Oxidative Stress and Ramadan Observance; A Possible Influence of Associated Dieting

Document Type : Review Article


Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada


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


  1. Shephard RJ. The impact of Ramadan observance upon athletic performance. Nutrients. 2012; 4(4):491-505.
  2. Shephard RJ. Ramadan and sport: minimizing effects upon the observant athlete. Sports Med. 2013; 43(12):1217-41.
  3. Shephard RJ. Ramadan and the risk of sport injuries. Clin J Sports Med. 2014; 24(5):361-3.
  4. Vincent HK, Taylor AG. Biomarkers and potential mechanisms of obesity-induced oxidant stress in humans. Int J Obes. 2006; 30(3):400-18.
  5. Chaouachi A, Coutts AJ, Wong del P, Roky R, Mbasaa A, Amri M, et al. Haematological, inflammatory, and immunological responses in elite judo athletes maintaining high training loads during Ramadan. Appl Physiol Nutr Metab. 2009; 34(5):907-15.
  6. Maughan RJ, Leiper JB, Bartagi Z, Zrifi R, Zerguini Y, Dvorak J. Effect of Ramadan fasting on some biochemical and haematological parameters in Tunisian youth soccer players undertaking their usual training and competition schedule. J Sports Sci. 2008; 26(Suppl 3):S39-46.
  7. Chennaoui M, Desgorces F, Drogou C, Boudjemaa B, Tomaszewski A, Deplesse F, et al. Effects of Ramadan fasting on physical performance and metabolic, hormonal, and inflammatory parameters in middle-distance runners. Appl Physiol Nutr Metab. 2009; 34(4):587-94.
  8. Trabelsi K, Stannard SR, Maughan RJ, Jammoussi K, Zeghal K, Hakim A. Effect of resistance training during Ramadan on body composition, and markers of renal function, metabolism, inflammation and immunity in Tunisian recreational bodybuilders. Int J Sport Nutr Exerc Metab. 2012; 22(4):267-75.
  9. Donoshow JH. Glutathione peroxidase and oxidative stress. Toxicol Lett. 1995; 82-83:395-8.
  10. Venditti P, Di Meo S. Effect of training on antioxidant capacity, tissue damage and endurance of adult male rats. Int J Sports Med. 1997; 18(7):497-502.
  11. Bogdanis GC, Stavinrou P, Fatouros IG, Philippou A, Chatzinikolaou A, Draganidis, D, et al. Short-term high-intensity interval exercise training attenuates oxidative stress responses and improves antioxidant status in healthy humans. Food Chem Toxicol. 2013; 61:171-7
  12. Gonzalez-Fleche B, Reides C, Cutrin JC, Liesuy SF, Boveris A. Oxidative stress produced by suprahepatic occlusion and reperfusion. Hepatology. 1993; 18(4):881-9.
  13. Closa D, Folch-Puy E. Oxygen free radicals and the systemic inflammatory response. IUBMB Life. 2004; 56(4):185-91.
  14. Buchowski MS, Hongu N, Acra S, Wang L, Warolin J, Roberts LJ 2nd. Effect of modest caloric restriction on oxidative stress in women, a randomized trial. PLoS One. 2012; 7(10):e47079.
  15. Folmer V, Soares JC, Gabriel D, Rocha JB. A high fat diet inhibits D-aminolevulinate dehydratase and increases lipid peroxidation in mice. J Nutr. 2003; 133(7):2165-70.
  16. Evans P, Halliwell B. Micronutrients: oxidant/antioxidant status. Br J Nutr. 2001; 85(Suppl 2):S67-74.
  17. Skrha J. Effect of caloric restriction on oxidative markers. Adv Clin Chem. 2009; 47:223-47.
  18. Khaled T, Ahmed C, Zohra G, Choumous K, Zouheir S, Mounir ZK, et al. Physical activity during Ramadan fasting: effects on body composition, hematological and biochemical parameters. IOSR J Pharm. 2012; 2(5):33-41.
  19. França B, Panek AD, Elutherio EC. Oxidative stress and its effect during dehydration. Comp Biochem Physiol A Mol Integr Physiol. 2007; 146(4):621-31.
  20. Gregersen S, Samnocha-Bonet D, Heilbronn LK, Campbell LV. Inflammatory and oxidative stress responses to high carbohydrate and high-fat meals in healthy humans. J Nutr Metab. 2012; 2012:238056.
  21. Dembach AR, Sherman WM, Simonsen JC, Flowers KM, Lamb DR. No evidence of oxidant stress during high intensity rowing. J Appl Physiol. 1993; 74:2140-5.
