Hep B Blog

Is Fasting Safe for People Living with Hepatitis B?

Courtesy of Pixabay.
Courtesy of Pixabay.

By Christine Kukka

If you have hepatitis B  and you’re considering fasting to lose weight, celebrate Ramadan or “detox” your liver, think again and talk to your doctor first.

Fasting can lower blood sugar, zap your energy, stress your immune system and be life-threatening for people suffering liver damage from viral hepatitis.

“Fasting for very limited periods of time 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 liver damage (with ALT/SGPT levels exceeding 35 in men and 25 in women) and are taking medications to treat hepatitis B, research shows fasting may exacerbate liver damage.

Is limited fasting safe? Culturally, fasting is practiced to bring people closer to their spirituality and increase empathy for those living in poverty. For Muslims, fasting is practiced during Ramadan (beginning May 26 and ending June 25). During Ramadan, Muslims are instructed to abstain from eating and drinking from sunrise to sunset.

Image courtesy of Prakairoj at FreeDigitalPhotos.net.
Image courtesy of Prakairoj at FreeDigitalPhotos.net.

Historically, Islamic teachings allow pregnant women and people with serious medical conditions to break with 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 (distention of abdomen due to the accumulation of fluid in the peritoneal cavity) or liver cancer, fasting is not allowed.

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). Other reports suggest that hepatitis B viral production in the liver is strongly influenced by a person’s nutritional intake.

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 embarking on any kind of fasting program.

Courtesy of Pixabay.
Courtesy of Pixabay.

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 tea cup saucers for plates with no second servings;
  • And, 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 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.

Comments on this blog are closed. If you have questions about hepatitis B or this blog post, please email info@hepb.org or call 215-489-4900.

10 thoughts on “Is Fasting Safe for People Living with Hepatitis B?”

    1. Hello: Based on the doctors’ recommendations, you should not fast if you are taking treatment for liver damage. Please talk to your doctor and review your health, ALT levels (liver damage risk) and viral load. Good luck.

  1. Hi..Im male, 39 YO. last years Ramadan i wsnt prescribed LAM 150gm. This years i hv bn on it for 14 months now. Baseline: F3-11.4kPA Fibroscan. ALT: 22.HbEag (-). VL: 2,996 iU/ML.

    My 1-year HBV DNA VL result hs not out yet ever since i take LAM 150gm a year ago to detect resistance/breakthru.

    Can i fast?


    1. Hello: According to the doctors quoted in the blog, if you have had liver damage and are now on treatment, you probably should not fast. I know your liver is healthy now because of the treatment, but when you take medication, it is important to stay hydrated especially.
      One last note, you probably know this, but the antiviral lamivudine (LAM) is no longer recommended for hepatitis B treatment because it causes a high rate of drug resistance. Experts recommend either tenofovir (Viread) or entecavir.
      You may want to review the World Health Organization’s hepatitis B treatment guidelines with your doctor at: http://www.who.int/hiv/pub/hepatitis/hepatitis-b-guidelines/en/
      Good luck.

  2. hai my name is Amanullah Khan and i m the patient of HBV since 2013 and taking antiviral medicine (Viread). i have one question that being patient of HBV and taking medicine regularly can i observe fast during the holy month of Ramzan. If not then according to medical point of view what are side effect of fast.

    1. Hello: The doctors quoted in the article recommend that people who have experienced liver damage and are currently being treated do not fast. They indicated your body needs the nutrients and liquids in order to protect your liver. Good luck.

  3. I have been under treatment of chronic hapatitis b for 3 years now and I have been taking viread and I done the previous Ramadan without any problems.can I continue doing it this year I’m still taking viread .

    1. Hello: The doctors quoted in the article would caution you against fasting during daylight hours because you are under treatment. Please talk to your doctor about this to see what their opinion is. Good luck.

  4. I’m very worried because I was diagnosed with hepatitis B here is the result as follow please Doctor tell me which type of hepatitis I have..
    S\p(ALT)…..36…U/L <41
    S/P-GAMMA GT(GGT)…17..UI/L…8-61
    haven't been placed on a treatment at the moment because I am one of these Asylum seekers in Italy.
    I'm really confused I don't what to do..

    1. Hello: I am sorry you have tested positive for hepatitis B, but based on your liver enzyme test (ALT) you are not experiencing liver damage and probably do not require treatment at this time.
      When liver cells are damaged, they release the enzyme ALT into the bloodstream. Healthy ALT levels range up to 40 in men and 19 in women.
      Please try to eat healthy foods, and avoid alcohol and cigarettes to take care of your liver.
      In about six months, get tested again to find out if you have chronic or acute hepatitis B. When healthy adults are infected, it takes about six months for their immune systems to clear the virus. However, if you were infected at birth or during early childhood, a hepatitis B infection becomes chronic and can last many years. Infants and young children’s immune systems don’t fight the infection, so it becomes a long-term infection.
      Good luck to you, I know your life is not easy. Our thoughts are with you.

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