|Year : 2020 | Volume
| Issue : 2 | Page : 187-190
Effect of jain fasting on anthropometric, clinical and biochemical parameters
Pratap Sanchetee1, Prakash Sanchetee2, MK Garg3
1 Bhagawan Mahavira International Research Center (BMIRC), JVBI, Ladnun; Sanchetee Hospital, Jodhpur, Rajasthan, India
2 Medical Practitioner, Kolkata, West Bengal, India
3 Department of Medicine and Endocrinology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
|Date of Submission||14-Nov-2019|
|Date of Decision||29-Nov-2019|
|Date of Acceptance||17-Jan-2020|
|Date of Web Publication||30-Apr-2020|
Sanchetee Neurology Research Institute, 429, Pal Link Road, Jodhpur - 342 008, Rajasthan
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background and Aims: Fasting has a long tradition in most cultures and has many health benefits. Most of the studies are from daytime fasting or intermittent fasting. There is paucity of data from complete fasting (no food and fruits, water only). This prospective study is conducted with aims to study impact of complete fasting on clinical and biochemical parameters. Methods: One hundred ten participants of either gender who voluntarily fasted (3-30 days) were included and underwent clinical and biochemical examination before and after fasting. Results: A total of 110 healthy volunteers (M: 27, F: 83) with mean age 51 ± 16 years (range 18-86) and body mass index 27.1 ± 4.9 kg/m2 (16.1-45.2) were studied. They had undergone fast for varying duration between 3-30 days (short fast: 3-7 days = 72; prolong fast: >7 days = 38). There were significant decrease in weight (66.8 ± 11.0 to 64.7 ± 11.1 kg, P < 0.0001), BMI (27.1 ± 4.9 to 26.2 ± 4.9 kg/m2, P < 0.0001), systolic blood pressure (130 ± 17 to 128 ± 15 mmHg, P = 0.012), serum globulin (3.10 ± 0.42 to 3.01 ± 0.41 mg/dl, P = 0.024), and serum high density lipoprotein (48.3 ± 12.2 to 45.7 ± 12.6 mg/dl, P < 0.0001) post fasting. However, significant increase was observed in pulse rate (81 ± 10 to 83 ± 11 beat/min, P = 0.001), fasting plasma glucose (102.9 ± 35.0 to 132.0 ± 42.0 mg/dl, P < 0.0001), serum triglycerides (137.6 ± 68.3 to 149.0 ± 67.1 mg/dl, P = 0.031), very low density lipoprotein (22.0 ± 10.5 to 24.2 ± 11.1 mg/dl, P = 0.010), and serum cortisol levels (13.5 ± 5.9 to 17.2 ± 6.3 μg/dl, P < 0.0001). These changes were more pronounced with prolong fasting, but were not affected by gender. Conclusions: Fasting results in improvement in anthropometric, physical and biochemical parameters related to physical health. It can be recommended as a mean for improving quality of life.
Keywords: Anthropometry, fasting, lipid profile, serum cortisol
|How to cite this article:|
Sanchetee P, Sanchetee P, Garg M K. Effect of jain fasting on anthropometric, clinical and biochemical parameters. Indian J Endocr Metab 2020;24:187-90
|How to cite this URL:|
Sanchetee P, Sanchetee P, Garg M K. Effect of jain fasting on anthropometric, clinical and biochemical parameters. Indian J Endocr Metab [serial online] 2020 [cited 2021 May 11];24:187-90. Available from: https://www.ijem.in/text.asp?2020/24/2/187/283557
| Introduction|| |
Fasting is primarily an act of voluntary abstinence or reduction of some or all food, drink, or both (absolute), for a period of time lasting typically between 12 h and 3 weeks to focus on health and/or spiritual uplift.,, Fasting has a long tradition in most cultures and religions. Religious fasting is intertwined with ritual and spiritual discipline. There is a widespread practice of fasting in many religious cultures including Islam, Christianity, Judaism, Jainism and Hinduism around the world. Calorie restriction triggers a complex series of intricate events, including activation of cellular stress response elements, improved autophagy, modification of apoptosis, and alteration in hormonal balance.,, Controlled studies with animals and human have found fasting protects or improves several cardiometabolic risk factors, such as diabetes, dyslipidemia, insulin resistance, inflammation cytokines, obesity, and hypertension.,,,
The challenge of long fasting is to maintain physiological homeostasis relying solely on endogenous resources. There are behavioural, physiological, and biochemical responses that reduce metabolic rates, maintain tissue structure and function. During the initial few hours of fasting, liver glycogen is the source of glucose in the body and subsequently extrahepatic source comes to rescue.
