Millions of Muslims around the world fast during the holy month of Ramadan as one of the basic requirements of religion. Many of the world's major religions recommend a period of fasting or abstinence to their adherents. Muslims fast for more than 14 hrs and abstain from eating and drinking during the time between sunrise and sunset in Ramadan. During Ramadan, people fasting, eat two meals, one just before dawn (the sahur) and one just after sunset (the iftar), in which they not only abstain from eating and drinking, but also restrain their entire body, including eyes, ears, and tongue. Thus, fasting teaches us self-control and self-discipline with the goal to improve their spiritual and physical state and to fortify their relationship with God.

Daily intermittent fasting may switch glucose metabolism to ketone metabolism, inducing anti-inflammatory, anti-oxidative and stress resistance effects. The role of spirituality and religion in health and disease has been considered since years and some believe that spirituality is part of the biological–psychological–social model, and there are evidences that show strong religious beliefs, spiritual longing, prayer, and worship have positive effects on a person's physical and mental health. Moreover, religious components such as trust in God, reading or listening to Quran, and participation in repetitive rituals like prayers have been revealed to have positive relationship with lower risk of depression, anxiety, and stress, as well as enhanced quality of individuals’ life.

According to World Health Organization, almost 500 million people worldwide are suffering from mental disorders, among whom half are suffering from mood disorders such as depression and anxiety disorders. Depressive and anxiety disorders are leading worldwide causes of disability and loss of quality-adjusted life year in people aged < 40 years. Studies report that fasting has positive effects on physical health, such as cancer, cardiovascular diseases, and regulation of inflammatory response in infections as well as on mental health. The positive effects on mental health include increased level of alertness, improved mood, subjective well-being, and sometimes euphoria. Overweight/obesity is associated with increased depression and fasting may be effective in improving depressive symptoms by favoring weight loss.

What Intermittent Fasting Does to Your Brain……..

1. Triggers autophagy

Fasting turns on an important process called autophagy, in which brain takes out the trash that builds up during the day. This self-cleaning process helps detoxify the brain, clear out old and damaged cells, and sweep away debris. This nightly housekeeping promotes the regeneration of newer, healthier cells. Studies have shown that problems with autophagy have been linked to Alzheimer’s disease, depression, bipolar disorder, schizophrenia, and other neuropsychiatric disorders.

2. Improves memory

Restricting the hours of eating has been shown to significantly improve memory. Studies have shown that after 4 weeks of intermittent fasting, people showed improved performance on a spatial planning and working memory task.

3. Brightens mood

Fasting improves mood and decreases tension, anger and confusion. Fasting also causes weight loss that is associated with significant improvement in emotional well being and depression.

4. Reduces inflammation

Chronic inflammation has been linked to many brain disorders, including depression, bipolar disorder, obsessive compulsive disorder (OCD), schizophrenia, Alzheimer’s disease, and more. Fasting decreases inflammation, which can have significant benefits for the brain health and mental well-being.

5 Fights high blood sugar

Fasting produces greater improvements in insulin sensitivity, which keeps blood sugar levels in control and prevents type 2 diabetes. High blood sugar is associated with a smaller hippocampus (the seahorse-shaped structure in the temporal lobes) that plays a role in mood, learning, and memory processes.. Anxiety and depression are higher in patients with type 2 diabetes than the general population.

6. Lowers blood pressure at night

Fasting decreases blood pressure which is beneficial for heart health, and anything that’s good for heart is also good for the brain. Hypertension lowers blood flow to the brain. Low blood flow on brain SPECT imaging scans has been seen with depression, bipolar disorder, schizophrenia, ADHD, traumatic brain injury, substance abuse, suicidal thoughts, and Alzheimer’s disease.

 

7. Burns excess fat

Fasting helps to burn more fat, which is good for brain health. Excess fat on your body is not your friend. Obesity is linked to several metabolic disorders and is detrimental to brain health. Obesity is associated with a greater risk of depression, bipolar disorder, panic disorder, agoraphobia (fear of going out), and addictions.

How does fasting Benefit your Mental Health?

1. Relief from stress: Fasting has direct effect on physical and mental health by relieving stress. When people are fasting, they tend to make the eating schedule better. Studies have shown reduced levels of eating, including carbohydrates, fat, and others in specified amounts for several weeks, will enhance the ability to think and to control emotions that improves the mood and reduces stress. Moreover, fasting can stabilize the hormone cortisol production by adrenal glands that plays a role in body’s response to stress.

