- Fasting is generally considered to be safe for most people
- The majority of the benefits result from regulating energy-balance
- Fasting results in increased breakdown of dysfunctional and damaged tissue (autophagy, mitophagy, apoptosis)
- Fasting also improves ‘fat adaptation’ (the use of fat for fuel)
- Fasting increases cortisol and stress hormone levels but these return to normal with adaptation to fasting
- Fasting is at least as effective for weight/fat loss as calorie restriction but is more effective for reducing IGF-1
- Fasting benefits asthma, autoimmune conditions, reduces side-effects from chemotherapy, reduces blood pressure, and improves mood disorders and skin health
Fasting has recently re-entered the mainstream consciousness as a diet and lifestyle practice that is perceived as an easy and effective way to improve health. Fasting though is nothing new and has been a dietary strategy employed for mental, physical, and spiritual health for millennia. A ‘natural’ free-living human, throughout much of our existence as a species, would have gone through frequent periods of fasting, both day-to-day and periodically. Only very recently have we had an abundance of food which has caused fasting to be seen as outside of the norm. The adaptations that we have developed to respond to nutrient and energy scarcity allowed us to survive in varied environments and through times of scarcity. As it turns out, many of these adaptations are also beneficial to health and to our ability to not just survive but to thrive.
What is fasting?
Fasting is the act of abstaining from all or some kinds of food or drink. Fasting has traditionally been associated with spiritual and religious practices rather than the primarily health-focus we see today. Thus, most definitions qualify fasting with ‘especially as a religious observance’.
There is no quantified definition for fasting though, and it could be considered to be any period of abstention from food or restriction of calories that is outside the ‘norm’ of dietary patterns. So, it can vary from missing one or more meals per day (intermittent fasting) through to missing entire days of eating (as in alternate-day fasting) or having a couple of days a week in which nothing is eaten, or calories are strictly controlled (such as in 5:2 fasting).
Religious fasting is still common and is reflected in the dietary habits of millions of believers and the health impact of religious fasting has been documented among Buddhists, Hindus, Christians, and Muslims.1 The most commonly observed religious fast carried out nowadays is the Ramadan fast of Islam. All adherents who are not ill, travelling, elderly, pregnant, diabetic, or menstruating, are expected to fast completely (without foods or liquids) between sunrise and sunset. Because the majority of the nearly 2 billion Muslims fast during this time, it’s unsurprising that much of the research on fasting has been carried out during Ramadan.
Overall, the reviews of studies conducted so far show that fasting provides a range of health benefits,2, 3 and that much of the benefit results from energy-restriction. By reducing the ‘feeding window’ available, people tend towards eating less overall because even if they ‘overeat’ during their non-fasting times, they do not eat more than they would have if not fasting. It has been observed in randomised controlled trials that fasting does not result in increased calorie intake during the non-fasting times.2
So, fasting is an effective way to achieve calorie-restriction, but it might also offer additional benefits by encouraging secondary processes such as reduced insulin-like growth factor (IGF-1), an anabolic chemical which, while beneficial to growth and repair, is also implicated in the development of cancer when produced in excess.
Fasting also increases autophagy and apoptosis (self-destruction and immune destruction of dysfunctional cells and tissues),4 reduces monocyte-driven inflammation and might offer additional benefits over and above the restriction of energy intake.5 Medically supervised fasts of 200-500 calories per day for 7-21 days have been shown to be beneficial for inflammatory disorders, reduce pain and inflammation, and improve mood and cognition, and are thought to work by also encouraging increased brain availability of serotonin, opioids, cannabinoids, and neurotrophic factors, along with neuroendocrine activation and by providing a mild stress response (which also results in the aforementioned reductions in monocyte driven inflammation and increased autophagy).6
Along with energy-restriction, fasting results in increased proportions of fat being used as fuel (‘fat-adaptation’) and the combination of fasting , fat-adaptation, and calorie restriction also improve glucose homeostasis (blood sugar control), blood lipids, and increase the availability of neuroprotective chemicals such as brain-derived neurotrophic factor (BDNF) which is critical to the repair and maintenance of the brain and central nervous system.2
In the studies performed to date (many of them on the Ramadan fast), fasting has been shown to be safe and with few, if any adverse effects. Water-only fasting equal to, or greater than two days has similarly been shown to be incredibly safe overall.7
Common types of fasting
|Type||Sub-type||Meals per day||Description|
|Intermittent fasting (IF)||14:10||2-3+||No food is eaten for a 14-hour window, i.e. between dinner and brunch|
|16:8||2+||No food is eaten for 16 hours. I.e. between dinner and lunch|
|20:4||1||One feeding window in the morning or evening. I.e. only feeding around dinnertime|
|12:12||Usually 2||2 meals per day, typically breakfast and dinner|
|Alternate day fasting||Any||“Feed day” followed by “fast day” (usually 0-300 calories)|
|5:2 fasting||Any||5 “feed days” followed by 2 “fast days” (usually 0-300 calories)|
|Periodic fasting||3 or more days of fasting every 1-12 months or more|
|Religious fasting||Lenten fast||Any||Traditionally avoidance of meat, dairy, eggs, sugar, and any intoxicants for 40 days. This resulted in energy-restriction|
|Orthodox fast||Any||Similar to a Lenten fast|
|Ramadan fast||1-2 feeding windows||Food (and liquids) are abstained from between dawn and dusk|
What is Autophagy?