Jains observe fasts of different types and of different duration. Human studies have largely been limited to observational studies of religious fasting during Ramadan,,,, which are type of intermittent fasting, whereas Jain fast are water only fast. Hence, the changes occurring with intermittent or alternate day fast,, cannot be extrapolated to complete fasting.
While religions have long maintained that fasting is good for the soul, but its bodily benefits were not widely recognized until the early 1900s'. The bulk of the scientific evidence for the health benefits of fasting has come from animal studies or fasting in human being in Islamic Ramadan., There are limited number of studies conducted in Buddhist or Christian populations but none on Jain fasting. This study aims to study impact of Jain fasting on health i.e. weight, BMI, pulse, blood pressure, lipid profile, renal functions, blood sugar, hematological parameters, serum proteins, and serum cortisol.
| Methods|| |
This was a prospective study conducted to measure the effect of fasting on 110 volunteers during Paryusan parv of Jain religion. Participants gave informed consent and completed a basic demographic questionnaire including age and date of birth, gender, marital status, occupation, income, and education on a pre-structured proforma. A complete physical examination and review of their medical records were done. Basic systemic examination was done in all subjects. Subjects with neurological, cognitive or physical disability were excluded from the study. It was advised to end fast if health significantly deteriorates because of any acute illness during study period. All subjects did water only fast. In addition, they were engaged mostly in religious rituals with reduction in physical activity. Fasting was defined as short (fasting up to 7 days) and prolong (>7-30 days).
All participants were examined at start of fast and after termination of fast in the fasting state. Height was measured without shoes to the nearest 0.5 cm. Body weight (BW) was measured (to the nearest 0.1 kg) with a calibrated digital weighing scale (Tanita BWB-800A; Tanita, Corp., Tokyo, Japan) in the morning in light clothing without shoes. Body mass index (BMI) was calculated using the BMI formula, wherein BMI = Weight (kg)/height squared (m2). Pulse was measured for one minute while lying down after 5 min of rest in a quiet environment. At the same stage, systemic arterial systolic (SBP) and diastolic blood pressure (DBP) (in millimeter of mercury) was recorded in the right upper limb by auscultatory method using a mercury sphygmomanometer.
Fasting venous blood samples were collected and was analysed for complete blood count, plasma glucose, blood urea, serum creatinine, serum protein (including albumin and globulin levels), serum lipid profile (total cholesterol-TC, low density lipoprotein-LDL, very low-density lipoprotein-VLDL, high-density lipoprotein-HDL, triglyceride-TG) by autoanalyzer. Serum cortisol was measured by Auto Immunoassay Analyzer (Cobas E 411, Roche) and Cortisol reagent (Roche) with intra-assay and inter-assay coefficient of variation ɝ% and % respectively. The present study aimed to study effect of fasting on anthropometric, clinical and biochemical parameters during Paryusan parva.
Statistical analysis was done using SPSS version 16. All the data passed the normality test. All paired parameters (pre- and post-fasting) were analysed by paired 't' test. Significance of changes in all parameters between genders and duration of fast were calculated by Students 't' test. All tests were two-sided, and the probability (P) level of less than 0.05 was considered as significant.
| Results|| |
A total of 110 subjects (M: 27, F: 83) in the age range of 13-86 years (average 50.2 years) participated in the study. While 72 subjects did short fasting (average 3.4 days), 38 did prolong fasting (average 10.1 days). Mean BMI of participants was 27.08 (16.1-45.2).
