SHAFAQNA SCIENCE- 15 medical recommendations for Ramadan fasting according to the findings of a research on “Islamic Fasting and Health” which was published in 2010 by Iranian physician, Dr Fereidoun Azizi.
Many of the world’s great religions recommend periods of fasting and, of these, the Islamic fast during the Month of Ramadan is strictly observed worldwide by millions of Muslims. Ramadan is the 9th month of the Islamic lunar calendar and fasting during Ramadan is the religious duty of all healthy adult Muslims. A whole month of intermittent fasting, from dawn to dusk, every year is particular only to Islam.
1. Fasting teaches self-discipline and self-restraint
The experience of fasting teaches Muslims self-discipline and self-restraint and enables them to empathize with those less well off, the suffering and the impoverished. During Ramadan, the majority of Muslims have two good-sized meals, one immediately after sunset and the other just before dawn. They are permitted to eat and drink just between sunset and dawn, when they begin their day of fasting until sunset.
2. Ramadan fasting disciplines the body
Ramadan fasting disciplines the body to restrain from eating food and drinking water. It also requires restraining every part of one’s physical body, the mouth and ears from gossip and profanity; all sexual thoughts and activities during fasting hours are forbidden too. Thereby, a Muslim engages his or her entire body in the physical observance of the Ramadan fast. The eyes, the ears, the tongue, and even the private parts are equally obligated to be restrained.
3. Metabolic effects of fasting
Genetic and environmental factors, such as nutrition habits and the length of fasting day may influence the metabolic effects of fasting during Ramadan. Serum cholesterol may decrease in the earlier days of fasting and subsequently rise to pre-fasting values during the following days of Ramadan. It seems that changes in blood lipids are variable and is probably dependent on the quality and quantity of food consumption and the degree of weight changes. The main recommendations for those fasting during Ramadan are avoiding weight gain and reducing the consumption of total calories and saturated fatty acids.
4. Fasting for patients with diabetes
Approximately half of the patients with type 1 and two thirds of the patients with type 2 diabetes observe Islamic fasting in Muslim countries. Most of the studies on Islamic fasting show that patients with type 2 and even well-controlled type 1 diabetes are encountered with no major problems during Ramadan fasting. Small decreases in daily energy intake, accompanied by around 2 kg weight loss, induce a decrease in FPG and increase insulin sensitivity in subjects with metabolic syndrome.
5. Fasting for patients with valvular problems
Assessment of abdominal fat distribution via computed sonography showed no change in males but a reduction was seen in the visceral fat component in females and younger individuals, probably because of fat redistribution associated with more physical activity. There seems to be no contraindications to fasting for patients with valvular problems or subjects with mild coronary artery disease.
6. Fasting for patients with respiratory problems
It has been demonstrated that fasting in Ramadan does not exert any significant effect on pulmonary volume functions and spirometry values in healthy individuals. However, dehydration and dryness of the respiratory tract mucosa may worsen bronchoconstriction in asthmatic patients. Asthmatic patients whose disease is stable are permitted to fast while using inhalers, slow release drugs, and suppositories. The majority of patients with clinically symptomatic chronic lung disease or asthma, however, should be advised against fasting in Ramadan.
7. Fasting for patients with intestinal disorders
Fasting may benefit patients with spastic colitis and other intestinal motility disorders. Ramadan fasting is harmless to the liver in normal subjects. Those with clinically apparent hepatitis and cirrhosis should not fast.
8. Fasting for patients with kidney disease
Patients with chronic kidney disease should be advised against fasting. They must be advised about the potential risk of hyperkalaemia and if they still insist on fasting, their renal function and electrolytes should be controlled, and should any deterioration occur, they must break their fast. Stable renal transplant patients may be allowed to fast under observation of a specialist.
9. Changes in serum urea and creatinine during Ramadan fasting
Urinary volume, osmolality, pH, nitrogen, solute and electrolyte excretion remain normal with maybe small, insignificant changes in serum urea and creatinine during Ramadan fasting. There is no significant change in intraocular pressure during Islamic fasting. Chronotype as evaluated by the Horn and Ostberg scale was changed significantly during Ramadan with an increase in the evening type and a decrease in the morning type of subjects.
10. Headaches during fasting
Headaches were reported by 41% in fasting as compared to 8% of non-fasting subjects, with the tension type reported in 78% of the cases. Any increase in the hours of daily fasting, especially in those prone to headaches, increased headache frequency. The most important exogenous-associated factor was caffeine withdrawal.
11. Weight losses during Ramadan
Weight losses of 1.7, 1.8, 2.0, 3.8 kg and more after fasting the month of Ramadan have been reported in normal weight individuals. It has also been reported that overweight persons lose more weight than normal or underweight subjects; another study, however, reported an increase in body weight due to more consumption of sweets and total calories.
12. Fasting for pregnant women
Pregnant women should be advised against fasting except for those who are well nourished, do not have emesis, and have an appropriate diet. Lactating mothers should not fast.
13. Fasting and drug taking
Adherence to and frequencies of drug taking appear to be uncompromised in various patients during Ramadan fasting, although there have been some reports to the contrary. Parenteral administration (intravenous or intramuscular) of certain necessary medications or the use of suppositories and inhalers are allowed by some scholars during fasting. However, taking of oral medications is not allowed and, if there is no other alternative route for medications, the patient is exempt from fasting.
14. Ramadan fasting is safe for all healthy individuals
During the fasting days of Ramadan, glucose homeostasis is maintained by meals taken before dawn and by liver glycogen stores. Changes in serum lipids are variable and depend on the quality and quantity of food consumption and changes in weight. There are no adverse effects of Ramadan fasting on the heart, lung, liver, kidney, eyes, hematologic profile, endocrine and neuropsychiatric functions. Although Ramadan fasting is safe for all healthy individuals, those with various diseases should consult their physicians and follow scientific recommendations.
15. Patients who must avoid fasting
Physicians should make every attempt to prescribe long-acting or slow-release drugs once or twice at night, and allow the patient to observe fasting. Patients who must take their medications more than twice in 24 h should avoid fasting.
Source: Azizi, F. (2010) Islamic Fasting and Health, Annals of Nutrition & Metabolism, 273–282