In simple terms, autophagy is a mechanism in cells of the body that removes unnecessary or dysfunctional components. The word itself means ‘eating the self’ (auto=self, phagy=to eat).
In more complex terms, it is a lysosomal degradation process which eliminates damaged organelles (cell components), long-lived misfolded proteins and invading pathogens. The function of autophagy is to remove damaged or dysfunctional cell components and recycle them into amino acids (and other substrates) to be used as building blocks of tissues and for energy. The proper regulation of autophagy is essential for health and we are only just beginning to understand the implications of having this process running at the optimal level (i.e. consistent with our development over time.) In the modern food and lifestyle environment, it is highly likely that persistent stressors, such as food scarcity and heat stress have been largely eliminated, and we are also far less active than our forebears. These changes have led to a reduction in our biologically normal levels of autophagy. So, providing some of these ‘stressors’ in our lifestyle can positively impact the regulation of autophagy and helps to preserve our cell integrity and energy restriction by fasting or calorie-restricted diets are the most potent non-genetic stimulators of autophagy.8
Effects on Stress Hormones
Fasting results in a significant increase in cortisol and other ‘stress’ hormones (and more than calorie-restriction) but this effect appears to attenuate back to baseline after several weeks, suggesting that there is no long term negative effect on cortisol status resulting from behavioural fasting.9
Effects on Immunity
No significant effects on circulating immune complexes, immunoglobulins or c-reactive protein have been seen as a result of Ramadan fasting. However, there are small reductions in pro-inflammatory cytokines (interleukin 1β, interleukin 6, tumour necrosis factor-alpha).10, 11 These ‘pro-inflammatory cytokines’ are chemical messengers for the inflammatory cascade and increased inflammatory cytokines are observed in inflammatory and autoimmune conditions. Reductions in these markers are a key therapeutic target in conditions like lupus, rheumatoid arthritis, Crohn’s disease and more.
Fasting vs Calorie Restriction
Intermittent fasting regimens have gained considerable popularity in recent years because many people find these diets easier to follow than traditional calorie-restriction approaches.
Intermittent fasting involves restricting energy intake on 1–3 days of the week and eating freely on the non-restricted days. Alternate-day fasting is a subclass of intermittent fasting, which consists of a “fast day” (75% energy restriction) alternating with a “feed day” (ad libitum food consumption). Recent findings suggest that fasting is at least as effective as calorie restriction for weight loss and the improvement of cardiometabolic risk markers (like glucose, fasting insulin, and insulin sensitivity).12
However, insulin-like growth factor (IGF-1) (high levels of which are implicated in cancer development and growth) might be reduced more by fasting than calorie-restriction. A systematic review of fasting vs calorie-restriction for the reduction of IGF-1 suggested that fasting significantly decreases IGF-1 levels (WMD: -28.87 ng/ml, 95% CI: −43.69, −14.05, I2 = 00%), an effect that was not seen in most calorie-restricted groups.
Only calorie restriction to less than 50% of habitual calories had a comparable effect on IGF-1.13 Fasting was also found to modulate the IGF-1 receptor (IGF-1R)/epithelial growth factor (EGF) receptor (EGFR) and the Akt/mTOR pathways, which are dysregulated in obesity and may lead to skin cancer.14
Effects of Fasting on Health Conditions
Among asthmatic patients, in a case-control study involving 15 asthmatic patients and 14 controls, fasting was shown to significantly decrease the inflammatory marker c-reactive protein but there was no significant difference in lung function tests or respiratory symptoms. This suggests that fasting is safe and may reduce inflammation for people with asthma.10
In a pilot study, people with candida infection were treated with either nystatin (an anti-fungal medication) (n = 40) alone or in combination with an ‘anti-candida diet’ (n = 80). The diet consisted of the following food restrictions:
No significant effect (positive or negative) has been observed as a result of Ramadan fasting for systemic lupus, multiple sclerosis, or inflammatory bowel disease.10 However, small reductions in important inflammatory markers of clinical importance to autoimmune conditions, particularly tumour necrosis factor-alpha have been observed.10, 11
A majority of studies on the effect of fasting on blood pressure in hypertensive patients have shown significant reductions in systolic blood pressure. However, there appears to be little significant effect on diastolic blood pressure. Overall, fasting is considered to be a safe method that can help to reduce blood pressure in those with hypertension.15
Both human and animal studies demonstrate that fasting is effective for reducing the side-effects of chemotherapy (organ damage, toxicity, immunosuppression, and weight loss) and suppress tumour growth and improve survival rates. For these benefits, a fasting duration of longer than 48 hours was found to be crucial. Because of these results, fasting is now considered an effective option to improve both quality-of-life and outcomes in cancer patients.16
In a recent review published in 2015, six studies on intermittent fasting, featuring overweight or obese participants were analysed. A variety of fasting styles was used in these studies, from 5:2 to 3:4, through to 2:5 (days ‘fed’:‘fasted’). All studies reported a decrease in blood pressure (up to 4%), fours studies reported decreased insulin concentrations (with three reducing mean insulin to within reference range. Additionally, and perhaps most importantly, attrition rates (how many people stopped the diets) were lower than typically seen in studies of weight management, at around 20%.17 Calorie-restricted diet interventions for weight loss show attrition rates of around 36% (with a higher rate of attrition in low-fat, high-carbohydrate interventions).18