There was significant decrease in weight, BMI, SBP, serum globulin and serum HDL post fasting. However, significant increase was observed in pulse rate, fasting plasma glucose, blood urea, albumin globulin ratio, serum TG, VLDL, and serum cortisol levels [Table 1]. These changes were similar in both genders (data not shown).
|Table 1: Change in anthropometric, clinical and biochemical parameters with fasting|
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Prolong fast lead to significantly higher weight loss, decrease in BMI and fall in hemoglobin, serum total protein and serum globulin when compared to short fasting. Serum triglycerides levels and albumin globulin ratio increased significantly with prolong fast when compared to short fast. On the contrary, fasting plasma glucose was significantly increased after short fast than prolong fast. Several parameters e.g. pulse rate, blood urea, serum creatinine, serum albumin, serum total cholesterol and serum LDL showed increase with short fasting, whereas decreased significantly with prolong fasting. There was no significant difference in SBP, DBP, serum HDL, serum VLDL and serum cortisol between short fasting and prolong fasting [Table 2].
|Table 2: Change in anthropometric, clinical and biochemical parameters according to fasting duration|
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| Discussion|| |
Fasting is practiced in various religion all around the world, however, type of fasting differs among religion. Fasting during Ramadan period is intermittent with fasting duration of 12-18 hours each day, whereas it is water only for the duration of fasting in the Jain religion. Calorie intake during Ramadan is usually normal or may exceed from pre-Ramadan period, but there is total calorie restriction during Jain fast.
Body weight and BMI
In the present study, we have observed significant reduction in mean body weight -2.1 ± 1.0 Kg following fast. A similar trend was observed for BMI also. In various meta-analysis a significant weight loss of 1.24 kg [95% confidence interval (CI), −1.60 to − 0.88 kg] and 1.46 kg in overweight and obese subjects were observed during Ramadan, and Christian fast., In our study, weight loss sustained was more than reported during Ramadan, which is due to total restriction of calories than intermittent fasting. A similar trend in weight loss with fasting has been observed by many other workers also.,, In the initial period, major contributor for weight loss with fast is loss of water; body fat and muscle mass rescue the calorie deficiency in later stage.
In the present study, we have observed a significant increment in fasting sugar level at pre-fast level to post-fast level. This increment was significantly more with shorter duration of fast than with longer duration fast. Most of the studies and a meta-analysis showed decrease in blood glucose level during Ramadan.,, A study from Thailand reported increase blood glucose levels during Ramadan particularly in women. Many of the participants had blood glucose higher than normal and may have undiagnosed pre-diabetes (16 participants – 14.5%) or diabetes (21 participants – 19.15%), where fasting may lead to deterioration of metabolic control and increase in blood glucose due to increase in stress hormone.
As fast progresses, fats are also mobilized in addition to carbohydrates. Thus, a significant increase in serum triglyceride levels was observed by us with longer duration of fast. While serum HDL continue to decline with different duration of fast, total cholesterol, LDL, and VLDL showed an increase during early fast but showed declining trend as fast progressed in present study. Various studies have reported inconsistent effect of intermittent fasting on lipid profile. Most of the studies have reported an increase in HDL,,,,, or no change,; increase in total cholesterol, or no change,,,; increase in serum LDL,, or no change.,,, Serum triglycerides were not affected by intermittent fasting. [14,,,, Increase in triglycerides was the consistent difference between our study and studies among intermittent fasting. With intermittent fasting, there is constant replacement of glycogen stores., Hence, subjects have decreased lipolysis compared to complete fasting, which can explain this difference.,
It is an indicator of stress of both types in the body i.e., physical (metabolic) and mental. Fasting is a strong metabolic stress for the body and cortisol makes an attempt to correct glucose deficit in blood along with other counter regulatory hormones. For a few subjects, even fasting is a stress on mind as well. Predictably, in this study we have observed an increase in cortisol level throughout the fast. A systemic review and meta-analysis also reported elevated plasma cortisol following caloric restriction and the meta-regression analysis showed a negative association between the serum cortisol level and the duration of caloric restriction.
