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Tailoring Lifestyle Medicine in Ethiopia: A Narrative Review on Adapting the Nutritional Pillar to the Ethiopian Context

Submitted:

25 October 2026

Posted:

26 October 2026

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Abstract
Background: Lifestyle medicine (LM) is defined as the discipline of studying how daily habits and practices impact both the prevention and treatment of disease, often in conjunction with pharmaceutical or surgical therapy, to provide an important adjunct to overall health. The pillars of LM comprise nutrition, physical activity, sleep, stress management, avoidance of harmful substances and social connections. Materials and Methods: We conducted a narrative review of the existing literature by searching for literature in PubMed and google scholar. Snowballing of references was also used to identify relevant articles from the articles that came out of the search. We included other studies evaluating Ethiopian dietary habits, staple diets, and EOTC or Islamic (Ramadan) fasting practices. Result: Ethiopian staples like teff injera exhibit low glycemic profiles, aligning with traditional practices that protect against Western-diet-induced metabolic and inflammatory risks. Adherence to Orthodox Christian and Islamic (Ramadan) fasting practices significantly improves mainly cardiometabolic markers, lowering blood pressure, optimizing lipid profiles and injury markers. In addition, these culturally and religious integrated non-pharmacological interventions consistently lower anthropometric measurements, weight, and long-term chronic disease risk profiles. Conclusions: Aligning the nutritional pillar of lifestyle medicine with Ethiopia’s traditional cuisine and religious fasting cycles offers clear health benefits.
Keywords: 
healthy lifestyle
;  
Ethiopia
;  
diet
;  
food
;  
and nutrition
;  
health policy
;  
preventive medicine
Subject: 
Public Health and Healthcare  -   Health Policy and Services

Background

Lifestyle medicine(LM) is defined as the discipline of studying how daily habits and practices impact both the prevention and treatment of disease, often in conjunction with pharmaceutical or surgical therapy, to provide an important adjunct to overall health [1]. Further, the American college of lifestyle medicine (ACLM) defines it as a medical specialty that uses therapeutic lifestyle interventions as a primary modality to treat chronic conditions including, but not limited to, cardiovascular diseases, type 2 diabetes, and obesity [2]. The field is part of modern medicine based on a wide range and large volume of evidence supporting the health benefits of daily habits and practices [3]. It is distinct from other aspects of medicine, particularly conventional medicine, in that the core principles are to use daily healthy habits to prevent, treat, and even reverse chronic diseases. Contrary to conventional medicine, where the emphasis is on medications whose benefits are condition-specific, the benefits of lifestyle are not [2]. The pillars of LM comprise nutrition, physical activity, sleep, stress management, avoidance of harmful substances and social connections [4]. This narrative review focuses on one of the 6 pillars of lifestyle medicine—nutrition.
Globally, there is strong evidence on the role of nutrition in the fight against Cardiovascular disease (CVD9, Diabetes mellitus (DM), obesity, cancer and many other medical conditions [3]. Considering this, many health professionals provide advice to their patients and the community about dietary restrictions, meal plans or nutritional recommendations. Yet barriers such as underestimating dominant food patterns, family food habits, religious practices and knowledge about the nutritional habits of the community are not considered while providing this advice [5,6,7]. Research also tends to oversee the benefits of integrating the staple diet and nutrition related religious practices of the community into their plans and rather focus on adopting western diet recommendations into local practices. This inevitably leads to high occurrence of non-communicable diseases (NCD), low treatment adherence, high costs and eventually public health crisis. Although many studies have indicated the benefit of whole grain, vegetable and fruit-based diet, and intermittent fasting, most have been conducted in western settings with varying population, dietary habits and religious practices. Therefore, the findings of these studies fail to provide comprehensive and lucid information for national decisionmakers and executers in Ethiopia’s setting. The purpose of this narrative review is to provide summary of existing literature on nutritional practices and habits underscoring the benefits of interpreting the nutritional pillar of Lifestyle within the traditional cuisine and religious fasting cycles in Ethiopia.

