 (1,475-2,062) in NRm, p < 0.001. The highest differences in NRm and Rm median scores were observed in communications (OR = 3.64; 95% CI 2.7-5.57) and treatment adherence (OR = 3.09; 95% CI 2.48-3.84) domains especially in the age of 13-18 years. Parents of adolescent boys, who are usually risk-takers and more exposed to outdoor activities, perceived lower QoL for them. Parents of adolescents with T1D perceived a lower QoL for their children during RF, especially in the treatment adherence and communication domains.

Impact of Ramadan fasting on disease activity in patients with multiple sclerosis: a multicenter study

BACKGROUND

The safety of Ramadan fasting for Muslim patients suffering from multiple sclerosis (MS) is still a matter of debate. This work aimed to study the clinical course of MS during Ramadan fasting and to clarify the predictors of relapses and symptoms exacerbation.

METHODS

This retrospective study included 153 Muslim patients with MS. Data related to the disease course before Ramadan were obtained from patients' files, whereas data related to the disease activity during Ramadan, were collected from patients over the two months following Ramadan.

RESULTS

Patients with MS who experienced relapses, exacerbation of symptoms and development of new symptoms during Ramadan had a statistically significant longer disease duration compared to those who did not experience (P < 0.001, <0.001, 0.01 respectively). Also, patients who experienced relapses, exacerbation of symptoms and development of new symptoms during Ramadan had a statistically significant higher expanded disability status scale (EDSS) compared to those who did not experience (P <0.001, <0.001,0.01, respectively). The occurrence of relapses, exacerbation of symptoms and development of new symptoms during Ramadan, were significantly higher in patients who experienced relapses in the preceding year compared to those who did not (P= 0.002, 0.002, 0.01, respectively). Binary logistic regression revealed that each score elevation of EDSS increased the odds of relapse during Ramadan by 1.02 (P-value = 0.04). Also, each month's increase in disease duration increased the odds of relapse during Ramadan by 1.87 (P-value = 0.046).

CONCLUSION

High EDSS and long disease duration are independent predictors of relapse during Ramadan.

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.

The Effects of Intermittent Fasting on Brain and Cognitive Function

The importance of diet and the gut-brain axis for brain health and cognitive function is increasingly acknowledged. Dietary interventions are tested for their potential to prevent and/or treat brain disorders. Intermittent fasting (IF), the abstinence or strong limitation of calories for 12 to 48 h, alternated with periods of regular food intake, has shown promising results on neurobiological health in animal models. In this review article, we discuss the potential benefits of IF on cognitive function and the possible effects on the prevention and progress of brain-related disorders in animals and humans. We do so by summarizing the effects of IF which through metabolic, cellular, and circadian mechanisms lead to anatomical and functional changes in the brain. Our review shows that there is no clear evidence of a positive short-term effect of IF on cognition in healthy subjects. Clinical studies show benefits of IF for epilepsy, Alzheimer’s disease, and multiple sclerosis on disease symptoms and progress. Findings from animal studies show mechanisms by which Parkinson’s disease, ischemic stroke, autism spectrum disorder, and mood and anxiety disorders could benefit from IF. Future research should disentangle whether positive effects of IF hold true regardless of age or the presence of obesity. Moreover, variations in fasting patterns, total caloric intake, and intake of specific nutrients may be relevant components of IF success. Longitudinal studies and randomized clinical trials (RCTs) will provide a window into the long-term effects of IF on the development and progress of brain-related diseases.

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.

The Holy Month of Ramadan: Mass-Gathering Event Implications for Hospital Surge Capacity Planning in Saudi Arabia

OBJECTIVES

The goal of this study is to determine the impact of the Holy Month of Ramadan on emergency department (ED) and hospital resource utilization in comparison to the time of Hajj and the rest of the year, so as to better define future resource needs of hospitals responding to events of this large size and duration.

METHODS

A retrospective chart review was conducted of electronic medical records, ED visits, and hospital admissions during Ramadan, Hajj, and all other months over a three-year period on the Hijra calendar (1438-1440) or Gregorian (2016-2019). Primary outcomes were the change in the number of ED visits, hospital admissions, and intensive care unit (ICU) admissions during Ramadan in comparison to during Hajj and other months. Secondary outcomes included mortality; number of surgeries by specialty; and admissions to cardiac, respiratory, orthopedic, and neurosurgery wards.

RESULTS

During the three years, ED visits increased during Ramadan by 83.0%, 74.8%, and 40.3%, respectively, when compared to non-Hajj, non-Ramadan months. Hospital admissions rose by 21.05%, 50.96% and 48.22%. Combined ED and in-hospital mortality rose by 15.21%, 21.47%, and 1.39%. While there was a large increase in ICU admissions during Ramadan of 1440 (May 2019), this was not a trend seen in other years. Despite there only being two years of data for comparison, there was a trend towards increased admissions to all specialty wards. There was an average 46.69% increase in admissions to the general surgery ward during Ramadan months compared to other months, a 31.06% increase in admissions to the orthopedic surgery ward, and a 44.05% increase in admissions to the cardiac care unit.