  22. Bouhlel E, Salhi Z, Bouhlel H, Mdella S, Amamou A, Zaouali M, et al. Effect of Ramadan fasting on fuel oxidation during exercise in trained male rugby players. Diabetes Metab. 2006; 32(6):617-24.
  23. Al-Shafei AI. Ramadan fasting ameliorates oxidative stress and improves glycemic control and lipid profile in diabetic patients. Eur J Nutr. 2014; 53(7):1475-81.
  24. Mencci E, Mele MC. Amino acids and plasma antioxidant activity. Amino Acids. 1997; 12(3):373-7.
  25. Chaouachi A, Chamari K, Roky R, Wong P, Mbazza A, Bartagi Z, et al. Lipid profiles of judo athletes during Ramadan. Int J Sports Med. 2008; 29(4):282-8.
  26. Chaouachi A, Leiper JB, Souissi N, Coutts AJ, Chamari K. Effects of Ramadan intermittent fasting on sports performance and training: a review. Int J Sports Physiol Perform. 2009; 4(4):419-34.and oxidative stress
  27. Chaouachi A, Leiper JB, Chtourou H, Aziz AR, Chamari K. The effects of Ramadan intermittent fasting on athletic performance: recommendations for the maintenance of physical fitness. J Sports Sci. 2012; 30(Suppl 1):S53-73.
  28. Ibrahim WH, Habib HM, Jarrar AH, Al Baz SA. Effect of Ramadan fasting on markers of oxidative stress and serum biochemical markers of cellular damage in healthy subjects. Ann Nutr Metab. 2008; 53(3-4):175-81.
  29. Ozturk E, Balat O, Ugur MG, Yazixioglu C, Pence S, Erel O, et al. Effect of Ramadan fasting on maternal oxidative stress during the second semester: a preliminary study. J Obstet Gynaecol Res. 2011; 37(7):729-33.
  30. El Ati J, Bell C, Danguir J. Increased fat oxidation during Ramadan fasting in healthy women: an adaptive mechanism for body-weight maintenance. Am J Clin Nutr. 1995; 62(2):302-7.
  31. Febbraio MA, Steensberg A, Keller C, Starkie RL, Nielsen HB, Krustrup P, et al. Glucose ingestion attenuates interleukin-6 release from contracting skeletal muscle in humans. J Physiol. 2003; 549(Pt 2):607-12.
  32. Sayedda K, Kamal S, Ahmed QS. Effect of Ramadan fasting on anthropometric parameters, blood pressure, creatine phosphokinase activity, serum calcium and phosphprus in healthy students of Shri Ram Murti Smarak Institute of Medical Sciences. Natl J Physiol Pharm Pharmacol. 2013; 3(1):48-52.
  33. Al Hourani HM, Atoum MF, Akel S, Hijjawi N, Awawadeh S. Effects of Ramadan fasting on some haematological and biochemical parameters. Jordan J Biol Sci. 2009; 2(3):103-8.
  34. Faris MA, Husein RN, Al-Kurd RA, Al-Fararjeh MA, Bustanji YK, Mohammad MK. Impact of Ramadan intermittent fasting on oxidative stress as measured by urinary 15-f(21)-isoprostane. J Nutr Metab. 2012; 2012:802924.
  35. Sülü B, Öztürk B, Güven A, Kilic K. The effect of long-term controlled fasting (the Ramadan model) on body mass index, blood biochemistry and oxidative stress factors. Turk Klin J Med Sci. 2010; 30(3):855-63.
  36. BaHamman AS, Pandi-Perumal SR, Alzoghaibi MA. The effect of Ramadan intermittent fasting on lipid peroxidation in healthy young men while controlling for diet and sleep: a pilot study. Ann Thorac Med. 2016; 11(1):43-8.
  37. Galasetti PR, Nemet D, Pescatello A, Rose-Gottrron C, Larson J, Cooper DM. Exercise, caloric restriction and systemic oxidative stress. J Invest Med. 2006; 54(2):67-75.
  38. Velthuis-te Wierik EJ, van Leeuwen RE, Hendricks JF, Verhagen H, Loft S, Poulsen HE, et al. Short-term moderate energy restriction does not affect indicators of oxidative stress and genotoxicity in humans. J Nutr. 1995; 125(10):2631-9.
  39. Lee KH, Bartsch H, Nair J, You DH, Hong YC, Cho SH, et al. Effect of short-term fasting on urinary excretion of primary lipid peroxidation products and on markers of oxidative DNA damage in healthy women. Carcinogenesis. 2006; 27(7):1398-403.