Main limitation of the study was inability to re-assess participants following resumption of diet after sufficient duration as other studies have reported reversal of all accrued benefit 4 weeks after Ramadan fast.,
| Conclusion|| |
The present study, first of its kind on prolong fasting, has convincingly demonstrated an improvement in BMI, blood pressure, and lipid profile. Serum cortisol levels increased with duration of fast. Fasting is a cost-effective, non-invasive, has minimal risk of adverse effects for practice in most cases, and has the added benefit of improving physical fitness.
We greatly acknowledge the guidance and support of Samani Chaitanya Pragyaji from, BMIRC, JVBI, Ladnun 341306.
Financial support and sponsorship
This work was funded and supported by the Bhagawan Mahavira International Research Center (BMIRC), Jain Vishva Bharti Institute (Deemed University), Ladnun 341306.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Rizza W, Veronese N, Fontana L. What are the roles of calorie restriction and diet quality in promoting health and longevity? Ageing Res Rev 2014;13:38-45.
Lessan N, Ali T. Energy metabolism and intermittent fasting: The Ramadan perspective. Nutrients 2019;11:1192.
Golbidi S, Daiber A, Korac B, Li H, Essop MF, Laher I. Health benefits of fasting and caloric restriction. Curr Diab Rep 2017;17:123.
Anton SD, Moehl K, Donahoo WT, Marosi K, Lee SA, Mainous AG 3rd
, et al
. Flipping the metabolic switch: Understanding and applying the health benefits of fasting. Obesity 2018;26:254-68.
Johnstone A. Fasting for weight loss: An effective strategy or latest dieting trend? Int J Obes (Lond) 2015;39:727-33.
Varady KA. Intermittent versus daily calorie restriction: Which diet regimen is more effective for weight loss? Obes Rev 2011;12:e593-601.
Nair PM, Khawale PG. Role of therapeutic fasting in women's health: An overview. J Mid-life Health 2016;7:61-4.
] [Full text]
Barnosky AR, Hoddy KK, Unterman TG, Varady KA. Intermittent fasting vs daily calorie restriction for type 2 diabetes prevention: A review of human findings. Transl Res 2014;164:302-11.
Secor SM, Carey HV. Integrative physiology of fasting. Compr Physiol 2016;6:773-825.
Julka S, Sachan A, Bajaj S, Sahay R, Chawla R, Agrawal N, et al
. Glycemic management during Jain fasts. Indian J Endocr Metab 2017;21:238-41.
] [Full text]
Patterson RE, Sears DD. Metabolic effects of intermittent fasting. Annu Rev Nutr 2017;37:371-93.
Mansi KMS. Study the effects of Ramadan fasting on the serum glucose and lipid profile among healthy Jordanian students. Amer J Applied Sci 2007;4:565-9.
Mirmiran P, Bahadoran Z, Gaeini Z, Moslehi N, Azizi F. Effects of Ramadan intermittent fasting on lipid and lipoprotein parameters: An updated meta-analysis. Nutr Metab Cardiovasc Dis 2019;29:906-15.
Iqbal M, Jamea AA, Alonso-Alonso M, Al-Regaiey KA, Bashir S. Cortical thickness, neurocognitive, and body composition effects of fasting during Ramadan. J Res Med Sci 2019;24:50.
] [Full text]
Antoni R, Johnston KL, Collins AL, Robertson MD. Investigation into the acute effects of total and partial energy restriction on postprandial metabolism among overweight/obese participants. Br J Nutr 2016;115:951-9.
Heilbronn LK, Smith SR, Martin CK, Anton SD, Ravussin E. Alternate-day fasting in nonobese subjects: Effects on body weight, body composition, and energy metabolism. Amer J Clin Nutr 2005;81:69-73.
Horne BD, Muhlestein JB, Anderson JL. Health effects of intermittent fasting: Hormesis or harm? A systematic review. Am J Clin Nutr 2015;102:464-70.