CONCLUSIONS

Ramadan is associated with a significant increase in the population of Makkah (Mecca), Saudi Arabia. Despite this study only focusing on a three-year period, and some variables with only two years of data available, it demonstrates a significant increase in ED visits, hospital admissions, and mortality during Ramadan compared to non-Hajj/non-Ramadan months. During mass gatherings of this size, it would benefit local and regional hospital systems to devote increased resources to patient care, especially to the ED, to prevent morbidity and mortality.

Ten days of complete fasting affected subjective sensations but not cognitive abilities in healthy adults

PURPOSE

People may be unable to obtain anything edible for days under some circumstances, but they must maintain their calmness and cognition to navigate solutions. Our aim was to study changes in subjective sensations and cognition in healthy adults during a 10-day complete fasting experiment.

METHODS

Thirteen healthy male volunteers voluntarily participated in the 22-day experiment comprising 4 phases: 3 days of baseline consumption, 10 days of complete fasting (only water ad libitum), 4 days of calorie restriction, and a 5-day recovery period. The volunteers' subjective sensations, cognitive performance, and serum energy substances were measured at 6 time points.

RESULTS

Across the 6 time points, the trajectories of subjective sensations in response to fasting were "U"- or " ∩ "-shaped curves instead of progressive discomfort or mood enhancement. A significant fasting time effect was found on depression-dejection (baseline: 16.85 ± 2.88; highest score on the third day of completing fasting: 17.69 ± 3.97, P = 0.04) and self-rated anxiety (baseline: 26.23 ± 4.75; highest score on the sixth day of completing fasting: 30.85 ± 5.58, P = 0.01), and the change curves were consistent with the inflection point of the energy substrates shifting from serum glucose to ketone. In addition, basic cognitive functions appeared to be unaffected during the 10-day fast.

CONCLUSIONS

Our study showed strong influences on the sensations from the third to sixth days of the prolonged fasting period but no significant effects on basic cognitive abilities associated with the energy substance switch. These findings could contribute to the development and understanding of survival strategies in food-shortage emergencies or of intermittent fasting programmes.

Time restricted feeding and mental health: a review of possible mechanisms on affective and cognitive disorders

In the last decades, a high increase in life expectancy not adequately balanced by an improvement in the quality of life has been observed, leading possibly to an increase in the prevalence of affective and cognitive disorders related to aging, such as depression, cognitive impairment, dementia and Alzheimer's disease. As mental illnesses have multifactorial aetiologies, many modifiable factors including lifestyle and nutrition play an essential role. Among nutritional factors, intermittent fasting has emerged as an innovative strategy to prevent and treat mental health disorders, sleep disturbances and cognitive impairment. Among all types of intermittent fasting regimens, the time restricted feeding appears to be the most promising protocol as it allows to induce benefits of a total fasting without reducing global calories and nutrients intake. This review summarises the evidence on the effect of time restricted feeding towards brain health, emphasising its role on brain signalling, neurogenesis and synaptic plasticity.

Self-Coping Strategies Among Jordanian Athletes During Ramadan Fasting: A Questionnaire Proposal

: This study aims to categorize the adaptation strategies of Muslim athletes who fast during Ramadan and proposes a self-coping strategy questionnaire as a complementary assessment tool. A total of 109 Jordanian Muslim athletes (mean age 20.0 ± 8.5 years) were surveyed by completing a self-coping questionnaire designed to classify an individual athlete’s level of adaptation. This study was conducted during the month of Ramadan 2019 and developed based on the training, nutritional, psychological, self-control, and recovery dimensions. Seventy percent of athletes found that they developed good or very good coping mechanisms. Coping strategies vary from one dimension to another, but in general, athletes often had a positive perceived coping. Athletes expressed that they are shifting the training hours with a preference for quality training rather than quantity and associated with a longer rest time. In addition, they were in favor of food hygiene associated with a strategy of sharing meals and providing water. The majority (59%) of the athletes said they were psychologically prepared for the potential effects of fasting. This research shows that athletes develop self-adjusting strategies to counter the effects of fasting. The questionnaire on the self-coping strategies provides important and precise information on the level of coping achieved by the athletes.

Intermittent Fasting Enhanced the Cognitive Function in Older Adults with Mild Cognitive Impairment by Inducing Biochemical and Metabolic changes: A 3-Year Progressive Study

Intermittent fasting (IF) refers to various dietary regimens that cycle between a period of non-fasting and a period of total fasting. This study aimed to determine the effects of IF on cognitive function among elderly individuals who practice IF who have mild cognitive impairment (MCI). A total of 99 elderly subjects with MCI of Malay ethnicity without any terminal illness were recruited from a larger cohort study, LRGS TUA. The subjects were divided into three groups, comprising those who were regularly practicing IF (r-IF), irregularly practicing IF (i-IF), and non-fasters (n-IF). Upon 36 months of follow-up, more MCI subjects in the r-IF group reverted to successful aging with no cognitive impairment and diseases (24.3%) compared to those in i-IF (14.2%) and n-IF groups (3.7%). The r-IF group’s subjects exhibited significant increment in superoxide dismutase (SOD) activity and reduction in body weight, levels of insulin, fasting blood glucose, malondialdehyde (MDA), C-reactive protein (CRP), and DNA damage. Moreover, metabolomics analysis showed that IF may modulate cognitive function via various metabolite pathways, including the synthesis and degradation of ketone bodies, butanoate metabolism, pyruvate metabolism, and glycolysis and gluconeogenesis pathways. Overall, the MCI-afflicted older adults who practiced IF regularly had better cognitive scores and reverted to better cognitive function at 36 months follow-up.