  40. Khajafi HA, Bener A, Osman. M, Al Merri A, Al Suwaidi J. The impact of diurnal fasting during Ramadan on the lipid profile, hs-CRP, and serum leptin in stable cardiac patients. Vasc Health Risk Manag. 2012; 8:7-14.
  41. Nematy M, Alinnezhad-Namaghi M, Rashed MM, Mozhdehifard M, Saijadi SS, Akhlagi S, et al. Effects of Ramadan fasting on cardiovascular risk factors: a prospective observational study. Nutr J. 2012; 11:69-75.
  42. Abedelmalek S, Souissi N, Takayuki A, Hadouk S, Tabka Z. Effect of acute maximal exercise on circulating levels of interleukin-12 during Ramadan fasting. Asian J Sports Med. 2011; 2(3):154-60.
  43. Hammouda O, Chtourou H, Aloui A, Mairi MA, Chahed H, Miled A, et al. Does Ramadan fasting affect the diurnal variations in metabolic responses and total antioxidant capacity during exercise in young soccer players? Sport Sci Health. 2014; 10(2):97-104.
  44. Bouhlel H, Bogdanis G, Hamila A, Miled A, Chelly MS, Denguezeli M, et al. Effects of Ramadan observance on repeated cycle ergometer sprinting and associated inflammatory and oxidative stress responses in trained young men. J Fasting Health. 2016; 4(1):39-47.
  45. Degoutte F, Jouanel P, Bègue RJ, Colombier M, Lac G, Pecquignot JM, et al. Food restriction, performance, biochemical, psychological and endocrine changes in judo athletes. Int J Sports Med. 2006; 27(1):9-18.
  46. Finaud J, Degoutte F, Scislowski V, Rouveix M, Durand D, Filaire E. Competition and food restriction effects on oxidative stress in judo. Int J Sports Med. 2006; 27(10):834-41.
  47. Suzuki M, Nakaji S, Umeda T, Mochida N, Kojima A, Mashiko T, et al. Effects of weight reduction on neutrophil phagocytic activity and oxidative burst activity in female judoists. Luminescence. 2003; 18(4):214-7.
  48. Rankin JW, Shute M, Heffron SP, Saker KE. Energy restriction but not protein source affects antioxidant capacity in athletes. Free Rad Biol Med. 2006; 41(6):1001-9.
  49. Kotani K, Yamada T. Oxidative stress and metabolic syndrome in a Japanese female population. Australas J Ageing. 2012; 31(2):124-7.
  50. Roberts CK, Sindhu KK. Oxidative stress and metabolic syndrome. Life Sci. 2009; 84(21-22):705-12.
  51. Fontana L, Meyer TE, Klein S, Holloszy JO. Long-term calorie restriction is highly effective in reducing the risk for atherosclerosis in humans. Proc Natl Acad Sci U S A. 2004; 101(17):6659-63.
  52. Magliano DJ, Liew D, Ashton EL, Sundarajan V, McNeil JJ. Novel biomedical risk markers for cardiovascular disease. J Cardiovasc Risk. 2003; 10(1):41-55.
  53. Barocas DA, Motley S, Cookson MS, Chang SS, Penson DF, Dai Q, et al. Oxidative stress measured by urine F2-isoprostanelevel is associated with prostate cancer. J Urol. 2011; 185(6):2102-7.
  54. Ames BN, Shigenaga MK. Oxidants are a major contributor to aging. Ann N Y Acad Sci. 1992; 663:85-96.
  55. Sohal RS, Weindruch R. Oxidative stress, caloric restriction, and aging. Science. 1996; 273(5271):59-63.
  56. Shephard RJ. Aging, physical activity and health. Champaign, IL: Human Kinetics Publishers; 1997.
  57. Yavari A, Javadi M, Mirmiran P, Bahadoran Z. Exercise-induced oxidative stress and dietary antioxidative. Asian J Sports Med. 2015; 6(1):e24898.
  58. Ristow M, Zarse K, Oberbach A, Klöting N, Birringer M, Kiehntopf M, et al. Antioxidants prevent health-promoting effects of physical exercise in humans. Proc Natl Acad Sci U S A. 2009; 106(21):8665-70.
  59. Mohajeri FA, Ahmadi Z, Hassanshahi G, Mohajeri EA, Ravari A, Ghalebi SR. Does Ramadan fasting affect inflammatory responses: evidence for modulatory roles of this unique nutritional status via chemokine network. Iran J Basic Med Sci. 2013; 16(12):1217-22.