Ramadan fasts can also reduce triglyceride concentrations, total cholesterol, and increase HDL cholesterol in women.19 In support of this, 85 studies (containing over 4000 participants) conducted in 23 countries between 1982 and 2019 have demonstrated that Ramadan fasting results in reductions in waist circumference, systolic blood pressure, fasting glucose, and triglycerides, while also increasing HDL cholesterol.20 A meta-analysis of nine fasting studies (n = 746) found significant reductions in body fat and (non-significant) reductions in weight, waist circumference, total cholesterol, triglycerides, blood pressure, glucose, and insulin, with a non-significant increase in HDL cholesterol.21
Most studies have noted improvements in lipid profile from Ramadan fasting but not reductions in cardiovascular disease incidence or hospitalisation.23 The incidence of cardiovascular events (stroke, myocardial infarction, and congestive heart failure) also, does not differ significantly between fasting and non-fasting periods.24, 25
Metabolic syndrome and diabetes
In patients with insulin-dependent (Type 1) diabetes, no change in glycaemic control has been observed and only minor effects (hypoglycaemic events, hyperglycaemia, or diabetic ketoacidosis) have also been observed, but these effects are considered to be trivial and not meaningful when compared to usual care. It has been concluded that Ramadan-style fasting is feasible for Type 1 diabetic patients under the care of a suitably qualified practitioner.26, 27 Furthermore, Ramadan fasting is considered to be ‘non-risky’ for both controlled and partially controlled diabetes.28
Some studies have shown executive function deficits from fasting, others have shown benefits or unclear results. In a review of ten scientific papers on short-term fasting also showed inconsistent results, with several studies reporting no observable differences as a result of fasting, and others showing deficits on tasks designed to test psychomotor speed, executive function, and mental rotation.29
Overall, reviews of the evidence suggest that there are no adverse effects on markers of kidney health (such as urea, uric acid, and creatinine) resulting from fasting.30-32
In contrast to the equivocal findings for cognition, mood disorders seem to benefit from fasting.
In one study, eight days of fasting (300 kcal/day) resulted in a significant improvement in mood after the fifth day. In another, two weeks of fasting (250 kcal/day) resulted in over 80% of fasters showing rapid decreases in depression and anxiety scores, and improved depression and mania scores in bipolar disorders have been reported in fasting studies.33
Obesity and overweight
Intermittent fasting has become perhaps most popular among people wanting to lose fat and weight and those seeking to maintain a healthy body weight and fasting has been demonstrated to be effective for the treatment of obesity.34 Studies on people overweight or with obesity show that fasting is equal to calorie-restricted interventions for weight loss,35, 36 and at least one study has suggested that fasting is superior to calorie-restriction for loss of body fat, and two studies report greater improvements in insulin resistance (as measured by insulin homeostasis) when compared to continuous energy restriction.35 Interestingly, hyperphagia (overeating) is not observed in studies of intermittent fasting and in the ‘fed’ phases, people typically still achieve a 20% calorie restriction on habitual energy intakes.35
Reviews of the effects of the Ramadan fast consistently show that there are significant reductions in weight and body fat resulting from the fasting period (e.g. body fat reductions of −1.46% [95% confidence interval: −2.57 to −0.35] p = 0.010). These reductions are greatest for those that have higher body fat levels and become non-significant for normal-weight people, however, loss of fat-free mass (i.e. muscle) can also be appreciable (approximately 30% of fat-mass). There is also a relatively consistent return to pre-fasting weight after the cessation of fasting (at ~2–5 weeks).37, 38
Maintenance of weight loss
One month of a weight maintenance fasting protocol (one day of fasting and six days of ad libitum Mediterranean diet) successfully maintained reductions in weight and improvements in insulin sensitivity that had been achieved over three months following a 5:2 fasting protocol for weight loss. However, other analyses have shown higher numbers of people continuing to follow a calorie-restricted diet vs fasting over 6 months (58% IF vs 85% calorie-restriction).35
Prevention of weight gain
There are currently no randomised controlled trials specifically on the prevention of weight gain among healthy, normal-weight people. Two studies have looked at metabolic effects of fasting in healthy adults and these have corrected for energy deficit by strictly controlling calorie intake on non-fasting days so as to not have an overall calorie deficit. It was reported that there was sustained hunger in fasters and difficulty maintaining normal activity during fasting days in an alternate day fasting protocol.35
Overall, there appears to be no marked benefit or decrement resulting from fasting for physical or mental fitness.39-41 Subjective feelings of fatigue or mental performance can show some decline, implying some level of ‘stress’ on the athlete, however, most of these studies also show that these measures may not result in decreases in performance.41 Markers of inflammation related to this increase in stress have been observed in some but not all studies on Ramadan fasting.10 Additionally, aerobic fitness may be compromised, while inflammatory marker IL6 is increased and along with epinephrine and norepinephrine (‘fight or flight’ stress-hormones) and fatigue levels. Importantly though, these measures returned to normal after approximately one week, suggesting that adverse stress effects abate with adaptation to fasting.10 Markers of electrolyte and hydration status and kidney function do not change markedly during Ramadan.42 Measures associated with cardiometabolic health LDL cholesterol, HDL cholesterol and the inflammatory marker c-reactive protein are improved by fasting in athletes, similar to the effects observed in non-athletes.10