Effects of transcranial direct current stimulation over frontal, parietal and cerebellar cortex for cognitive function during fasting in healthy adults

Background

Transcranial direct current stimulation (tDCS) is a neuromodulation tool used to modify the cognitive function in subjects. There is a paucity of data on tDCS' effect on cognitive function during Ramadan fasting. This paper aims to assess the effect of tDCS of three brain areas, including the right dorsolateral prefrontal cortex (DLPFC), posterior parietal cortex (PPC), and cerebellum on cognitive function, and obtain safety data in healthy adults during Ramadan fasting.

Methods and material

A total of 42 healthy, right-handed participants were randomly assigned to one of the 6 stimulation groups: active (anodal)-tDCS of right DLPFC, PPC, and cerebellum; or sham for DLPFC, PPC, and cerebellum after 8 h of fasting for Ramadan. Safety data and cognitive function, such as attention-switching tasks (AST), were obtained by employing the Cambridge Neuropsychological Test Automated Battery (CANTAB) before and after each tDCS session. The cognitive function outcome variables were the response time and the percentage of correct answers in AST. For sham stimulation, the placement of the electrodes was the same as for the active stimulation.

Results

An improvement in performance time in attention tasks was observed; however, it did not reach a significant level after anodal stimulation of the DLPFC, PPC, and cerebellum. Overall, there were no statistically significant differences between the active and sham tDCS groups in cognitive function. There were no significant side effects of tDCS during fasting for any group.

Conclusions

Our data suggest that there are variable effects of tDCS on attention tasks during Ramadan fasting. TDCS appears to be safe, well-tolerated and adhered to the international standard of safety in the local population during Ramadan fasting. Further large sample size studies should be conducted to validate the current study findings and reach better conclusions.

Intermittent Fasting: Physiological Implications on Outcomes in Mice and Men

Intermittent fasting (IF) is a widely practiced dietary method that encompasses periodic restriction of food consumption. Due to its protective benefits against metabolic diseases, aging, and cardiovascular and neurodegenerative diseases, IF continues to gain attention as a preventative and therapeutic intervention to counteract these chronic diseases. Although numerous animal studies have reported positive health benefits of IF, its feasibility and efficacy in clinical settings remain controversial. Importantly, since dietary interventions such as IF have systemic effects, thoroughly investigating the tissue-specific changes in animal models is crucial to identify IF's mechanism and evaluate its potential adverse effects in humans. As such, we will review and compare the outcomes and underlying mechanisms of IF in both animal and human studies. Moreover, the limitations of IF and inconsistencies between preclinical and clinical studies will be discussed to provide insight into the gaps between translating research from bench to bedside.

Assessment of fatigue severity and neurocognitive functions in the real setting of Ramadan in patients with type 2 diabetes mellitus

OBJECTIVES

Type 2 diabetes mellitus (T2DM) is linked with a risk of dementia and decline in neurocognitive function. The current observational case-control study was conducted to evaluate the effect of fasting during Ramadan on cognitive functions and fatigue severity in T2DM patients using the Cambridge Neuropsychological Test Automated Battery (CANTAB).

METHODS

This research was conducted at King Saud University Medical city, on 82 subjects including 43 control and 39 T2DM patients of both genders. The standardized Fatigue Severity Scale (FSS) and tests from CANTAB, including the Motor Screening Task (MOT), Spatial Span (SSP) and Intra-Extra Dimensional Set Shift (IED) were recorded during 3rd week and 2-3 weeks after Ramadan under controlled environmental conditions. Neurocognitive functions were recorded through CANTAB.

RESULTS

IED errors (24.43 vs 50.73, p = 0.007), MOT mean and median latency (1466.32 vs 1120.27, p = 0.002) were significantly higher in T2DM than controls. IED stages completed (7.43 vs 8.69, p = 0.003) and SSP Span length were significantly lower in T2DM than controls (4.13 vs 4.82, p = 0.059). The significant differences between T2DM patients and controls persisted in the post. T2DM patients made more errors and completed less IED stages than did the controls, indicating that a worsened flexibility of attention relative to controls. Moreover, T2DM patients exhibited longer latencies in MOT, indicating poor motor performance. A comparison of performances by T2DM patients on FSS and CANTAB during and after Ramadan showed that fasting substantially increased fatigue scales, motor performance, and working-memory capacity.

CONCLUSIONS

Patients with T2DM have impaired cognitive functions including poor motor performance, low flexibility of attention, and poor working memory capacity compared to healthy control subjects during and also in post Ramadan period. However, there is no clear statistical evidence that the cognitive functions (except for SSP SL scores) and fatigue severity of T2DM subjects differ between Ramadan and after Ramadan in both T2DM and controls.