Materials and Methods

We conducted a narrative review of the existing literature by searching for literature in PubMed and google scholar. The articles were identified by conducting an abstract/title search with the following terms: Ethiopia AND (“Orthodox fasting” OR “Tsom” OR “Ramadan fasting” OR “religious fasting”) AND (“lipid profile” OR “metabolic syndrome” OR “body composition” OR “biomarkers” OR “weight reduction” OR “cardiometabolic” OR “diabetes” OR “blood pressure”),Ethiopia AND (“Orthodox fasting” OR “Tsom” OR “Ramadan fasting” OR “religious fasting”) AND (“lipid profile” OR “metabolic syndrome” OR “body composition” OR “biomarkers” OR “weight reduction” OR “cardiometabolic” OR “diabetes” OR “blood pressure”),Ethiopia AND “Minimum Dietary Diversity” AND micronutrient. An additional targeted search was conducted using Google Scholar to gather additional information. Snowballing of references was also used to identify relevant articles from the articles that came out of the search. We included studies that discussed effect of Ethiopian Orthodox Tewahedo Church (EOTC) and Islamic (Ramadan) fasting practices as well as Ethiopian dietary habits, staple diet and practices.

Results

Traditional Ethiopian Staples and Population Dietary Patterns

Injera is a fermented Ethiopian traditional staple food usually prepared form teff flour and consumed by almost all the Ethiopians at least once in a day [8]. The glycemic index (GI) and glycemic load (GL) of Teff Injera is very low as compared to white wheat bread and corn injera and such low-GI and/or low-GL diets are independently associated with a reduced risk of certain chronic diseases [9]. Among the twelve traditional Ethiopian foods, white teff injera, red teff injera, maize injera, barley bread, Qocho bread, Chickpeas sauce and Lentil sauce were found to have low-GI while Maize bread, wheat bread, bulla genfo, and white bread have moderate to high-GI [10].
In the 2024–25 Ethiopian Demographic and Health Survey(EDHS), the foods most commonly consumed among women age 15–49 during the day or night preceding the interview were grain-based foods (95%), followed by pulses such as beans, peas, and lentils (64%) followed by roots, tubers, and plantains and 40% consumed dark green leafy vegetables [11]. In contrast, the least consumed items were fruit juices or fruit-flavored drinks, nuts and seeds, and sodas, malt drinks, or sports and energy drinks and overall, 22% of women consumed foods from at least five of the 10 possible food groups (minimum dietary diversity) [11]. In systematic review the pooled prevalence of minimum dietary diversity among adolescent girls in Ethiopia was 43% (95% CI: 30, 56) with significant heterogeneity [12]. Regarding meat consumption, Ethiopians are one of the lowest per capita of meat consumers in the world with 8 kg, of which about 5.3 kg comes from beef [13]. But in adults aged 20 or more, red meat consumption significantly exceeds the healthy maximum limit while consumption of Fruit, legumes, nuts, vegetables and whole grains is below average [14].In addition, nearly a quarter of Ethiopians consume alcohol [15].

Religious Dietary Practices

Devout Ethiopian Orthodox Tewahedo Christians fast for about two-thirds of the year (∼250 days); characterized by skipping meal and strict vegan diet consumption [16].The Wednesday and Fridays fasting also resemble a form of intermittent fasting recently named as 5:2 which symbolizes 2 days of fasting out of the seven days in a week [17]. Among Ethiopian orthodox fasting participation is 89.42% in Elderly, 88.53% in Adults and 64.51% in adolescents [18]. During Ethiopian orthodox fasting significant decrease in body weight or body mass index (BMI), body fat, trunk fat mass has been recorded [19,20]. Similarly, an observational study documented a significant decrease in body fat composition and BMI among fasting individuals compared to non-fasting individuals suggesting better cardio-metabolic health outcomes with fasting [21]. In addition, High density lipoprotein (HDL) was significantly higher (68.29 mg/dl vs 57.24 mg/dl), while total cholesterol (181.01 mg/dl vs 173.80 mg/dl) and the mean triglyceride levels (142.76 mg/dl vs 129.39 mg/dl) were significantly lower among fasters [22]. Furthermore, fasting blood sugar was high among non-fasters compared to fasters [22] and mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) dropped by 9.19 mmHg and 9.44 mmHg respectively with the proportion of patients exceeding hypertensive thresholds falling sharply [23]. In type 2 diabetes patients, glucagon and leptin were reduced

