Ramadan Fasting and Cholesterol Reduction
Yes, Ramadan fasting can reduce total cholesterol and LDL cholesterol levels, with the most consistent benefit being a significant increase in HDL cholesterol and reduction in LDL cholesterol, particularly in metabolically unhealthy individuals. 1
Evidence for Lipid Profile Improvements
The most recent guideline evidence from 2025 demonstrates that time-restricted feeding during Ramadan produces significant but small reductions in total cholesterol and LDL cholesterol, with the greatest benefits observed in metabolically unhealthy participants. 1 These improvements are accompanied by:
- Reductions in serum triglycerides (ranging from 16-42% in various studies) 1, 2
- Increases in HDL cholesterol 1
- Decreased diastolic blood pressure 1
Magnitude and Consistency of Effects
Multiple guidelines and research studies confirm these lipid changes:
- Total cholesterol decreases by approximately 7.9% during Ramadan fasting 3
- LDL cholesterol shows significant reductions of 11.7% that persist even one month after Ramadan 3, 4
- HDL cholesterol increases markedly by 14.3-30%, representing the most robust and consistent finding 3, 4, 5
- Triglycerides decrease by approximately 30% during the fasting period 3
The 2021 Liver International guidelines specifically note that studies focusing on NAFLD patients found significant decreases in total cholesterol levels along with improvements in liver enzymes and hepatic fat deposition. 1
Important Caveats and Nuances
Weight Loss Dependency
The beneficial effects on lipid profiles appear most pronounced when Ramadan fasting is accompanied by weight loss (>5% body weight reduction). 1 Without caloric restriction and weight loss, the lipid improvements may be less substantial. 1
Variable Results
Not all studies show uniform benefits. One study from 2006 found that while weight decreased, LDL actually increased and HDL decreased during Ramadan, suggesting that dietary composition during non-fasting hours significantly influences outcomes. 6 This highlights that the quality of food consumed during eating windows matters as much as the fasting itself. 6
Metabolic Health Status
The American College of Cardiology notes that lipid improvements are particularly significant in metabolically unhealthy individuals (those with metabolic syndrome, obesity, or pre-existing dyslipidemia), while healthy individuals may show more modest changes. 1, 2
Clinical Recommendations
Who Benefits Most
Patients with NAFLD, metabolic syndrome, and dyslipidemia are strongly recommended to fast during Ramadan, especially when combined with dietary modifications that induce weight loss (Grade A recommendation, Level II evidence). 1
Contraindications
Despite lipid benefits, certain populations should avoid Ramadan fasting due to cardiovascular risks:
- Patients with acute coronary syndrome 1, 7, 2
- Advanced heart failure 1, 7, 2
- Recent percutaneous coronary intervention or cardiac surgery 1, 7, 2
- Severe aortic stenosis or poorly controlled arrhythmias 7, 2
Sustainability of Benefits
The lipid improvements appear to persist for at least one month after Ramadan ends, suggesting potential for longer-term cardiovascular benefit. 8, 3 However, it remains uncertain whether intermittent fasting provides more cardiovascular benefit than simple caloric restriction alone. 1, 7
Practical Considerations
The lipid-lowering effects are likely mediated through:
- Reduced meal frequency leading to improved insulin sensitivity 1
- Changes in dietary composition during eating windows (increased monounsaturated and polyunsaturated fats) 3
- Weight loss when caloric intake is restricted 1
- Favorable modification of body composition and reduced ectopic fat deposition 1, 7
The optimal eating window appears to be 8-12 hours based on cardiovascular safety data, as eating windows shorter than 8 hours are associated with higher cardiovascular mortality risk. 2