Ramadan and Health
by Abdul A. Samra. MD. PhD. Chief of Division of Endocrinology. Diabetes and Metabolic Diseases, Wayne State University and Detroit Medical Center
Allah says: “whoever is sick or on a journey may break his/her fast and make up fasting on others days and that Allah wants ease not hardship for us” (Chapter 2:185). Thus fasting of Ramadan is an obligation upon the healthy individual who is not traveling. For others fasting can be “prohibited”, “optional” or “obligatory” depending on the health condition of the person.
Fasting is “prohibited” if there is a risk to the individual, such as an elderly affected by chronic illness requiring multiple medications during the day. Such a person must not fast. Instead, he/she should feed a needy person for each day of Ramadan, if he can afford it.
Fasting is optional for somebody who is generally healthy but who develops a acute illness, such as flu or headache. The individual may fast if he/she can endure it. Alternatively he/she may not fast and make up the missed days after Ramadan.
Fasting is “obligatory” on a person whose illness benefits from fasting, such as type 2 diabetes treated by lifestyle modification “exercise and diet”.
The following recommendations can be used as guidelines. However, a person who is not healthy should seek his/her doctor advice regarding fasting in Ramadan.
Meals, Food and Physical Activity
Have two meals daily with enough fluids particularly at Suhoor. Remember that the early morning meal, Suhoor, is a “Sunnah”. Having Suhoor is essential to maintain fluid balance, especially during the hot weather of August. Avoid excess spices and fried foods. Avoid overeating at diner “Iftar”. If you do not lose weight in Ramadan then you are “overeating”. Have moderate physical activity followed by 30 min rest (relaxation) in the afternoon.
Fasting during Pregnancy and Nursing
A pregnant woman may chose to fast in Ramadan if she feels strong and healthy enough to fast, especially during the early part of the pregnancy. It is recommended that she does not fast during the last few months of pregnancy because the fetus requires a lot of nutrition at that time. It is also recommended that she does not fast in early pregnancy if she develops nausea and vomiting. A nursing mother should not fast since she risks her health and the health of her baby.
Fasting of Children
Fasting under the age of seven isn't advisable. Children may be trained to fast ½ or ¾ of day, etc. Fasting of children is tolerated differently depending on the child’s general health, nutrition and attitude, therefore, children should be treated differently based on their general health and body built.
Fasting of Elderly
An elderly with good health may fast and benefit from fasting. However, an elderly with underweight or with a chronic illness should not fast in Ramadan. Elderly who are not generally healthy should discuss with their physician before they attempt fasting.
Fasting and Medications:
Taking tablets breaks the fast. However, most patients can take their oral medications at “Suhoor” and “Iftar” times. Individuals who feel strong to fast and who are on multiple medications during the day should consult their physician for changing the timing of medication. Many scholar consider that intravenous infusions breaks the fast whereas all other forms of medications that are not taken orally (subcutaneous and intramuscular injections, inhalers, patches, ointment, ear drops and eye drops) do not break the fast, as they are not food and drink.
Fasting and Diabetes
Diabetics treated by lifestyle modification or by medications that do not cause hypoglycemia (very low blood glucose) may benefit from fasting and therefore should fast. Diabetics on oral medications that cause hypoglycemia or on insulin injections should not fast until they consult with their physician. Any diabetic who decide to fast Ramadan shall check glucose level whenever he/she feels symptoms of hypoglycemia and shall break fast if glucose level is below 70, such a person shall not fast next day unless a physician is consulted for adjustment of his/her medication dose or timing.
Fasting and Smoking
Smoking is wasteful and seriously bad for health. Ramadan is a great opportunity to change many unhealthy habits, and smoking is definitely one of them.
Fasting and Dehydration
Poor hydration can be made worse by weather conditions, and even everyday activities like walking to walk or housework. If you feel disorientated and confused, or faint due to dehydration, you must stop fasting and have a drink of water or other fluid. Islam doesn't require you harm yourself in fulfilling the fast. If a fast is broken, it will need to be compensated for by fasting at a later date.
Fasting and Kidney Diseas
People who have a history or recurrent kidney stones become at increased risk for stone recurrence during fasting due to dehydration and should not fast. People with advanced kidney disease or on dialysis should not fast.
Fasting and Peptic Ulcers, Heart Burn, Gastritis And Hiatus Hernia
Increased acid levels in the empty stomach in Ramadan aggravate the above conditions. Avoid spicy foods, coffee, and Cola. Consult your physician for preventive therapy.
Fasting and Other Chronic Disease
People with stable chronic diseases (heart, lung, liver, etc.) may fast; they should consult their physicians for the potential risk. Generally, people requiring multiple oral medications during the day should not fast.