Pregnancy and infant outcomes
No negative effects on outcomes such as foetal growth and development, intrauterine and early-life conditions, pre-term delivery, or markers of health status have been observed in those observing Ramadan while pregnant.43-45 However, some micronutrients may be reduced in the breast milk of fasting mothers and both micro- and macronutrient intakes of some pregnant women during Ramadan have been found to be deficient.44
No significant differences have been observed in growth rates between children following or not following the Ramadan fast.46
In a survey of 108 obstetricians and gynaecologists, most physicians recommended against fasting in the second or third trimester, while fasting on the first trimester was controversial. Senior specialists were more lenient about fasting than younger specialists (62% and 35%, respectively, p = 0.01) and religious and traditional physicians were more likely to permit fasting (the Yom Kippur fast) compared to their secular colleagues (53% and 25%, respectively, p = 0.01).47
In a prospective study on 100 patients with schizophrenia, there were increased lymphocytes, monocytes, fibrinogen and c-reactive protein, especially in schizophrenic patients with metabolic syndrome. This offers a significant contrast to other studies which have shown benefits to mental health conditions and to inflammatory disorders (note: inflammation and mental health are strongly linked). Further research is required to understand the implications of fasting for people with schizophrenia.10
Fasting might be beneficial to the health of the skin and in treating pathology of this organ. Calorie restriction had previously been demonstrated to reduce skin irritation following topical retinol treatment (a common application for skin disorders such as acne) without reducing the treatment-effect of the medication.48
Wound healing can be either improved or worsened by fasting. It has been demonstrated that benefits to wound healing might come from increasing macrophage activity, increases in transforming growth factor-alpha (TGF-α), and the secretion of other factors that encourage tissue formation. However, fasting before and during wounding might have a detrimental effect, one which is reversed by feeding for several days before wounding and during the early recovery phase, likely due to increases in growth factors like IGF-1 and by increasing collagen production through anabolic signalling.14 Calorie restriction and fasting are also likely to reduce the ageing of the skin by reducing rates of glycation and free radical and other damage along with distinct epigenomic signalling to slow ageing processes.14
Furthermore, fasting is also likely to reduce the incidence or severity of autoimmune-related disorders of the skin such as psoriasis.14
Adverse effects and Cautions
Some studies have noted the adverse effects of Ramadan fasting. These have included headaches, heartburn, constipation, dehydration, decreased sleep quality, and anaemia.49 There are also anecdotal suggestions that people with Gilbert’s syndrome (a typically mild congenital condition marked by the liver not being able to process bilirubin) may have to modify fasts as energy and lipid insufficiency or long fasting periods can worsen bilirubin levels resulting in fatigue and mood disturbance, possibly related to neurotoxicity of very high bilirubin levels. Additionally, it has been suggested (again, anecdotally) that if someone is not sufficiently fat-adapted, they might experience symptoms similar to those commonly called ‘keto-flu’. As we have demonstrated, keto-flu has the strongest association with energy-restriction, not how much carbohydrate is restricted (in a low-carb diet context)50 and so, this makes sense
Fasting, on the whole, is safe and effective for weight and fat loss and a range of health outcomes. It is at least as effective as calorie restriction for the improvement of body composition and cardiometabolic outcomes and may offer some particular benefits to the reduction of IGF-1, which has potential anti-cancer implications, and for the improvement of other processes that help to regulate the epigenome and the clearance of damaged and dysfunctional tissues from the body.
On the other hand, fasting is unlikely to benefit hypertrophy as it typically results in energy-restriction overall, even on non-fasting days and thus, it becomes more difficult to achieve a caloric surplus required for muscle growth. Fasting may also not benefit individuals who are behaviourally more comfortable with portion-control and planned energy-restriction. Enforcing a fasting protocol in contrast to one’s behavioural tendencies is likely to lead to failure.
Overall, for the improvement of health, energy must be kept in balance. If fasting helps you to do that, it is a useful intervention that is safe and effective and might have some additional benefits to health over and above energy-control. So, if you can stick to fasting, and it helps you to feel and perform at your best, do it. If it is more difficult for you to implement than another dietary strategy that gives you great results, don’t!
1. Persynaki A, Karras S, Pichard C. Unraveling the metabolic health benefits of fasting related to religious beliefs: A narrative review. Nutrition. 2017;35:14-20.
2. Horne BD, Muhlestein JB, Anderson JL. Health effects of intermittent fasting: hormesis or harm? A systematic review. The American Journal of Clinical Nutrition. 2015;102(2):464-70.
3. Johnson M, Morton L. The effects of intermittent fasting on body composition in resistance trained males: A review of the literature. European Journal of Sport Studies. 2013;1.
4. Derakhshan M, Derakhshan R. Fasting and Apoptosis: A Mini Review. Journal of Nutrition,Fasting and Health. 2015;3(4):166-8.
5. Ahmed A, Saeed F, Arshad MU, Afzaal M, Imran A, Ali SW, et al. Impact of intermittent fasting on human health: an extended review of metabolic cascades. International Journal of Food Properties. 2018;21(1):2700-13.