Azizi F. Islamic fasting and health. Ann Nutr Metab 2010;56:273-82.
Norouzy A, Salehi M, Philippou E, Arabi H, Shiva F, Mehrnoosh S, et al
. Effect of fasting in Ramadan on body composition and nutritional intake: A prospective study. J Hum Nutr Diet 2013;26(Suppl 1):97-104.
Sadeghirad B, Motaghipisheh S, Kolahdooz F, Zahedi MJ, Haghdoost AA. Islamic fasting and weight loss: A systematic review and meta-analysis. Public Health Nutr 2014;17:396-406.
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:E478.
Karras SN, Koufakis T, Petróczi A, Folkerts D, Kypraiou M, Mulrooney H, et al
. Christian Orthodox fasting in practice: A comparative evaluation between Greek Orthodox general population fasters and Athonian monks. Nutrition 2019;59:69-76.
Ziaee V, Razaei M, Ahmadinejad Z, Shaikh H, Yousefi R, Yarmohammadi L, et al
. The changes of metabolic profile and weight during Ramadan fasting. Singapore Med J 2006;47:409-14.
Trepanowski JF, Kroeger CM, Barnosky A, Klempel MC, Bhutani S, Hoddy KK, et al
. Effect of alternate-day fasting on weight loss, weight maintenance, and cardioprotection among metabolically healthy obese adults: A randomized clinical trial. JAMA Intern Med 2017;177:930-8.
Kul S, Savaş E, Öztürk ZA, Karadaǧ G. Does Ramadan fasting alter body weight and blood lipids and fasting blood glucose in a healthy population? A meta-analysis. J Relig Health 2014;53:929-42.
Ongsara S, Boonpol S, Prompalad N, Jeenduang N. The effect of Ramadan fasting on biochemical parameters in healthy Thai subjects. J Clin Diagn Res 2017;11:BC14-8.
Saleh SA, El-Kemery TA, Farrag KA, Badawy MR, Sarkis NN, Soliman FS, et al
. Ramadan fasting: Relation to atherogenic risk among obese Muslims. J Egypt Public Health Assoc. 2004;79:461-83.
Akaberi A, Golshan A, Moojdekanloo M, Hashemian M. Does fasting in Ramadan ameliorate Lipid profile? A prospective observational study. Pak J Med Sci 2014;30:708-11.
Roky R, Houti I, Moussamih S, Qotbi S, Aadil N. Physiological and chronobiological changes during Ramadan intermittent fasting. Ann Nutr Metab 2004;48:296-303.
Mazidi M, Rezaie P, Chaudhri O, Karimi E, Nematy M. The effect of Ramadan fasting on cardiometabolic risk factors and anthropometrics parameters: A systematic review. Pak J Med Sci 2015;31:1250-5.
Aksungar FB, Topkaya AE, Akyildiz M. Interleukin-6, C-reactive protein and biochemical parameters during prolonged intermittent fasting. Ann Nutr Metab 2007;51:88-95.
Akanji AO, Mojiminiyi OA, Abdella N. Beneficial changes in serum apo A-1 and its ratio to apo B and HDL in stable hyperlipidaemic subjects after Ramadan fasting in Kuwait. Eur J Clin Nutr 2000;54:508-13.
Lamine F, Bouguerra R, Jabrane J, Marrakchi Z, Ben Rayana MC, Ben Slama C, et al
. Food intake and high density lipoprotein cholesterol levels changes during Ramadan fasting in healthy young subjects. Tunis Med 2006; 84:647-50.
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 2016;19:151-7.
Horne BD, Muhlestein JB, Lappe DL, May HT, Carlquist JF, et al
. Randomized cross-over trial of short-term water-only fasting: Metabolic and cardiovascular consequences. Nutr Metab Cardiovasc Dis 2013;23:1050-7.
Hajek P, Myers K, Dhanji AR, West O, McRobbie H. Weight change during and after Ramadan fasting. J Public Health (Oxf) 2012;34:377-81.
[Table 1], [Table 2]