Discussion

Currently, the shift to Western diet is widely noticeable and this transition is not without risks. Switching to a Western diet has been linked to triggering of pro-inflammatory state and promoting the development of NCDs [24]. The Western diet is a modern dietary pattern characterized by high intakes of pre-packaged foods, refined grains, red meat, processed meat, high-sugar drinks, fried foods, conventionally raised animal products, high-fat dairy products, and high-fructose product [25] and aspects of Western lifestyle can induce maladaptive trained immunity [26],which promotes the development of NCDs [27]. On neurological level, animals fed a Western-style illustrate rapid deficient in hippocampal function and poorer appetitive control [28]. These altered unfavorable physical and metabolic developments are the reason for preserving the consumption of heritage diets or incorporating indigenous and traditional foods into dietary practices as they could have a critical role in preventing and managing NCDs [24].However, Social and systemic influences portray certain foods that are closely linked to cultural identity as “unhealthy,” causing some ethnic minority subgroups to abandon traditional foods and cooking preparation methods in favor of Westernized meal patterns [29]. This nutritional transition leads to a higher incidence and prevalence of nutrition-related NCDs.
Energy restriction, time-restricted feeding, and vegetarian diet have separately been shown to be beneficial effect on health, insulin sensitivity and activities of appetite hormones [16]. Greek Christian Orthodox fasting, which spans 180–200 days annually, follows a dietary pattern high in complex carbohydrates and fiber, and low in refined carbohydrates, thereby promoting optimal health through the regulation of lipid and glucose homeostasis[30,31,32]. Adherence to Greek Orthodox fasting periods contributed to a reduction in the blood lipid profile and c-reactive protein (CRP), while increase in insulin sensitivity and in some longer duration fasting cholesterol reduction of 80% was observed [33,34,35]. In managing type 2 diabetes patients, the fasting practice should be taken to consideration as reduction of BMI, waist circumference, and glycosylated hemoglobin after fasting was also detected [36]. In addition, among type 2 diabetes patients; SBP, total cholesterol, triglycerides, fasting blood sugar and uric acid also significantly decreased [37]. While in some studies, BMI, DBP, High-density lipoprotein cholesterol (HDL-c), hip and waist circumference insignificantly differed among fasting group compared to non-fasting with lower values among fasting groups [37,38]. A different research done on overweight individuals replicated the findings where Fasting resulted in decreased body weight, waist circumference, waist-to-hip ratio, BMI and total body fat, as well as blood glucose, total cholesterol and Low-density lipoprotein cholesterol (LDL-c) levels [39]. Regarding vitamin and minerals levels of Orthodox individuals, Hemoglobin, hematocrit, iron, and ferritin levels were significantly higher after Coptic Orthodox Church (COC) fasting, although vitamin B12 and calcium levels were significantly lower and mainly attributed to reduced dietary intake of vitamin D (Vitamin D deficiency is prevalent among Greek monastic Orthodox populations) and B12 and minerals (mainly calcium), which requires further investigation [40,41,42,43]. It was also found that fasting decreased the levels of Calcium and Chloride ions while Serum sodium and potassium were influenced insignificantly [44]. Diet of fasting individuals aligned with World Cancer Research Fund Cancer recommendations in decreasing the chance of developing colorectal cancer compared non-fasting individuals [40]. Moreover, during 40 days of fasting a study indicated that the participants reduced weight while maintaining their muscle mass [45].
Ramadan is the ninth month of Islamic lunar calendar and the holy month of fasting with the common eating pattern during Ramadan month being one big meal before dawn (Sahoor) and one big meal after sunset (Iftar)[46]. Ramadan fasting was associated with a reduction in BMI, visceral fat, mid-arm circumference (MCL), Lactate Dehydrogenase (LDH) and muscle volume in both sexes but increase in blood glucose, LDL-c, and intramyocellular lipid (IMCL) with variation in sex was found [47]. The incidence of hypoglycemia during Ramadan was higher in type 2 diabetes patients on sulphonylureas and metformin, though statically insignificant [48]. A prospective study demonstrated that Ramadan fasting significantly reduces the 10-year coronary heart disease risk (based on the Framingham risk score) from 13.0 ± 8% to 10.8 ± 7%. Conversely, fasting did not significantly alter glucose homeostasis, systemic inflammation, or diastolic blood pressure[49]. A meta-analysis also showed Ramadan fasting resulted in slight improvement of overall metabolic profile and anthropometry among type 2 diabetes patients with relatively low incidence of hypoglycemia [46]. In addition, in type 2 diabetes patients, Ramadan fasting decreased adiponectin and increased leptin, Leptin-to-Adiponectin Ratio (LAR), insulin, and insulin resistance and decreased growth hormone (GH) with the exception of a slight improvement in hemoglobin A1C (HbA1c) [50]. In observational study, the metabolic scores for lung cancer, colorectal cancer, and breast cancer were lower after Ramadan [51]. Ramadan fasting was associated with reductions in liver fat and liver injury markers in adults with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), with Alanine Aminotransferase (ALT) levels fell falling by more than 20% in 70% in participants following at least 21 days of fasting [52].
In recent years, spiritual health has garnered the attention of healthcare professionals as a pivotal facet of both individual and collective existence. A study by Koenig (2020) suggested that well-being and spiritual activities enhance physiological function and prevent physical complications in disease [53]. Results of available studies suggest that Orthodox Fasting could be an alternative and an effective lipid-lowering strategy in specific populations with dyslipidemia but further steps are needed to evaluate the efficacy and safety [54]. Another study supporting religious intervention suggests that religious involvement is associated with a reduction in pro-inflammatory cytokine levels and an increase in immune functions necessary to resist infections [53].