6. Michalsen A. Prolonged Fasting as a Method of Mood Enhancement in Chronic Pain Syndromes: A Review of Clinical Evidence and Mechanisms. Current Pain and Headache Reports. 2010;14(2):80-7.
7. Finnell JS, Saul BC, Goldhamer AC, Myers TR. Is fasting safe? A chart review of adverse events during medically supervised, water-only fasting. BMC complementary and alternative medicine. 2018;18(1):67.
8. Bagherniya M, Butler AE, Barreto GE, Sahebkar A. The effect of fasting or calorie restriction on autophagy induction: A review of the literature. Ageing Research Reviews. 2018;47:183-97.
9. Nakamura Y, Walker BR, Ikuta T. Systematic review and meta-analysis reveals acutely elevated plasma cortisol following fasting but not less severe calorie restriction. Stress (Amsterdam, Netherlands). 2016;19(2):151-7.
10. Adawi M, Watad A, Brown S, Aazza K, Aazza H, Zouhir M, et al. Ramadan Fasting Exerts Immunomodulatory Effects: Insights from a Systematic Review. Frontiers in Immunology. 2017;8(1144).
11. Faris MeA-IE, Jahrami HA, Obaideen AA, Madkour MI. Impact of diurnal intermittent fasting during Ramadan on inflammatory and oxidative stress markers in healthy people: Systematic review and meta-analysis. Journal of Nutrition & Intermediary Metabolism. 2019;15:18-26.
12. Barnosky AR, Hoddy KK, Unterman TG, Varady KA. Intermittent fasting vs daily calorie restriction for type 2 diabetes prevention: a review of human findings. Translational Research. 2014;164(4):302-11.
13. Rahmani J, Kord Varkaneh H, Clark C, Zand H, Bawadi H, Ryan PM, et al. The influence of fasting and energy restricting diets on IGF-1 levels in humans: A systematic review and meta-analysis. Ageing Research Reviews. 2019;53:100910.
14. Bragazzi NL, Sellami M, Salem I, Conic R, Kimak M, Pigatto PDM, et al. Fasting and Its Impact on Skin Anatomy, Physiology, and Physiopathology: A Comprehensive Review of the Literature. Nutrients. 2019;11(2):249.
15. Alinezhad-Namaghi M, Salehi M. Effects of Ramadan fasting on blood pressure in hypertensive patients: a systematic review. Journal of Fasting and Health. 2016;4(1):17-21.
16. Sun L, Li Y-J, Yang X, Gao L, Yi C. Effect of fasting therapy in chemotherapy-protection and tumorsuppression: a systematic review. Translational Cancer Research. 2017;6(2):354-65.
17. Hankey C, Klukowska D, Lean M. A systematic review of the literature on intermittent fasting for weight management. The FASEB Journal. 2015;29(1_supplement):117.4.
18. Hession M, Rolland C, Kulkarni U, Wise A, Broom J. Systematic review of randomized controlled trials of low-carbohydrate vs. low-fat/low-calorie diets in the management of obesity and its comorbidities. Obes Rev. 2009;10(1):36-50.
19. Rouhani MH, Azadbakht L. Is Ramadan fasting related to health outcomes? A review on the related evidence. J Res Med Sci. 2014;19(10):987-92.
20. Faris MeA-IE, Jahrami HA, Alsibai J, Obaideen AA. Impact of Ramadan Diurnal Intermittent Fasting on Metabolic Syndrome Components in Healthy, Non-Athletic Muslim People Aged Over 15 Years: A Systematic Review and Meta-Analysis. British Journal of Nutrition.1-51.
21. Francis L, Young J, Lara J. The impact of intermittent fasting on body composition and cardiovascular biomarkers: a systematic review and meta-analysis. Proceedings of the Nutrition Society. 2017;76(OCE2):E42.
22. Horne BD, Muhlestein JB, May HT, Carlquist JF, Lappe DL, Bair TL, et al. Relation of routine, periodic fasting to risk of diabetes mellitus, and coronary artery disease in patients undergoing coronary angiography. Am J Cardiol. 2012;109(11):1558-62.
23. Mazidi M, Rezaie P, Karimi E, Nematy M. Effects of Ramadan fasting on lipid profile: A narrative review. Journal of Fasting and Health. 2014;2(2):57-61.
24. Turin TC, Ahmed S, Shommu NS, Afzal AR, Al Mamun M, Qasqas M, et al. Ramadan fasting is not usually associated with the risk of cardiovascular events: A systematic review and meta-analysis. J Family Community Med. 2016;23(2):73-81.
25. Salim I, Al Suwaidi J, Ghadban W, Alkilani H, Salam AM. Impact of religious Ramadan fasting on cardiovascular disease: a systematic review of the literature. Current Medical Research and Opinion. 2013;29(4):343-54.
26. Alabbood MH, Ho KW, Simons MR. The effect of Ramadan fasting on glycaemic control in insulin dependent diabetic patients: A literature review. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2017;11(1):83-7.
27. Vakili R, Niazi Z, Rezaie P. Type 1 diabetes and Ramadan fasting: A narrative review. Journal of Fasting and Health. 2016;4(1):22-4.
28. Shadman Z, Akhoundan M, Khoshniat Nikoo M. A Review of Ramadan Fasting and Diabetes Mellitus: Controversies Regarding the Effects of Ramadan Fasting on Diabetic Patients. Journal of Nutrition,Fasting and Health. 2014;2(3):119-30.
