The effect of Ramadan fasting and Melatonin supplementation on Sleep quality, Melatonin and Growth hormone to Cortisol Ratio in male athletes Ali Rostamdokht1, Mahdi Ghahremani Moghaddam1*, Russel J Reiter2, Nahid Bijeh1 1Department of exercise Physiology, faculty of sport sciences, Ferdowsi university of Mashhad, Mashhad, Iran. 2Department of Cellular and Structural Biology, UT Health San Antonio, San Antonio, TX, USA *corresponding author: Mahdi Ghahremani Moghaddam. Email: m.ghahremani@um.ac.ir, Mobile number: +989155571102, Telephone: +985138832568, +985138805420. Fax: +985138829580. Abstract Background: Food habits and wake-sleep cycle regulated by circadian rhythms. Ramadan fasting (RF) changes food habits and wake-sleep cycle in fasted people and causes imbalanced circadian rhythm. Melatonin hormone increase sleep quality and daily awareness. No available data were found about Ramadan fasting and Melatonin supplementation on Sleep quality, Melatonin and Growth hormone to Cortisol Ratio. Also, because of lunar calendar, month of Ramadan takes place in different seasons, each year the Ramadan month occurs 11 days earlier, which have different fasting time and day light. Although, about 1.5 Billion Muslims lives that more than 500 thousands of them fast in Ramadan [1]. So, it is important to study and improve their sleep quality and finally health. Therefore, the purpose of this study is the effect of four weeks Ramadan fasting and Melatonin supplementation (MS) on Sleep quality, Melatonin levels and Growth hormone to Cortisol Ratio in male athletes. Materials and Methods: Thirty active males (20-25 years) were divided into supplement (15) and placebo (15) groups. Fat percentage and Hormones (melatonin, growth hormone, cortisol and growth hormone-cortisol ratio) was evaluated in three bouts: (1) before-month (2) middle of the month (3) after-month. Blood samples collected three times; before sleep (11 pm), wake up time for Sahari (3 am) and morning wake up time (7 am). The study was conducted during a week before of Ramadan, which was used as a baseline period (BL), during the second (R2) and last (LR) weeks of Ramadan 1437 Hijri (corresponding to the period from June 7, 2016 to July 7, 2016). To ensure that the participants had regular sleep patterns, they were asked to maintain sleep diaries for two weeks prior to the study. Fasting time for the participants was from before sunshine to sunset during Ramadan. During Ramadan, participants received 3 mg Melatonin capsule or matching placebo (cellulose) was taken orally 1 hr before bedtime each night for month of Ramadan. Three days before blood samplings the participants (both groups) controlled and had the same diet and sleep plan. Before starting the study, each participant was asked to IPAQ, PAR-Q, PSQI (Pittsburgh sleep quality index). Fat percentage measured by caliper (four point way) and calculated by Siri’s formula. Before the beginning of the study, a familiarization meeting was held for the subjects. Subjects did not have any illness that fasting would exacerbate it, and all had good sleep quality. They were also asked to avoid smoking, caffeine, tryptophan and folate during the study. To investigate the intervention effect of supplement and sleep condition on dependent variable used by Repeated Measure (factorial 3*3*2) and bonferroni post hoc tests. Results: The findings of this study indicate that after one month of melatonin supplementation, serum levels of melatonin significantly increased at the beginning of the night in the supplement group compared with placebo (245.5% in the middle of the month compared to the previous month and 261% at the end of the month Compared to the previous month). Also, midnight, which is the peak in melatonin secretion, the supplementation group significantly increased the proportion of the placebo group (846% in the middle of the month compared with the previous one and 736.5% at the end of the month compared to the previous month), which increased the depth of sleep. Also, at the beginning of the morning, serum levels of melatonin in the supplement and placebo group decreased by 1.2% and 11.9% respectively, indicating a daily increase in consciousness. During the month of Ramadan, the peak nightly secretion of melatonin is lower than before Ramadan, which may be due to exposure to artificial light for a longer period during Ramadan. It is indicated that, melatonin reduces the delay in starting sleep, increases the overall sleep time and improves overall sleep quality [2]. Results about GH showed more GH levels in melatonin supplemented group. An important point of the study\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\'s finding is that the growth hormone coincides with the increase in melatonin, and it shows the important role of melatonin in stimulating the growth hormone secretion. The findings of the present study indicate that, serum cortisol levels decreased at baseline in the supplement group compared to the placebo group (7% in the middle of the month compared with the beginning of the month and 17.3% at the end of the month compared to the beginning of the month), which reduces consciousness and improves sleep status. Also, midnight cortisol was at its lowest level, and the supplementation group significantly decreased the proportion of placebo group (22.3% at the end of the month compared to the middle and 4.3% at the end of the month compared to the previous month). Results showed positive GH/Cortisol levels in melatonin supplemented group. Many anabolic hormones, such as melatonin and GH, are secreted during sleep, and the rate of secretion of catabolic hormones such as cortisol increases during awakening. conclusion: The hormone melatonin itself stimulates the secretion of the growth hormone [3], and the peak time of secretion of both hormones is also close, that is, they reach the peak at the same time as entering the deep sleep stage [4, 5]. Melatonin increases the release and expression of the GH gene, a response completely blocked by Somatostatin. An imbalance in quality or quantity of sleep causes a collapse in the secretion of total anabolic and catabolic hormones [6, 7]. According to research results, supplementing melatonin with improved anabolic condition and regulated wake-sleep cycle can help Ramadan fasting condition and prevent to decrease performance followed to Ramadan fasting. Finally, this study demonstrates Melatonin supplementation can have several benefits during Ramadan. 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