Effects of 25-Min Nap Opportunity during Ramadan Observance on the 5-m Shuttle Run Performance and the Perception of Fatigue in Physically Active Men

We aimed to investigate the effects of a 25-min nap opportunity on physical performance during the 5-m shuttle run test (5mSRT), feelings (i.e., evaluated by the feeling scale), attention (i.e., evaluated by the digit cancellation test) and the perception of fatigue (i.e., recorded by the rating of perceived exertion (RPE)) during Ramadan observance. Twelve physically active men (age: 21.1 ± 3.2 yrs, height: 1.76 ± 0.05 m, body-mass: 71.2 ± 9.3 kg) voluntarily participated in five test sessions: 15 days before Ramadan (BR), the first 10 days of Ramadan (FR), the last 10 days of Ramadan (ER), 10 days after Ramadan (10AR) and 20 days after Ramadan (20AR). During each test session, participants performed the digit cancellation test, a 5-min standard warm-up, the 5mSRT (6 × 30-s with 35-s intervals-between) and the rating of perceived exertion (RPE) after no-nap (N0) and 25-min nap opportunity (N25) conditions. Participants also completed the Pittsburgh Sleep Quality Index (PSQI) during each period. The total distance covered during the 5mSRT did not differ significantly before, during or after Ramadan, but was significantly greater after N25 compared to N0 at 10AR (687.5 ± 23.0 m vs. 725.6 ± 41.1 m; p = 0.018) and 20AR (698.3 ± 19.8 m vs. 742.6 ± 58.3 m; p = 0.003). The attention scores were higher after N25 in comparison with N0 at 10AR (p = 0.04) and 20AR (p = 0.02). RPE scores were not significantly different between N25 and N0 conditions. Feelings scores were higher after N25 compared to N0 during both FR (p = 0.007) and 20AR (p = 0.04). A significant deterioration of sleep quality was recorded during Ramadan (i.e., PSQI scores were significantly higher during and after compared to BR (p < 0.0005)). A 25-min nap opportunity was beneficial for physical and cognitive performance after Ramadan observance; however, any effect is insufficient to show significant beneficial impacts during Ramadan.

Effect of diurnal fasting on sleep during Ramadan: a systematic review and meta-analysis

PURPOSE

The current meta-analysis aimed to obtain a more stable estimate of the effect size of Ramadan diurnal intermittent fasting (RDF) on sleep duration and daytime sleepiness.

METHODS

Databases (Scopus, ScienceDirect, ProQuest Medical, PubMed/MEDLINE, Web of Science, EBSCOhost, Cochrane, CINAHL, and Google Scholar) were searched from database inception to the end of June 2019. The sleep quality measures analyzed were excessive daytime sleepiness (EDS) measured by the Epworth sleepiness scale (ESS) and total sleep time (TST). Subgroup analyses for age, sex, and levels of physical activity were conducted.

RESULTS

We identified 24 studies (involving 646 participants, median age 23.7 years, 73% men) conducted in 12 countries from 2001 to 2019. The results revealed that TST decreased from 7.2 h per night [95% confidence interval (CI) 6.7-7.8] before Ramadan to 6.4 h (95% CI 5.3-7.5) during Ramadan, while the ESS score increased slightly from 6.1 (95% CI 4.5-7.7) before Ramadan to 7.0 (95% CI 5.2-8.8) during Ramadan. Effect sizes on sleep quality measures during RDF demonstrated a moderate reduction in TST (number of studies, K = 22; number of subjects, N = 571, Hedges' g value of -0.43, 95% CI - 0.64 to -0.22, Q = 90, τ² = 0.15, I² = 78%, P < 0.001), while ESS score showed negligible effect on EDS (K = 9, N = 362, Hedges' g value of -0.06, 95% CI -0.43 to 0.28, Q = 21, τ² = 0.13, I² = 76%, P value = 0.001).

CONCLUSION

During the month of Ramadan, there is approximately a 1 hour reduction in TST and nearly a 1 point increase in the ESS score.

Observing Ramadan and sleep-wake patterns in athletes: a systematic review, meta-analysis and meta-regression

Objective

To evaluate the effect of observing Ramadan on athletes’ sleep patterns.

Design

Systematic review and meta-analysis.

Data sources

The entire content of PubMed/MEDLINE and Web of Science.

Eligibility criteria for selecting studies

Single-group, prepost and cross-over design studies conducted in athletes aged ≥18 years, training at least twice a week and published in English before 12 July 2018 were included. Studies assessing sleep quantity, quality, daytime sleepiness and/or daily naps based on objective or subjective methods were deemed eligible.

Study appraisal

The methodological quality was assessed using ‘QualSyst’.