29. Benau EM, Orloff NC, Janke EA, Serpell L, Timko CA. A systematic review of the effects of experimental fasting on cognition☆. Appetite. 2014;77:52-61.
30. Mirsane SA, Shafagh S, Oraei N. Effects of Fasting in the Holy Month of Ramadan on the Uric Acid, Urea, and Creatinine Levels: A Narrative Review. Journal of Nutrition,Fasting and Health. 2016;4(4):130-5.
31. Bragazzi NL. Ramadan fasting and chronic kidney disease: A systematic review. J Res Med Sci. 2014;19(7):665-76.
32. Emami-Naini A, Roomizadeh P, Baradaran A, Abedini A, Abtahi M. Ramadan fasting and patients with renal diseases: A mini review of the literature. J Res Med Sci. 2013;18(8):711-6.
33. Fond G, Macgregor A, Leboyer M, Michalsen A. Fasting in mood disorders: neurobiology and effectiveness. A review of the literature. Psychiatry Research. 2013;209(3):253-8.
34. The Society of Korean Medicine R, Park W, Cha Y. 비만에 대한 절식요법의 임상연구 고찰: 국내 한의학 연구 중심으로. Journal of Korean Medicine for Obesity Research. 2016;16(1):50-63.
35. Harvie M, Howell A. Potential Benefits and Harms of Intermittent Energy Restriction and Intermittent Fasting Amongst Obese, Overweight and Normal Weight Subjects—A Narrative Review of Human and Animal Evidence. Behavioral Sciences. 2017;7(1):4.
36. Harris L, Hamilton S, Azevedo LB, Olajide J, De Brún C, Waller G, et al. Intermittent fasting interventions for treatment of overweight and obesity in adults: a systematic review and meta-analysis. JBI Database of Systematic Reviews and Implementation Reports. 2018;16(2):507-47.
37. Fernando HA, Zibellini J, Harris RA, Seimon RV, Sainsbury A. Effect of Ramadan Fasting on Weight and Body Composition in Healthy Non-Athlete Adults: A Systematic Review and Meta-Analysis. Nutrients. 2019;11(2):478.
38. Sadeghirad B, Motaghipisheh S, Kolahdooz F, Zahedi MJ, Haghdoost AA. Islamic fasting and weight loss: a systematic review and meta-analysis. Public Health Nutrition. 2014;17(2):396-406.
39. Levy E, Chu T. Intermittent Fasting and Its Effects on Athletic Performance: A Review. Current Sports Medicine Reports. 2019;18(7):266-9.
40. Attarzadeh Hosseini SR, Hejazi k. A Review of Ramadan Fasting and Regular Physical Activity on Metabolic Syndrome Indices. Journal of Nutrition,Fasting and Health. 2016;4(1):1-16.
41. Chaouachi A, John BL, Souissi N, Aaron JC, Chamari K. Effects of Ramadan Intermittent Fasting on Sports Performance and Training: A Review. International Journal of Sports Physiology and Performance. 2009;4(4):419-34.
42. Trabelsi K, Moalla W, Boukhris O, Ammar A, Elabed K, Hakim A, et al. Effects of Practicing Physical Activity During Ramadan Fasting on Health-Related Indices: An Updated Brief Review. Int J Sport Stud Hlth. 2018;1(3):e83789.
43. Mirsane SA, Shafagh S. A narrative review on fasting of pregnant women in the holy month of Ramadan. Journal of Fasting and Health. 2016;4(2):53-6.
44. Faris MeA-IE, Al-Holy MA. Implications of Ramadan intermittent fasting on maternal and fetal health and nutritional status: A review. Mediterranean Journal of Nutrition and Metabolism. 2014;7(2):107-18.
45. Glazier JD, Hayes DJL, Hussain S, D’Souza SW, Whitcombe J, Heazell AEP, et al. The effect of Ramadan fasting during pregnancy on perinatal outcomes: a systematic review and meta-analysis. BMC Pregnancy and Childbirth. 2018;18(1):421.
46. Mazidi M, Rezaie P, Nematy M. The effects of Ramadan fasting on growth parameters: A narrative review. Journal of Fasting and Health. 2014;2(1):41-5.
47. Adler-Lazarovits C, Weintraub AY. Physicians’ attitudes and views regarding religious fasting during pregnancy and review of the literature. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2019;233:76-80.
48. Varani J, Bhagavathula N, Aslam MN, Fay K, Warner RL, Hanosh A, et al. Inhibition of retinoic acid-induced skin irritation in calorie-restricted mice. Archives of dermatological research. 2008;300(1):27-35.
49. Maideen P, Mohamed N, Jumale Ab, Balasubramaniam R. Adverse health effects associated with Islamic fasting-A literature review. Journal of Fasting and Health. 2017;5(3):113-8.
50. Harvey C. How Low Do You Need to Go? Exploring the Variability in the Effects of Keto‐induction and Individual Outcomes From Low‐carbohydrate Diets: Auckland University of Technology; 2019.
