Impact of Fasting on Glucose and Lipid Levels

Fasting and Medication Response

Fasting has been associated with difficulties in managing glucose and lipid levels, potentially affecting the efficacy of medications. Individuals with type 2 diabetes face these metabolic challenges along with a further complication: a reduced response to antiplatelet medications, such as aspirin.

Study Overview

To investigate the connection between fasting and its metabolic and pharmacological effects, researchers conducted a study published in PLOS One, focusing on 177 patients observing Ramadan while taking aspirin. Ramadan is a significant period of fasting and prayer for the Muslim community. The objective was to assess whether fasting influences aspirin resistance and to identify any differences in this effect among type 2 diabetic patients.

Participant Recruitment and Criteria

Participants were recruited from medical centers and screened during follow-up appointments. Inclusion criteria required participants to be over 40 years old, have at least two cardiovascular risk factors, maintain platelet levels greater than 100 x 10^6/L, not suffer from terminal illnesses or have used antidepressants recently, and if diabetic, to have their condition well-controlled.

Study Methodology

Over four years, participants underwent physical examinations and fasting blood samples were collected at three intervals: one week before Ramadan, during the final week of Ramadan, and one month after Ramadan concluded. While no dietary restrictions were set, participants filled out a questionnaire regarding their food intake two days prior to blood testing and reported on medication compliance.

Measuring Aspirin Resistance

The Verify Now System assessed platelet reactivity in Aspirin Reaction Units (ARU). Typically, aspirin inhibits platelet activation, resulting in ARU values below 550. Values exceeding 550 indicate aspirin resistance, suggesting a failure in this inhibitory function.

Findings on Aspirin Resistance

Analysis of the overall study population revealed no significant changes in ARU or aspirin resistance across the fasting periods. However, a noteworthy increase in aspirin resistance was observed specifically among diabetic patients. The rate of aspirin resistance rose from 18.1% before Ramadan to 29.9% during Ramadan, maintaining an elevated level of 26.0% after Ramadan.

Glycemic and Lipid Changes

Among all participants, blood glucose levels averaged 8.9 mmol/L prior to fasting, increased to 9.5 mmol/L during fasting, and decreased to 8.6 mmol/L afterward. Additionally, both triglycerides and HDL cholesterol levels surged during Ramadan but returned to baseline following the fasting period. Similar trends were noted in diabetic participants.

Compliance and Reporting Challenges

The study’s authors acknowledged the challenge in accurately assessing participants’ adherence to their aspirin regimens. Despite compliance questionnaires, the possibility of misreporting existed.

Conclusion

The study highlights the potential effects of glycemic and lipid management on aspirin resistance, indicating that the increase in aspirin resistance observed during Ramadan fasting is particularly relevant for individuals with type 2 diabetes.

Reference

Bouida, W., Beltaief, K., Baccouche, H., Sassi, M., Dridi, Z., Trabelsi, I.,…Nouira, S. (2018). Effects of Ramadan fasting on aspirin resistance in type 2 diabetic patients. PLoS ONE 13(3), e0192590. https://doi.org/10.1371/journal.pone.0192590