Results

Of 13 selected articles, 7 were of strong quality, 3 were moderate and 3 were weak. 11 studies evaluated total sleep time (TST); this decreased during Ramadan in 4 studies, increased in 1 and remained unchanged in 6. Pooled TST findings indicated a moderate effect size (− 0.97, SE=0.37, 95% CI −1.69 to −0.25, t=−2.64, p=0.01) with significant heterogeneity but no publication bias. Meta-regressions showed no effects of study year, age, sample size, type of sport or competition level, but there were effects of country (with France and Tunisia being the most affected countries and Turkey the least affected, Q=32.14, p<0.0001) and study design (Q=7.74, p=0.02). Four studies measured self-reported sleep quality and it decreased in three studies. One study of sleep architecture reported more frequent waking and more light sleep during Ramadan. Daily nap duration was increased in two studies, but daytime sleepiness remained unchanged in four studies.

Conclusion

When athletes continue to train at least two times/week while observing Ramadan, TST is decreased compared with athletes’ baseline levels.

Sleep Patterns, Alertness, Dietary Intake, Muscle Soreness, Fatigue, and Mental Stress Recorded before, during and after Ramadan Observance

Ramadan is one of the pillars of the Islamic creed. Its observance commonly causes chrono-biological changes. The present study examined sleep and alertness during Ramadan observance relative to data collected before and after Ramadan in a sample of young, physically active men. Information was also collected on dietary intake, muscle soreness, fatigue, and mental stress over the three periods. Fourteen physically active men (age: 21.6 ± 3.3 years, height: 1.77 ± 0.06 m, body-mass: 73.1 ± 9.0 kg) completed the Hooper questionnaire and the Pittsburgh Sleep Quality Index (PSQI) and responded to the digit cancellation test (DCT) fifteen days before Ramadan, during the last ten days of Ramadan and 20 days after Ramadan. The PSQI results indicated that sleep duration was significantly longer before Ramadan (p = 0.003) and after Ramadan (p = 0.04) compared to during Ramadan and was longer before Ramadan than after Ramadan (p = 0.04). In addition, the sleep efficiency was lower during Ramadan in comparison to before Ramadan (p = 0.02) and after Ramadan (p = 0.04). The daytime dysfunction score increased during Ramadan in comparison with before Ramadan (p = 0.01) and after Ramadan (p = 0.04), and the sleep quality score was higher during (p = 0.003) and after Ramadan (p = 0.04) as compared to before Ramadan. The sleep disturbance score increased during Ramadan relative to before Ramadan (p = 0.04). However, Ramadan observance had no significant effect on sleep latency. Mental alertness also decreased at the end of Ramadan compared to before (p = 0.003) or after Ramadan (p = 0.01). Dietary intake, muscle soreness, fatigue, and mental stress as estimated by the Hooper questionnaire remained unchanged over the three periods of the investigation (p > 0.05). In conclusion, Ramadan observance had an adverse effect on sleep quantity and on mental alertness, but not on sleep quality. However, dietary intake, muscle soreness, fatigue, and mental stress remained unaffected.

Dietary Practices Adopted by Track-and-Field Athletes: Gluten-Free, Low FODMAP, Vegetarian, and Fasting

Some track-and-field athletes implement special diets aiming to improve health and/or performance. An evidence-based approach to any diet is recommended to minimize the risks associated with unnecessary dietary restriction, which may potentially do more harm than good. Four prevalent diets are reviewed in this study: (a) gluten-free; (b) low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP); (c) vegetarian; and (d) fasting diets. Recently, gluten-free diets and low FODMAP diets have emerged as novel regimes thought to improve gastrointestinal health and reduce the risk of exercise-associated gastrointestinal symptoms. No direct beneficial outcomes have been associated with avoiding gluten for clinically healthy athletes. Indirectly, a gluten-free diet is associated with other dietary changes, particularly FODMAP reduction, which may improve adverse gastrointestinal symptoms. Vegetarian diets can optimally support athletic demands. However, attention is required to ensure adequate energy and intake of specific nutrients that are less abundant or less well absorbed from plant sources. Finally, fasting is a long-standing concept that is undertaken on a voluntary and obligatory basis. Despite limited supporting research, voluntary fasting is a popular alternative to conventional diets perceptually offering health and body composition benefits. Strict obligatory fasting guidelines likely require the implementation of tailored nutrition strategies to help athletes cope with athletic demands. Overall, a multitude of factors influence adherence to special diets. Even when adherence to a special diet is a necessity, education and advice from an accredited dietitian/nutritionist are recommended for track-and-field athletes to optimize nutrition for health and performance.

Repeated-sprints exercise in daylight fasting: carbohydrate mouth rinsing does not affect sprint and reaction time performance

To determine the effect of carbohydrate mouth rinsing (CHO-MR) on physical and cognitive performance during repeated-sprints (RS) after 3 days of intermittent fasting (abstaining from food and fluid 14 h per day). In a randomized and counter-balanced manner 15 active healthy males in a fasted state performed a RS-protocol [RSP; 2 sets (SET1 and SET2) of 5×5 s maximal sprints, with each sprint interspersed with 25 s rest and 3 min of recovery between SET1 and SET2] on an instrumented non-motorized treadmill with embedded force sensors under three conditions: i) Control (CON; no-MR), ii) Placebo-MR (PLA-MR; 0% maltodextrin) and iii) CHO-MR (10% maltodextrin). Participants rinsed their mouth with either 10 mL of PLA-MR or CHO-MR solution for 5 s before each sprint. Sprint kinetics were measured for each sprint and reaction time (RTI) tasks (simple and complex) were assessed pre-, during- and post-RSP. There was no statistical main effect of CHO-MR on mean power, mean speed, and vertical stiffness during the sprints between the PLA-MR and CON condition. Additionally, no statistical main effect for CHO-MR on accuracy, movement time and reaction time during the RTI tasks was seen. CHO-MR did not affect physical (RSP) or cognitive (RTI) performance in participants who had observed 3 days of intermittent fasting (abstaining from food and fluid 14 h per day).

