Impact of Ramadan Fasting on Medical Conditions: A Concise Narration of the Literature in 2023

Abstract Ramadan fasting (RF), the religious practice of abstaining from food and drink from dawn to sunset during the Islamic holy month, continues to generate significant research interest regarding its health implications. This narrative review synthesizes findings from 141 studies published in 2023, offering clinicians an updated perspective on the evolving evidence base. Research highlights RF's complex physiological effects, demonstrating both potential benefits and risks across various medical domains. The gut microbiome undergoes temporary alterations during fasting, with reductions in beneficial bacteria followed by post-Ramadan recovery of diversity. Cardiovascular studies reveal improved endothelial function and arterial elasticity, though they also identify delayed hospital presentations for acute coronary events. Maternal–fetal research provides reassuring data, with large-scale analyses showing no significant association between in utero RF exposure and childhood stunting or underweight. Endocrine management studies offer practical insights, showing flexibility in thyroxine timing and safe glucocorticoid adjustment protocols for adrenal insufficiency patients. Renal research demonstrates that strategic nighttime hydration can mitigate daytime dehydration effects, while neurological investigations characterize the prevalent but manageable phenomenon of caffeine-withdrawal headaches. Mental health findings present a nuanced picture, with population-level improvements in well-being contrasting with increased stress among specific subgroups like male students. Emergency department data show consistent patterns of complaints during Ramadan, without evidence of increased mortality. Specialty areas including bariatric surgery, ophthalmology, and hematology contribute valuable patient-specific considerations, while sports medicine research documents the trade-offs between fat reduction and athletic recovery in fasting athletes. The collective evidence underscores the importance of individualized, culturally competent care approaches that respect religious observance while addressing medical needs. Key clinical takeaways include the value of pre-Ramadan assessments, the feasibility of medication timing adjustments, and the need for targeted monitoring in vulnerable populations. Despite methodological limitations inherent in a single-database, nonsystematic review, this synthesis provides practitioners with actionable insights to guide patient counseling and management during Ramadan. Future research directions should prioritize long-term outcome studies, investigations in high-risk populations, and implementation science to translate evidence into clinical practice. The 2023 literature ultimately reinforces that with appropriate preparation and monitoring, most patients can safely observe Ramadan fasting while maintaining health stability.