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Vol. 49, No. 2, 2005
Issue release date: March–April 2005
Ann Nutr Metab 2005;49:77–82

Effects of Intermittent Fasting on Serum Lipid Levels, Coagulation Status and Plasma Homocysteine Levels

Benli Aksungar F. · Eren A. · Ure S. · Teskin O. · Ates G.
Departments of aBiochemistry, bMicrobiology, cMetabolism and Nutrition, dCardiovascular Surgery and eCardiology, School of Medicine, Maltepe University, Istanbul, Turkey

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Background: During Ramadan, Muslims fast during the daylight hours for a month. The duration of restricted food and beverage intake is approximately 12 h/day which makes Ramadan a unique model of intermittent fasting. Many physiological and psychological changes are observed during Ramadan that are probably due to the changes in eating and sleeping patterns. Methods: Serum total cholesterol, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), prothrombin time, activated partial thromboplastin time (aPTT), plasma fibrinogen, D-dimer and homocysteine levels were measured in 24 healthy fasting volunteers (12 females, 12 males) aged 21–35 years. Venous blood samples were taken 1 week before Ramadan, on the 21st day of Ramadan and 20 days after Ramadan. Results: No significant changes were observed on serum total cholesterol, triglycerides and LDL levels. HDL levels were significantly elevated during Ramadan (p < 0.001) and 20 days after Ramadan (p < 0.05). Prothrombin time, aPTT, fibrinogen and D-dimer levels were in the physiologic limits in all samples but D-dimer levels were significantly low at the end of Ramadan in comparison to pre- and post-fasting levels (p < 0.001). Homocysteine levels, being still in reference ranges, were low during Ramadan (p < 0.05) and reached the pre-fasting levels after Ramadan. Conclusion: Our results demonstrate that intermittent fasting led to some beneficial changes in serum HDL and plasma homocysteine levels, and the coagulation status. These changes may be due to omitting at least one meal when the body was particularly metabolically active and possibly had a low blood viscosity level at the same time. We conclude that intermittent fasting may have beneficial effects on hemostatic risk markers for cardiovascular diseases.

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  1. Adlouni A, Ghalim N, Beslimane A, Lecerf JM, Saile R: Fasting during Ramadan induces a marked increase in high-density lipoprotein cholesterol and decrease in low-density lipoprotein cholesterol. Ann Nutr Metab 1997;41:242–249.
  2. Roky R, Chapotot F, Hakkou F, Benchekroun MT, Buguet A: Sleep during Ramadan intermittent fasting. J Sleep Res 2001;10:319–327.
  3. Selhub J: Homocysteine metabolism. Annu Rev Nutr 1999;19:217–246.
  4. Schreiner PJ, Wu KK, Malinov MR, Stinson VL, Szklo M, Nieto FJ, Heiss G: Hyperhomocyst(e)inemia and hemostatic factors: The atherosclerosis risk in communities study. Ann Epidemiol 2002;12:228–236.
  5. Danesh J, Whincup P, Walker M, Lennon L: Fibrin D-dimer and coronary heart disease. Prospective study and meta-analysis. Circulation 2001;103:2323–2327.
  6. Lowe GDO, Rumley A: Use of fibrinogen and fibrin D-dimer in prediction of arterial thrombotic events. Thromb Haemost 1999;82:667–672.
  7. Moss AJ, Goldstein RE, Marder VJ, Sparks CE, Oakes D, Greenberg H, et al: Thrombogenic factors and recurrent coronary events. Circulation 1999;99:2517–2522.
  8. Lowe GDO, Yarnell JWG, Rumley A, Bainton D, Sweetnam PM: C-reactive protein, fibrin D-dimer, and incident ischemic heart disease in Speedwell study. Arterioscler Thromb Vasc Biol 2001;21:603–610.
  9. Bogdan A, Bouchareb B, Touitou Y: Ramadan fasting alters endocrine and neuroendocrine circadian patterns. Meal-time as a synchronizer in humans? Life Sci 2001;68:1607–1615.
  10. Iraki L, Bogdan A, Hakkou F, Amrani N, Abkari A, Touitou Y: Ramadan diet restrictions modify the circadian time structure in humans. A study on plasma gastrin, insulin, glucose, and calcium and on gastric pH. J Clin Endocrinol Metab 1997;82:1261–1273.
  11. Leiper JB, Molla AM, Molla AM: Effects on health of fluid restriction during fasting in Ramadan. Eur J Clin Nutr 2003;57:(suppl 2):S30–S38.