How does diurnal intermittent fasting impact sleep, daytime sleepiness, and markers of the biological clock? Current insights

Mealtimes and feeding schedules may interfere with the circadian system and impact sleep. The practice of intermittent fasting (IF) in its different formats is increasing worldwide. However, most studies addressing the effect of IF on circadian rhythms, daytime sleepiness, and sleep architecture have been conducted during diurnal IF for Ramadan. In this article, we analyze the effect of diurnal IF on the circadian clock, sleep, and daytime sleepiness. In free-living, unconstrained environments that do not control for lifestyle changes such as sleep/wake schedules, sleep duration, and light exposure, studies have demonstrated sudden and significant delays in bedtime and wake time during diurnal intermittent fasting for Ramadan. However, subsequent studies that accounted for lifestyle factors and sleep/wake patterns have reported no changes in markers of the biological clock, daytime sleepiness, or sleep parameters. Nevertheless, several researchers have demonstrated a reduction in the proportion of rapid eye movement stage sleep as the significant alteration in sleep architecture during fasting.

Repeated Sprints in Fasted State Impair Reaction Time Performance

OBJECTIVE

The aim of this study was to assess the effects of 3-day Islamic intermittent fasting (3d-IF) on cognitive performance and serum levels of neurotrophic factors (brain-derived neurotrophic factor [BDNF] and vascular endothelial growth factor [VEGF]) before and after repeated sprints.

METHODS

Twenty-one physically active male Muslims (29.8 ± 5.9 years, exercising 4 ± 1.5 times/week) were randomly assigned to one of 2 experimental sessions: the control or nonfasting session (CS) or the fasting session (FS). These 2 sessions occurred 7 days apart in a counterbalanced crossover design. In both conditions, the test was performed at the same time of day, approximately 1 hour before sunset. In the FS, the test occurred on the third day of the 3d-IF and involved the participants' performance of the following: (a) two series of 5 maximal 5-second sprints and (b) 2 cognitive tasks: One Touch Stockings (OTS) and reaction time (simple and complex RTI).

RESULTS

In both conditions, the participants' reaction times during the RTI test were similar at the pre- and mid-exercise points, but postexercise, simple and complex reaction times were higher in FS compared to CS (p = 0.045, effect size [ES] = 0.21 and p = 0.006, ES = 0.41, respectively). However, OTS performance and serum levels of neurotrophic factors were not influenced by the 3d-IF.

CONCLUSION

Simple and complex reaction times during the RTI test were negatively affected by the 3d-IF after 2 bouts of intensive repeated sprints.

The effect of intermittent fasting during Ramadan on sleep, sleepiness, cognitive function, and circadian rhythm

PURPOSE

Studies have shown that experimental fasting can affect cognitive function, sleep, and wakefulness patterns. However, the effects of experimental fasting cannot be generalized to fasting during Ramadan due to its unique characteristics. Therefore, there has been increased interest in studying the effects of fasting during Ramadan on sleep patterns, daytime sleepiness, cognitive function, sleep architecture, and circadian rhythm.

METHOD

In this review, we critically discuss the current research findings in those areas during the month of Ramadan.

RESULTS

Available data that controlled for sleep/wake schedule, sleep duration, light exposure, and energy expenditure do not support the notion that Ramadan intermittent fasting increases daytime sleepiness and alters cognitive function. Additionally, recent well-designed studies showed no effect of fasting on circadian rhythms. However, in non-constrained environments that do not control for lifestyle changes, studies have demonstrated sudden and significant delays in bedtime and wake time.

CONCLUSIONS

Studies that controlled for environmental factors and sleep/wake schedule reported no significant disturbances in sleep architecture. Nevertheless, several studies have consistently reported that the main change in sleep architecture during fasting is a reduction in the proportion of REM sleep.

Rapid weight loss in the context of Ramadan observance: recommendations for judokas

Judo is a weight-classified combat sport, and many athletes seek to compete at the lightest possible weight category to gain an advantage from competing against shorter/smaller, and supposedly weaker opponents. To achieve a desired weight, most judokas opt for rapid weight loss techniques. Short-duration maximal efforts are not greatly affected by “making weight”, but prolonged and/or repeated exercise is significantly impaired. Negative effects on mood, ratings of perceived exertion, and cognitive function are also reported. Moreover, rapid weight loss reduces maximal cardiac output and glycogen stores, and impairs thermo-regulation. Limited empirical data suggest that Ramadan reduces judokas’ performance, and this is likely to be exacerbated by attempts at rapid weight loss. Weight reduction during Ramadan tends to be counterproductive, and judokas who aim for a lower weight category are advised to attempt any desired reduction of body mass during the weeks leading up to Ramadan, rather than during the holy month.

