Updated: 3-13-2023
If you have hepatitis B and you’re considering fasting to lose weight, celebrate Ramadan or “detox” your liver, talk to your doctor first.
Fasting can lower blood sugar, reduce your energy, stress your immune system and be life-threatening for people suffering liver damage from viral hepatitis.
“Fasting for limited periods of time during the day may be safe if you have no signs of liver damage—indicated by normal liver enzymes (ALT/SGPT) or an ultrasound exam of the liver,” said Hepatitis B Foundation Medical Director Dr. Robert Gish. However, if you have cirrhosis (with ALT/SGPT levels exceeding 35 in men and 25 in women) and are taking medications to treat hepatitis B, research shows fasting may be overwhelming to your liver and may worsen liver damage.
Dr. Gish added “Diabetes and fatty liver is quite common with hepatitis B. Fasting can cause disruption in sugar balance in your body and can cause hypoglycemia and this can worsen the fatty liver condition. If you take diabetes medication, this may unbalance your blood glucose and cause dizziness and low blood pressure.”.
Is limited fasting safe? Fasting is practiced to bring people closer to their spirituality and increase empathy for those living in poverty. For Muslims, fasting is practiced during the month of Ramadan. During Ramadan, Muslims are instructed to abstain from eating and drinking from sunrise to sunset. This may account for up to 16-18 hours of continuous fasting (depending on where a person lives), for a period of 29 or 30 days (depending on the Lunar Calendar).
Islamic teachings allow pregnant persons and people with serious medical conditions to break with the tradition and eat and drink during daylight hours if their health is at risk. Rawalpindi Medical College Principal and Professor of Medicine Dr. Muhammad Umar of Pakistan explained that if hepatitis B and C patients are healthy, they can safely fast during the day. But if they are taking antiviral medications or have serious liver damage such as cirrhosis (liver scarring) or ascites (buildup of fluid in the abdomen which may cause severe pain or swelling) or liver cancer, fasting is not allowed as it may jeopardize their health.
There is little research about what impact limited fasting has on people with chronic hepatitis B. A report in the Journal of Virology that studied the effect of fasting in hepatitis B-infected transgenic mice found that fasting increased viral load and production of hepatitis B surface antigen (HBsAg). You can find the report here Other reports suggest that hepatitis B viral production in the liver is strongly influenced by a person’s nutritional intake.
If you are considering observing Ramadan, please consider that for about 30 days, there will be fasting, interrupted sleep with Iftar (breaking fast) and Suhor (meal before sunrise) and potentially more physical activities with Tarawih Prayers (additional night prayers practiced during the month of Ramadan). Please talk to your doctor and discuss the entire Ramadan experience with them, and what it means to you considering living with hepatitis B and other illnesses you may have. It might also be helpful to talk to your Imam or spiritual mentor and see what they advise.
Watch the video below to listen to an imam’s perspective on fasting while sick.
What Should You Do if You Feel Sick During Ramadan? – Mufti Abdul Wahab Waheed | Ramadan FAQ
Bottom line: Hepatitis B patients with liver damage should not fast, and “healthy” people living with chronic hepatitis B should talk to their doctors before planning to fast.
Does fasting help us lose weight and reduce the risk of “fatty liver?” No. Nearly all medical experts agree fasting is not a healthy way to lose weight. When you fast, you lose fluid quickly, and your weight comes back quickly as soon as you start drinking water and hydrating yourself again.
Many experts say fasting makes it harder to lose weight because it slows your metabolic rate, so you process food slower. While fasting during daylight hours for Ramadan may not pose a medical risk if you’re healthy, if you go for long periods without eating, your immune system weakens and isn’t able to suppress a hepatitis B infection effectively.
“A weight loss program that works should include proper nutrition, exercise and portion control,” explained Dr. Gish. He has designed a weight loss guide and contract for patients and doctors that offers guidelines for achieving healthy, long-term weight loss. Dr. Gish’s dieting recommendations include:
- Keep a diary of everything you eat;
- Exercise three hours a week;
- Eat five small meals a day (150 to 200 calories each) using teacup saucers for plates with no second servings;
- Use glass cups or bottles for drinks, instead of plastic bottles that may contain toxic bis-Phenols (BP).
Will fasting “detox” your body or liver? Most doctors say no. There is no scientific evidence that shows fasting removes toxins from the body or the liver, because our organs are already very adept at doing that very effectively.
The liver, for example, is a natural detox center as long as it gets the water and nutrients needed to perform the job. Toxins don’t build up in the liver, it’s the liver’s job to break them down and dispose of them. Toxins can build up in fatty tissue, however, which is why a sustained, long-term weight-loss plan involving exercise and a healthy, low-fat diet is recommended.