1. Erdogan A, Rao SSC. Small Intestinal Fungal Overgrowth. Current Gastroenterology Reports. 2015;17(4):16.
2. Samaranayake LP, Macfarlane TW. The Effect of Dietary Carbohydrates on the In-vitro Adhesion of Candida Albicans to Epithelial Cells. Journal of Medical Microbiology. 1982;15(4):511-7.
3. Pizzo G, Giuliana G, Milici M, Giangreco R. Effect of dietary carbohydrates on the in vitro epithelial adhesion of Candida albicans, Candida tropicalis, and Candida krusei. The new microbiologica. 2000;23(1):63-71.
4. Abu-Elteen KH. The influence of dietary carbohydrates on in vitro adherence of four Candida species to human buccal epithelial cells. Microbial Ecology in Health and Disease. 2005;17(3):156-62.
5. Vargas SL, Patrick CC, Ayers GD, Hughes WT. Modulating effect of dietary carbohydrate supplementation on Candida albicans colonization and invasion in a neutropenic mouse model. Infection and Immunity. 1993;61(2):619.
6. Cavalheiro M, Teixeira MC. Candida Biofilms: Threats, Challenges, and Promising Strategies. Frontiers in Medicine. 2018;5(28).
7. THEIN ZM, SAMARANAYAKE YH, SAMARANAYAKE LP. Dietary sugars, serum and the biocide chlorhexidine digluconate modify the population and structural dynamics of mixed Candida albicans and Escherichia coli biofilms. APMIS. 2007;115(11):1241-51.
8. Nikawa H, Samaranayake LP, Hamada T. Modulation of the anti-candida activity of apo-lactoferrin by dietary sucrose and tunicamycin in vitro. Archives of Oral Biology. 1995;40(6):581-4.
9. Santana IL, Gonçalves LM, Vasconcellos AAd, da Silva WJ, Cury JA, Cury AADB. Dietary Carbohydrates Modulate Candida albicans Biofilm Development on the Denture Surface. PloS one. 2013;8(5):e64645.
10. Nikawa H, Nishimura H, Hamada T, Kumagai H, Samaranayake LP. Effects of dietary sugars and saliva and serum on Candida bioflim formation on acrylic surfaces. Mycopathologia. 1997;139(2):87-91.
11. Reed BD, Slattery ML, French TK. The association between dietary intake and reported history of Candida vulvovaginitis. J Fam Pract. 1989;29(5):509-15.
12. Weig M, Werner E, Frosch M, Kasper H. Limited effect of refined carbohydrate dietary supplementation on colonization of the gastrointestinal tract of healthy subjects by Candida albicans. The American Journal of Clinical Nutrition. 1999;69(6):1170-3.
13. Oberst-Walsh L, Cooper E, Sanders K. What is the effect of diet and dietary supplements on vulvovaginal candidiasis (VVC)? Evidence-Based Practice. 2016;19(3):E-2.
14. Otašević S, Momčilović S, Petrović M, Radulović O, Stojanović NM, Arsić-Arsenijević V. The dietary modification and treatment of intestinal Candida overgrowth – a pilot study. Journal de Mycologie Médicale. 2018;28(4):623-7.
15. Kadir T, Uygun B, Akyüz S. Prevalence of Candida species in Turkish children: relationship between dietary ıntake and carriage. Archives of Oral Biology. 2005;50(1):33-7.
16. Ogbolu DO, Oni AA, Daini OA, Oloko AP. In Vitro Antimicrobial Properties of Coconut Oil on Candida Species in Ibadan, Nigeria. Journal of medicinal food. 2007;10(2):384-7.
17. Gunsalus KTW, Tornberg-Belanger SN, Matthan NR, Lichtenstein AH, Kumamoto CA. Manipulation of Host Diet To Reduce Gastrointestinal Colonization by the Opportunistic Pathogen <span class="named-content genus-species" id="named-content-1">Candida albicans</span>. mSphere. 2016;1(1):e00020-15.
18. Jadhav A, Mortale S, Halbandge S, Jangid P, Patil R, Gade W, et al. The Dietary Food Components Capric Acid and Caprylic Acid Inhibit Virulence Factors in Candida albicans Through Multitargeting. Journal of medicinal food. 2017;20(11):1083-90.
19. Sudbery PE. Growth of Candida albicans hyphae. Nature Reviews Microbiology. 2011;9:737.
20. Arsenault AB, Gunsalus KTW, Laforce-Nesbitt SS, Przystac L, DeAngelis EJ, Hurley ME, et al. Dietary Supplementation With Medium-Chain Triglycerides Reduces Candida Gastrointestinal Colonization in Preterm Infants. The Pediatric Infectious Disease Journal. 2019;38(2):164-8.
21. Sheidaei S, Sadeghi T, Jafarnejad F, Rajabi O, Najafzadeh M. Herbal medicine and vaginal candidiasis in Iran: a review. Evidence Based Care. 2017;7(2):71-7.
22. Chaiprateep E. Development of Vaginal Tablets from Thai Herb Extracts for Candidiasis. Isan Journal of Pharmaceutical Sciences. 2018;14(1):58-66.
23. Abílio VMF, da Silva Mesquita B, da Silva ED, de Queiroz Carvalho FV, de Macêdo LLA, Dias de Castro R. Antifungal activity of natural products indicated by herb sellers (raizeiros) for the treatment of oral candidiasis. Revista Cubana de Estomatología. 2014;51(3):259-69.