Knowledge, beliefs and attitudes of Muslim footballers towards Ramadan fasting during the London 2012 Olympics: a cross-sectional study

OBJECTIVES

Muslims observe fasting during the month of Ramadan by abstaining from eating and drinking from dawn to sunset. Available literature shows that although several studies have been conducted on athletes to determine the effects of Ramadan fasting in terms of physical fitness and performance, little data are available regarding the knowledge, beliefs and attitudes of athletes (particularly footballers) towards Ramadan fasting during high-level competitions. This study explored the knowledge, beliefs and attitudes towards Ramadan fasting among football players participating in the London 2012 Olympics football tournament.

DESIGN

Cross-sectional study.

SETTINGS

Team training facility.

PARTICIPANTS

54 Muslim footballers participating in the London Olympics, 2012 OUTCOME MEASURES: Each participant was asked to complete a pre-validated structured questionnaire to assess knowledge, beliefs and attitudes regarding Ramadan fasting and their intention to fast during London 2012.

RESULTS

Of the 54 participating athletes, 21(39%) reported that they intended to fast during Ramadan, but not on a match day. This attitude differed across three teams interviewed -83%, 15% and 0%-showing cross-cultural variation. Overall, there was a lack of knowledge among footballers regarding the effects of Ramadan fasting on sleep and performance; around 30% of athletes gave incorrect responses. This knowledge was independent of their decision to fast on non-competition days (p>0.05).

CONCLUSIONS

This is the first study to describe the knowledge, beliefs and attitudes towards Ramadan fasting among athletes from Muslim-majority countries participating in a high-level competition. Appropriate knowledge can ensure optimum performance for athletes during Ramadan fasting. Coaches, family members and friends also in possession of this knowledge can provide moral support to the players.

Implications of oxidative stress in the brain plasticity originated by fasting: a BOLD-fMRI study

OBJECTIVES

The goal of this study was assessing the intermittent fasting effect on brain plasticity and oxidative stress (OS) using blood-oxygenation-level dependent (BOLD)-functional magnetic resonance image (fMRI) approach. Evidences of physiological and molecular phenomena involved in this process are discussed and compared to reported literature.

METHOD

Six fully healthy male non-smokers volunteered in this study. All volunteers were right handed, and have an equilibrated, consistent and healthy daily nutritional habit, and a healthy lifestyle. Participants were allowed consuming food during evening and night time while fasting with self-prohibiting food and liquids during 14 hours/day from sunrise to sunset. All participants underwent identical brain BOLD-fMRI protocol. The images were acquired in the Department of Radiology and Clinical Imaging of the University Hospital of Fez, Fez, Morocco. The anatomical brain and BOLD-fMRIs were acquired using a 1.5-Tesla scanner (Signa, General Electric, Milwaukee, United States). BOLD-fMRI image acquisition was done using single-shot gradient echo echo-planer imaging sequence. BOLD-fMRI paradigm consisted of the motor task where volunteers were asked to perform finger taping of the right hand. Two BOLD-fMRI scan sessions were performed, the first one between the 5th and 10th days preceding the start of fasting and the second between days 25th and 28th of the fasting month. All sessions were performed between 3:30 PM and 5:30 PM. Although individual maps were originated from different individual participants, they cover the same anatomic area in each case. Image processing and statistical analysis were conducted with Statistical Parameter Mapping version 8 (2008, Welcome Department of Cognitive Neurology, London UK).

RESULTS AND DISCUSSION

The maximal BOLD signal changes were calculated for each subject in the motor area M1; Activation maps were calculated and overlaid on the anatomical images. Group analysis of the data was performed, and the average volume and the maximum intensity of BOLD signal in the activated area M1 was determined for all studied volunteers. The current study allowed measuring regional brain volumes and neural network activity before and during an extended period of fasting using BOLD-fMRI. This demonstrated and confirmed the impact of fasting on human brain structure and function. Further studies are required to elucidate mechanisms and enable direct inference of a diet-induced OS effect on the brain.

Ramadan fasting does not adversely affect neuromuscular performances and reaction times in trained karate athletes

Background

The present study aimed to investigate the concomitant effects of Ramadan intermittent fast (RIF) and muscle fatigue on neuromuscular performances and reaction times in young trained athletes.

Methods

Eight karate players (17.2 ± 0.5 years) were tested on three sessions: during a control period (S1: one week before Ramadan), and during the first (S2) and the fourth week of RIF (S3). Dietary intake and anthropometric measurements were assessed before each session. During each test session, participants performed maximal voluntary isometric contractions (MVC) and a submaximal contraction at 75 % MVC until exhaustion (T_lim) of the right elbow flexors. Surface electromyography was recorded from biceps brachii muscle during MVC and T_lim. Simple (SRT) and choice (CRT) reaction times were evaluated at rest and just after T_lim in a random order.

