@article{3157217,
    title = "Relative Metabolic Stability, but Disrupted Circadian Cortisol Secretion
during the Fasting Month of Ramadan",
    author = "Bahijri, Suhad and Borai, Anwar and Ajabnoor, Ghada and Khaliq, Altaf and Abdul and AlQassas, Ibrahim and Al-Shehri, Dhafer and Chrousos, George",
    journal = "PLOS ONE",
    year = "2013",
    volume = "8",
    number = "4",
    publisher = "Public Library of Science",
    doi = "10.1371/journal.pone.0060917",
    abstract = "Background: Chronic feeding and sleep schedule disturbances are
stressors that exert damaging effects on the organism. Practicing
Muslims in Saudi Arabia go through strict Ramadan fasting from dawn till
sunset for one month yearly. Modern era Ramadan practices in Saudi
Arabia are associated with disturbed feeding and sleep patterns, namely
abstaining from food and water and increasing daytime sleep, and staying
awake and receiving food and water till dawn.
Hypothesis: Strict Ramadan practices in Saudi Arabia may influence
metabolism, sleep and circadian cortisol secretion.
Protocol: Young, male Ramadan practitioners were evaluated before and
two weeks into the Ramadan. Blood samples were collected at 9.00 am and
9.00 pm for measurements of metabolic parameters and cortisol. Saliva
was collected serially during the day for cortisol determinations.
Results: Ramadan practitioners had relative metabolic stability or
changes expected by the pattern of feeding. However, the cortisol
circadian rhythm was abolished and circulating insulin levels and HOMA
index were increased during this period.
Discussion: The flattening of the cortisol rhythm is typical of
conditions associated with chronic stress or endogenous hypercortisolism
and associated with insulin resistance.
Conclusions: Modern Ramadan practices in Saudi Arabia are associated
with evening hypercortisolism and increased insulin resistance. These
changes might contribute to the high prevalence of chronic
stress-related conditions, such as central obesity, hypertension,
metabolic syndrome and diabetes mellitus type 2, and their
cardiovascular sequelae observed in the Kingdom."
}