24. Ataei Z, Ansari M, Ayat Elahi Mousavi A, Mirzaei A. IN-VITRO STUDY OF ANTIFUNGAL EFFECTS OF SELECTED HERBAL EXTRACTS ON STANDARD AND WILD STRAINS OF CANDIDA ALBICANS. JOURNAL OF ISLAMIC DENTAL ASSOCIATION OF IRAN (MAJALLAH-I-DANDANPIZISHKI). 2007;19(2 (63)):91-7.
25. Gavanji S, Larki B. Comparative effect of propolis of honey bee and some herbal extracts on Candida albicans. Chinese Journal of Integrative Medicine. 2017;23(3):201-7.
26. Posters. Mycoses. 2011;54(s2):61-181.
27. Dhamgaye S, Devaux F, Vandeputte P, Khandelwal NK, Sanglard D, Mukhopadhyay G, et al. Molecular mechanisms of action of herbal antifungal alkaloid berberine, in Candida albicans. PloS one. 2014;9(8):e104554.
28. Soliman SSM, Semreen MH, El-Keblawy AA, Abdullah A, Uppuluri P, Ibrahim AS. Assessment of herbal drugs for promising anti-Candida activity. BMC complementary and alternative medicine. 2017;17(1):257.
29. Taguchi Y, Ishibashi H, Takizawa T, Inoue S, Yamaguchi H, Abe S. Protection of Oral or Intestinal Candidiasis in Mice by Oral or Intragastric Administration of Herbal Food, Clove (<i>Syzygium aromaticum</i>). 日本医真菌学会雑誌. 2005;46(1):27-33.
30. Bhat V, Sharma SM, Shetty V, Shastry CS, Rao CV, Shenoy S, et al. Characterization of Herbal Antifungal Agent, Origanum vulgare against Oral Candida spp. Isolated from Patients with Candida-Associated Denture Stomatitis: An In vitro Study. Contemp Clin Dent. 2018;9(Suppl 1):S3-S10.
31. Oz Y, Gundogdu N, Aslan M. In Vitro Contribution of Herbal Products on the Activity of Antifungal Drugs against Clinical Candida Isolates. Microbiology Research Journal International. 2019:1-9.
32. Singh S, Fatima Z, Hameed S. Insights into the mode of action of anticandidal herbal monoterpenoid geraniol reveal disruption of multiple MDR mechanisms and virulence attributes in Candida albicans. Archives of Microbiology. 2016;198(5):459-72.
33. Gavanji S, Zaker SR, Nejad ZG, Bakhtari A, Bidabadi ES, Larki B. Comparative efficacy of herbal essences with amphotricin B and ketoconazole on Candida albicans in the in vitro condition. Integrative Medicine Research. 2015;4(2):112-8.
34. Taweechaisupapong S, Khotphat P, Hoysang T, Chitropas P, Khunkitti W. The effects of three Thai herbal essential oils against Candida biofilms. Planta Med. 2007;73(09):P_083.
35. Kim J-Y, Yi Y-S, Lim Y-H. Biological and antifungal activity of herbal plant extracts against Candida species. Microbiology and Biotechnology Letters. 2009;37(1):42-8.
36. CHEN Z-l, XIE S-z. A Study of the in vitro Antimicrobial Effects of 14 Chinese Herbal Medicines on Candida Albicans [J]. Herald of Medicine. 2006;8.
37. Bhardwaj A, Gupta P, Kumar N, Mishra J, Kumar A, Rakhee, et al. Lingzhi or Reishi Medicinal Mushroom, <i>Ganoderma lucidum</i> (Agaricomycetes), Inhibits <i>Candida</i> Biofilms: A Metabolomic Approach. 2017;19(8):685-96.
38. Coelho JS, Polivy J, Herman CP. Selective carbohydrate or protein restriction: Effects on subsequent food intake and cravings. Appetite. 2006;47(3):352-60.
39. Watson NA, Dyer KA, Buckley JD, Brinkworth GD, Coates AM, Parfitt G, et al. Reductions in food cravings are similar with low-fat weight loss diets differing in protein and carbohydrate in overweight and obese adults with type 2 diabetes: A randomized clinical trial. Nutrition Research. 2018;57:56-66.
40. Ohlsson B, Darwiche G, Roth B, Bengtsson M, Höglund P. High fiber fat and protein contents lead to increased satiety reduced sweet cravings and decreased gastrointestinal symptoms independently of anthropometric hormonal and metabolic factors. Journal of Diabetes & Metabolism; 3. 2017;8.
41. Ortinau LC, Hoertel HA, Douglas SM, Leidy HJ. The impact of a protein-rich breakfast on food cravings and reward in overweight/obese ‘breakfast skipping’ adolescent girls. The FASEB Journal. 2013;27(1_supplement):1075.9-.9.
42. Watson H, Mitra S, Croden FC, Taylor M, Wood HM, Perry SL, et al. A randomised trial of the effect of omega-3 polyunsaturated fatty acid supplements on the human intestinal microbiota. Gut. 2018;67(11):1974-83.
43. Menni C, Zierer J, Pallister T, Jackson MA, Long T, Mohney RP, et al. Omega-3 fatty acids correlate with gut microbiome diversity and production of N-carbamylglutamate in middle aged and elderly women. Scientific Reports. 2017;7(1):11079.