Results

The total daily energy (S2: +19.5 %, p < 0.05; S3: +27.4 %, p < 0.01) and water (S2: +26.8 %, p < 0.01; S3: +23.2 %, p < 0.05) intake were significantly increased during RIF. However, neither body mass nor body mass index was altered by RIF (F_(2,14) = 0.80, p = 0.47 and F_(2,14) = 0.78, p = 0.48, respectively). In addition, T_lim (F_(2,14) = 2.53, p = 0.12), MVC (F_(2,14) = 0.51, p = 0.61) and associated electrical activity (F_(2,14) = 0.13, p = 0.88) as well as neuromuscular efficiency (F_(2,14) = 0.27, p = 0.76) were maintained during RIF. Moreover, neither SRT nor CRT was affected by RIF (F_(2,14) = 1.82, p = 0.19 and F_(2,14) = 0.26, p = 0.78, respectively) or neuromuscular fatigue (F_(1,7) = 0.0002, p = 0.98 and F_(1,7) = 3.78, p = 0.09, respectively).

Conclusions

The present results showed that RIF did not adversely affect the neuromuscular performances and anthropometric parameters of elite karate athletes who were undertaking their usual training schedule. In addition, neither RIF nor neuromuscular fatigue poorly affects reaction times in elite karate athletes.

Body mass loss correlates with cognitive performance in primates under acute caloric restriction conditions

Brain functions are known to consume high levels of energy, thus, the integrity of cognitive performance can be drastically impacted by acute caloric restriction. In this study, we tested the impact of a 40% caloric restriction on the cognitive abilities of the grey mouse lemur (Microcebus murinus). Twenty-three male mouse lemurs were divided into two groups: 13 control animals (CTL) that were fed with 105kJ/day and 10calorie restricted (CR) animals that received 40% less food (63kJ/day) than the CTL animals. The animals were fed according to their group for 19days. Before treatment, we assessed baseline associative learning capacities, resting metabolic rates and locomotor performance of both animal groups. After treatment, we tested the same functions as well as long-term memory. Our results showed that CR animals had lower learning performance following caloric restriction. The effects of caloric restriction on memory recall varied and depended on the metabolism of the individual animal. Body mass loss was linked to memory test performance in the CR group, and lower performance was observed in individuals losing the most weight. While CR was observed to negatively impact learning, locomotor capacities were preserved in CR animals, and there were higher resting metabolic rates in the CR group. Our data reinforce the strong link between energy allocation and brain function, and suggest that in the context of food shortage, learning capacities could be a limiting parameter in the adaptation to a changing environment.

Impact of Ramadan intermittent fasting on cognitive function in trained cyclists: a pilot study

This study assessed selected measures of cognitive function in trained cyclists who observed daylight fasting during Ramadan. Eleven cyclists volunteered to participate (age: 21.6±4.8 years, VO2max: 57.7±5.6 ml kg(-1)·min(-1)) and were followed for 2 months. Cognitive function (Cambridge Neuropsychological Test Automated Battery (CANTAB), Reaction Time index (RTI) and Rapid Visual Information Processing (RVP) tests) and sleep architecture (ambulatory EEG) were assessed: before Ramadan (BR), in the 1st week (RA1) and 4th week of Ramadan (RA4), and 2 weeks post-Ramadan (PR). Both cognitive tests were performed twice per day: before and after Ramadan at 8-10 a.m. and 4-6 p.m., and during Ramadan at 4-6 p.m. and 0-2 a.m., respectively. Training load (TL) by the rating of perceived exertion (RPE) method and wellness (Hooper index) were measured daily. If the TL increased over the study period, this variable was stable during Ramadan. The perceived fatigue and delayed onset muscle soreness (DOMS) increased at RA4. Sleep patterns and architecture showed clear disturbances, with significant increases in the number of awakenings and light sleep durations during Ramadan (RA1 and RA4), together with decreased durations of deep and REM sleep stages at PR. RTI (simple and multiple reaction index) reaction and movement times did not vary over the study period. The RVP test showed reduced false alarms during Ramadan, suggesting reduced impulsivity. Overall accuracy significantly increased at RA1, RA4 and PR compared to baseline. At RA4, the accuracy was higher at 0-2 a.m. compared to 4-6 p.m. Despite the observed disturbances in sleep architecture, Ramadan fasting did not negatively impact the cognitive performance of trained cyclists from the Middle East.

Does Ramadan Fasting Adversely Affect Cognitive Function in Young Females?

We examined the effects of Ramadan fasting on cognitive function in 17 female athletes. Data were obtained from participants of two fasting (n = 9) and nonfasting (n = 8) groups at three periods of the study (before Ramadan, at the third week in Ramadan, and after Ramadan). Digit span test (DST) and Stroop color test were employed to assess short-term memory and inhibition/cognitive flexibility at each time point. There were no significant changes for DST and Stroop task 1 in both groups, whereas Stroop task 2 and task 3 showed significant improvements in Ramadan condition (p < 0.05). Interference indices did not change significantly across the study except in post-Ramadan period of fasting group (p < 0.05). Group × week interaction was significant only for error numbers (p < 0.05). Athletes in nonfasting showed a significant decrease in number of errors in Ramadan compared to baseline (p < 0.05). The results suggest that Ramadan fasting may not adversely affect cognitive function in female athletes.