    External Resources

  12. Leiper JB, Prastowo SM: Effect of fasting during Ramadan on water turnover in men living in the tropics. J Physiol 2000;528:43P.
  13. Gerdes VE, Hovinga HA, Ten Cate H, Macgillavry MR, Leijte A, et al: Homocysteine and markers of coagulation and endothelial cell activation. J Thromb Haemost 2004;2:445–451.
  14. Homocysteine Studies Collaboration: Homocysteine and risk of ischemic heart disease and stroke. JAMA 2002;288:2015–2022.
  15. Bostom AG, Jaques PF, Nadeau MR, Williams RR, Ellison RC, Selhub J: Post-methionine load hyperhomocysteinemia in persons with normal fasting total plasma homocysteine – Initial results from the NHLBI Family Heart Study. Atherosclerosis 1995;116:147–151.
  16. Lowe GDO, Yarnell JWG, Sweetnam PM, et al: Fibrin D-dimer, tissue plasminogen activator, plasminogen activator inhibitor, and the risk of major ischaemic heart disease in the Caerphilly study. Thromb Haemost 1998;79:129–133.
  17. Cushman M, Lemaitre R, Kuller L, et al: Fibrinolytic activation markers predict myocardial infarction in the elderly: The cardiovascular health study. Thromb Vasc Biol 1999;19:493–498.
  18. Aybak M, Türkoğlu A, Şermet A, Denli O: Effect of Ramadan on platelet aggregation in healthy male subjects. Eur J Appl Physiol 1996;73:552–556.
  19. Sanders TAB, Oakley FR, Crook D, Cooper JA, Miller GJ: High intakes of trans- monounsaturated fatty acids taken for 2 weeks do not influence procoagulant and fibrinolytic risk markers for CHD in young healthy men. Br J Nutr 2003;89:767–776.
  20. Kuch B, Bobak M, Fobker M, Junker R, von Eckardstein A, Marmot M, Hense HW: Associations between homocysteine and coagulation factors – A cross-sectional study in two populations of central Europe. Thromb Res 2001;103:265–273.
  21. Klerk M, Verhoef P, Verbruggen B, Schouten EG, Blom HJ, Bos GM, der Heijer M: Effect of homocysteine reduction by B-vitamin supplementation on markers of clotting activation. Thromb Haemost 2002;88:230–235.
  22. Ridker PM, Hennekens CH, Cerkus A, et al: Plasma concentration of cross-linked fibrin degradation product (D-dimer) and the risk of future myocardial infarction among apparently healthy men. Circulation 1994;90:2236–2240.
  23. Tataru MC, Heinrich J, Junker R, et al: D-Dimers in relation to the severity of arteriosclerosis in patients with stable angina pectoris after myocardial infarction. Eur Heart J 1999;20:1493–1502.
  24. Sweetnam PM, Yarnell JWG, Lowe GDO, et al: The relative power of heat-precipitation nephelometric and clottable (Clauss) fibrinogen in the prediction of ischemic heart disease: The Caerphilly study and Speedwell studies. Br J Haematol 1998;100:582–588.
  25. Maislos M, Abou-Rabiah Y, Zuili I, Iordash S, Shany S: Gorging and plasma HDL-cholesterol – The Ramadan model. Eur J Clin Nutr 1998;52:127–130.
  26. Maislos M, Khamaysi N, Assali A, Abou-Rabiah Y, Zvili I, Shany S: Marked increase in plasma high-density-lipoprotein cholesterol after prolonged fasting during Ramadan. Am J Clin Nutr 1993;57:640–642.
  27. Grundy SM, Balady GJ, Criqui MH, Fletcher G, Greenland P, Hiratzka LF, et al: Primary prevention of coronary heart disease: Guidance from Framingham. A statement for healthcare professionals from the AHA task force on risk reduction. Circulation 1998;1876–1887.

    External Resources

  28. Onat A: Lipids, lipoproteins and apolipoproteins among Turks, and impact on coronary heart disease. Anadolu Kardiol Derg 2004;4:236–245.

    External Resources

  29. Kinosian B, Glick H, Garland G: Cholesterol and coronary heart disease: Predicting risks by levels and ratios. Ann Intern Med 1994;121:641–647.
  30. Wilson PWF, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB: Prediction of coronary heart disease using risk factor categories. Circulation 1998;97:1837–1847.

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