2.Improved mental function. When people fast, less toxic materials flow in the body through the blood and lymphatic system, making it easier for them to think. While fasting, the energy normally used to digest food is available to be used by the brain. This effect on mental health is not noticed in the first few days of a fasting because body takes time to adjust. You might have headaches or pain, which points towards the beginning of the process. When the body clears itself of toxins, the brain has access to a cleaner bloodstream, resulting in clear thoughts, better memory, and increased sharpness of all the senses.

3. Healing/rejuvenation. Fasting puts the body through a process of healing/ rejuvenation. It dissolves diseased cells, leaving only healthy tissue. There's also a noticeable redistribution of nutrients in the body. The body hangs onto precious vitamins and minerals while processing and getting rid of old tissue, toxins, or undesirable materials.

4. Increased willpower. Choosing to fast requires mental strength and the ability to resist short-term gratification to pursue long-term goals. When a person chooses to participate in such a challenging exercise and succeed, he/she experiences enormous gratification and a renewed sense of accomplishment.

 

Can people with mental illnesses fast in Ramadan?

As we are observing the holy month of Ramadan , patients with psychiatric disorders and their family members become worried and are pondering upon questions on whether people with psychiatric conditions should fast during Ramadan and how it might affect their health. What would be the effect of medicines on health after being hungry and thirsty for a long time.

Whether psychiatric patients can fast is very much interlinked with the severity of their condition, whether it's chronic and the properties of their drugs. In addition to these factors, patients need to be aware and careful about if they have comorbid diseases like a heart condition, hypertension, epilepsy, or diabetes. Adequate sleep schedules and patterns are quite important for many psychiatric patients. The sleep pattern is one of the important things to keep an eye on in Ramadan, and prolonged sleep regressions can cause a spike in the severity of the mental illness. Altered sleep patterns can lead to relapse of depressive disorder or bipolar illness. Adjustments to sleeping patterns and the withdrawal of food may pose some difficulties if you have a mental health condition. These changes in routine could exacerbate symptoms of conditions such as depression or bipolar disorder. People with bipolar disorder need to be careful about fasting and decisions on fasting should be made in consultation with psychiatrists. Patients need to be extra cautious while taking certain medications like Lithium, as dehydration, common during fasting can affect the drug plasma levels.

If you have any ongoing medical or psychiatric conditions, it would be beneficial to speak to your doctor ahead of Holy month. They can advise whether they think you are physically and mentally able to fast. You may also want to speak to your doctor if you are taking any medication before you adjust or stop taking them during Ramadan.

Tips to Use Fasting to Improve Your Well-Being

• Avoid excess sugar, salt, and spices to prevent dehydration, acidity and burning sensation in stomach, commonly associated with fasting. Avoid highly fried and processed foods.

• Eat sensibly at dusk and dawn. When you're getting ready to finish your fast, get back to eating slowly. Don't eat a huge meal right away. Instead, spread out your meals and let your body adjust and get used to the process of digesting food again. It is advisable to eat food that releases energy slowly, such as fruits, wholegrain, nuts and oats.

• Rest and recharge when appropriate. It’s important to establish a new sleep routine during Holy month, to ensure you get an appropriate amount of rest to recharge your body and renew your mind. Although you will need to change your sleeping routine to fit around your meals, getting at least four hours sleep a night, after Iftar, will help your body recharge. You may also be able to get a few hours extra after Suhoor, before it’s time to start your day.

• Exercise moderately to boost energy. Light-intensity exercise such as walking for at least 30 minutes is beneficial for health and mental wellbeing during Ramadan. This should last for no longer than 40 minutes. It is less tiring and less dehydrating than high-intensity exercise, such as running or cycling.

• It is advisable to seek Professional help and support for your mental health and strictly adhere to the advice of the Health Care Professional. Do not skip your medicines.

• Focus on positive thinking. Positive thoughts boost your mood and have the power to generate increased optimism and happiness.

 

How to manage medications during Ramadan?

Caring for patients who observe fasts during the month of Ramadan represents a unique undertaking for health care professionals, including pharmacists. Individuals who are on long term medication for chronic illnesses, need to adjust medication schedules so they can be taken between the evening meal of Iftar (sunset) and the morning meal of Sahur (dawn).For medications taken multiple times during the day, recommended strategies include choosing long-acting formulations (e.g., sustained release) or changing dosing regimens to once or twice daily. 

 

However, it is better to take advice from your treating doctor whether you can fast and if yes, how to manage medication to keep yourself mentally and physically fit.

Senior Resident Psychiatry

SKIMS Medical College Bemina Srinagar