  60. Aksungar FB, Topkaya AE, Akyildiz M. Interleukin-6, C-reactive protein and biochemical parameters during prolonged intermittent fasting. Ann Nutr Metab. 2007; 51(1):88-95.
  61. Asgary S, Aghaei A, Naderı GA, Kelishadi R, Gharipour M, Azali S. Effects of Ramadan fasting on lipid peroxidation, serum lipoproteins and fasting blood sugar. Med J Islamic Acad Sci. 2000; 13(1):35-8.
  62. Faris MA, Kacimi S, Al-Kurd RA, Fararjeh MA, Bustanji MK, Mohammad ML, et al. Intermittent fasting during Ramadan attenuates proinflammatory cytokines and immune cells in healthy subjects. Nutr Res. 2012; 32(12):947-55.
  63. Gumaa KA, Mustafa KY, Mahmoud NA, Gader AM. The effects of Ramadan fasting: 1. Serum uric acid and lipid concentrations. Br J Nutr. 1978; 40(3):573-81.
  64. Lahdimawan A, Handono K, Indra MR, Prawiro SR. Effect of Ramadan fasting on classically activated, oxidative stress and inflammation of macrophage. IOSR J Pharmacy. 2013; 3(4):14-22.
  65. Al-Shafei AI. Ramadan fasting ameliorates arterial pulse pressure and lipid profile, and alleviates oxidative stress in hypertensive patients. Blood Press. 2014; 23(3):160-7.
  66. Asemi Z, Samimi M, Taghizadeh M, Esmailzadeh A. Effects of Ramadan fasting on glucose homeostasis, lipid profiles, inflammation and oxidative stress in women with polycystic ovary syndrome in Kashan, Iran. Arch Iran Med. 2015; 18(12):806-10.
  67. El-Gendy OA, Roikaya M, El-Batae HE, Tawfeek S. Ramadan fasting improves kidney functions and ameliorates oxidative stress in diabetic patients. World J Med Sci. 2012; 7(1):38-48.
  68. Radhakishun N, Blokhuis C, van Vliet M, von Rosentiel I, Weijer O, Heymans M, et al. Intermittent fasting during Ramadan causes a transient increase in total, LDL, and HDL cholesterols and hs-CRP in ethnic obese adolescents. Eur J Pediatr. 2014; 173(8):1103-6.
  69. Shariatpanahi MV, Shariatpanahi ZV, Shahbazi S, Moshtaqi M. Effect of fasting with two meals on BMI and inflammatory markers of metabolic syndrome. Pak J Biol Sci. 2012; 15(5):255-8.
  70. Ünalacak M, Kara IH, Baltaci D, Erdem O, Bucapteke PG. Effects of Ramadan fasting on biochemical and haematological parameters and cytokines in healthy and obese individuals. Metab Syndr Relat Disord. 2011; 9(2):157-61.
  71. Bastard JP, Jardel C, Briuckert E, Blondy P, Capeau J, Laville M, et al. Elevated levels of interleukin 6 are reduced in serum and subcutaneous adipose tissue of obese women after weight loss. J Clin Endocrinol Metab. 2000; 86(9):3338-42.
  72. Heilbronn LK, de Jonge L, Frisard MI, DeLany JP, Larson-Meyer DE, Rood J, et al. Effect of 6-month calorie restriction on biomarkers of longevity, metabolic adaptation, and oxidative stress in overweight individuals: a randomized controlled trial. JAMA. 2006; 295(13):1539-48.
  73. Johnson JB, Summer W, Cutler RG, Martin B, Hyun DH, Dixit VD, et al. Alternate day calorie restriction improves clinical findings and reduces markers of oxidative stress and inflammation in overweight adults with moderate asthma. Free Rad Biol Med. 2007; 42(5):665-74.
  74. Meydani M, Das S, Band M, Epstein S, Roberts S. The effect of caloric restriction and glycemic load on measures of oxidative stress and antioxidants in humans: results from the CALERIE Trial of Human Caloric Restriction. J Nutr Health Aging. 2011; 15(6):456-60.
  75. Tchernof A, Nolan A, Sites CK, Ades PA, Poehlman ET. Weight loss reduces C-reactive protein levels in obese postmenopausal women. Circulation. 2002; 105(5):564-9.
  76. Wycherley TD, Brinkworth JD, Noakes M, Buckley JD, Clifton PM. Effect of caloric restriction with and without exercise training on oxidative stress and endothelial function in obese subjects with type 2 diabetes. Diabetes Obes Metab. 2008; 10(11):1062-73.