Strength and Limitations

This is the first study to review the implementation of the lifestyle medicine pillar in an Ethiopian setting and a pioneer in introducing the concept and benefits of lifestyle medicine within Ethiopia’s context. It is the first review to address and recognize the benefit of cultural adaptation and religious fasting within the Ethiopian healthcare system. This review paves the way for actionable, practicable, and localized dietary guidelines and policy formulations. Furthermore, it opens the way for Integrative and Holistic Health Modalities, such as lifestyle medicine, culinary medicine, preventive medicine, and functional medicine. Finally, it aligns with the World Health Organization (WHO) goals of preventive medicine and sustainable diets, making it ground-breaking in bringing global health trends into the discussion within the Ethiopian health system.
The review has several limitations. Most studies included are cross-sectional in nature, thus failing to establish temporal sequence and prove Causality. Furthermore, most included studies feature small sample sizes, reducing statistical power and increasing susceptibility to outliers. Given the scarce research on religious fasting practices in the Ethiopian setting, these findings should be interpreted with caution. Religious fasting is practiced by people of all faiths, including Christianity, Islam, Buddhism, Jainism, as well as Hinduism, Judaism, and Taoism, but our review only focuses on Ethiopian orthodox religion and Islamic Ramadan fasting. As this is narrative review, No Evidence-Based Synthesis was conducted and may be prone to subjectivity and bias.
In conclusion, Lifestyle medicine is a separate discipline with its own principles in contrast to conventional medicine and requires its own training and practice. Despite the overwhelming evidence that LM practices have a profound impact on health, health professionals have been slow to respond by understanding the problem, addressing these gaps and promoting the methods. This narrative review demonstrates that aligning the nutritional pillar of LM with Ethiopia’s traditional cuisine and religious fasting cycles offers clear health benefits.

Author Contributions

Conception and design: KY. Acquisition of data: DD, YB, EA Analysis and interpretation of data: DD, RM, EA. Drafting the article or revising it critically for important intellectual content: KY DD, YB, RM. All authors approved the final version of the manuscript.

Funding

The authors received no financial support for the research, authorship, and publication of this article.

Acknowledgments

I sincerely thank Dr. Yohannes Biru for his invaluable guidance throughout this research.

Conflicts of Interest

The authors declare no conflicts of interest.

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