EDITORIAL 167Acta Medica Indonesiana - The Indonesian Journal of Internal Medicine Fasting Can Prevent Various Chronic Diseases Ari Fahrial Syam Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Corresponding Author: Ari Fahrial Syam, MD., PhD. Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital. Jl. Diponegoro 71, Jakarta 10430, Indonesia. email: ari_syam@hotmail.com. The National Social Economy survey (SUSENAS) in 2004 shows that there are increased risk factors for coronary heart disease and stroke among Indonesian people. The survey indicates that unhealthy life style is also increasing in Indonesia, which includes smoking habit, lack of physical activities, unbalanced diet, obesity, low fiber diet/less fruit and vegetables in diet, high calorie and salty diet and high-animal fat diet. Such conditions must be anticipated by all of us. Ramadhan fasting for muslims is an opportunity to fix the condition of unhealthy lifestyle.1 Why Fasting Can Snap Out the Unhealthy Lifestyle? Ramadhan fasting that has been practiced by muslims is a condition, which medically has been known as ‘Prolonged Intermittent Fasting’. Fasting is a diet management, which alter the eating habit of 3 times daily into 2 times daily with a 14-hour interval period between meals, i.e. avoid eating and drinking starting from sahur (pre-dawn meal) until iftar (the evening meal when Muslims break their daily Ramadhan fast at sunset). By reducing the diet intake, the calorie and fat intake are also reduced. The low fat intake will also lower cholesterol intake. When an individual is practicing a good fasting, his/her laboratory parameters will be improved. Total cholesterol and triglycerides level will be reduced including the bad cholesterol (LDL), which also will be reduced. The uric acid level should also be reduced; likewise for individuals with high blood glucose level, their blood glucose level will be within the normal limits. Various studies on fasting individuals have reported reduced LDL and Increased HDL levels, which obviously bring positive effects on prevention of cardiovascular diseases.2 A s t u d y w a s c o n d u c t e d i n C i p t o Mangunkusumo Hospital (RSCM) Jakarta, Indonesia in 43 healthy subjects (medical personnel) who practiced Ramadan fasting in 2013. The study included several examinations, i.e. a complete examination of body composition using special instruments (GAIA 359 PLUS (Jawon Medical, South Korea)), anthropometric examination and an analysis on daily dietary intake. The examinations were carried out on the first day of Ramadan, on the 28th day and 4-5 week after the Ramadan fasting. Study subjects were free to have their usual meal when they fast and there was no limitation for physical activity. They performed their usual professional work as doctors, nurses and nutritional experts.3 The study then reveals that apparently during the Ramadan, there was reduced weight and altered body composition except for the body protein mass. Similar result was also found for waist to hip circumference ration, which was also reduced. It is interesting that the calorie intake actually did not change on the first and last days of fasting. However, activities related to religious services were increased such as increased activities of Taraweeh and Sunnah prayers. It means that there is increased energy expenditure during Ramadan. It may result in Ari F. Syam Acta Med Indones-Indones J Intern Med 168 reduced body fat although the individual may still have the same amount of dietary intake. In fact, the dietary intake can be reduced during Ramadhan, which will certainly bring better effect on health.3 During Ramadhan fasting, a smoker actually should be able to reduce the amount of his/her cigarette consumption as smoking breaks the fast. Smokers should be able to hold themselves not to smoke for 14 hours. After breaking the fast to the time of sahur, smokers also must perform obligatory prayers, Taraweh prayers and they also need to sleep; therefore, during the fasting, it is certain that the smokers will automatically reduce the amount of cigarette they consume. When performing Ramadhan fasting, daily activities are still carried out and in fact, sleeping all day long with fasting as an excuse is not recommended, either based on medical or religious point of views. During the Ramadhan fasting, in addition to the obligatory prayers, those who exercise the Ramadhan fasting are suggested to practice additional Sunnah prayers including the Night prayers, which contain Taraweeh prayers with 11 raka’at (movements and words performed while offering prayers) or some of the prayers come with 23 raka’at. Vegetables and fruit consumption is recommended when breaking a fast. The recommended menu for breaking a fast includes fruit juice and kurma (dried date palm fruit) and it is still recommended to have vegetables intake when breaking a fast and when having a sahur. Fruits and vegetables contain high fiber, mineral, vitamin, anti-oxidant and complex carbohydrates; while nuts even contain vegetable protein. Finally, by fasting, we can manage our eating habit, reduce carbohydrate and fat consumption, reduce the amount of cigarettes for smokers, still performing activity and increase fruits and vegetables intake. The serial of these healthy activities will make our body healthy and keep away various degenerative diseases such as stroke, heart diseases and obesity. Using this rationale, it can be said that Ramadhan fasting can also improve diseases caused by lifestyles, particularly the diseases in gastroenterology such as GERD diseases. Patients with functional dyspepsia will get better during Ramadhan fasting compared to when they are not having Ramadhan fasting. Ultimately, a muslim is expected to appreciate the health lessons offered during Ramadhan months. REFERENCES 1. Sadeghirad B, Motaghipisheh, Kolahdooz F, Zahdi MJ, Haghdoost. Islamic fasting and weight loss: a systematic review and meta-analysis. Public Health Nut. 2014;17(2):396–406. 2. Azizi F. Islamic fasting and health. Ann Nutr Metab. 2010;56:273–82. 3. Syam AF, Sobur CS, Abdullah M, Makmun D. Ramadan fasting decreases body fat but not protein mass. Int J Endocrinol Metab. 2016;14(1):e29687.