Ramadhan & Health
by Shahid Athar

Most Muslims do not fast because of medical benefits but because it has been ordained to them in
the Quran. The medical benefits of fasting are as a result of fasting. Fasting in general has been used
in medicine for medical reasons including weight management, for rest of the digestive tract and for
lowering lipids. There are many adverse effects of total fasting as well as so-called crash diets.
Islamic fasting is different from such diet plans because in Ramadan fasting, there is no malnutrition or
inadequate calorie intake. The caloric intake of Muslims during Ramadan is at or slightly below the
national requirement guidelines. In addition, the fasting in Ramadan is voluntarily taken and is not a
prescribed imposition from the physician.

Ramadan is a month of self-regulation and self-training, with the hope that this training will last
beyond the end of Ramadan. If the lessons learned during Ramadan, whether in terms of dietary
intake or righteousness, are carried on after Ramadan, it is beneficial for one's entire life. Moreover,
the type of food taken during Ramadan does not have any selective criteria of crash diets such as
those which are protein only or fruit only type diets. Everything that is permissible is taken in
moderate quantities.

The only difference between Ramadan and total fasting is the timing of the food; during Ramadan,
we basically miss lunch and take an early breakfast and do not eat until dusk. Abstinence from
water during this period is not bad at all and in fact, it causes concentration of all fluids within the
body, producing slight dehydration. The body has its own water conservation mechanism; in fact, it
has been shown that slight dehydration and water conservation, at least in plant life, improve their
longevity.

The physiological effect of fasting includes lower of blood sugar, lowering of cholesterol and
lowering of the systolic blood pressure. In fact, Ramadan fasting would be an ideal recommendation
for treatment of mild to moderate, stable, non-insulin diabetes, obesity and essential hypertension. In
1994 the first International Congress on "Health and Ramadan", held in Casablanca, entered 50
research papers from all over the world, from Muslim and non-Muslim researchers who have done
extensive studies on the medical ethics of fasting. While improvement in many medical conditions
was noted; however, in no way did fasting worsen any patients' health or baseline medical condition.
On the other hand, patients who are suffering from severe diseases, whether diabetes or coronary
artery disease, kidney stones, etc., are exempt from fasting and should not try to fast.

There are psychological effects of fasting as well. There is a peace and tranquility for those who fast
during the month of Ramadan. Personal hostility is at a minimum, and the crime rate decreases. This
psychological improvement could be related to better stabilization of blood glucose during fasting as
hypoglycemia after eating, aggravates behavior changes.

Recitation of the Quran not only produces a tranquility of heart and mind, but improves the memory.
Therefore, I encourage my Muslim patients to fast in the month of Ramadan, but they must do it
under medical supervision. Healthy adult Muslims should not fear becoming weak by fasting, but
instead it should improve their health and stamina.


DIABETES MELLITUS AND RAMADAN FASTING

Diabetes mellitus affects people of all faiths. Muslims are no exception. Many diabetic Muslims have
a desire to fast during the month of Ramadan, although if they cannot for health reasons, they have a
valid exemption. The dilemma for physicians and Muslim scholars is whether or not Muslim diabetic
patients (1) should be allowed to fast if they decide to; (2) can fast safely; (3) can be helped to fast if
they decide to; (4 ) can have their disease monitored at home; and (5) are going to derive any benefit
or harm to their health. Fasting during Ramadan by a Muslim diabetic patient is neither his right nor
Islamic obligation, but only a privilege to be allowed by his physician, at the patient's request,
knowing all the dangers and assuming full responsibility in dietary compliance and glucose
monitoring, with good communication between the physician and the patient .

PSYCHOLOGICAL STATE OF DIABETES DURING RAMADAN

Diabetes mellitus itself adversely affects patients' psychological states by changes in glucose
metabolism, blood and CSF osmolality, needs for discipline and compliance, fear of long term
complications and threat of hypoglycemic attacks and the possibility of dehydration and coma.

On the other hand, fasting during Ramadan has a tranquilizing effect on the mind, producing inner
peace and decrease in anger and hostility. Fasting Muslims realize that manifestations of anger may
take away the blessings of fasting or even nullify them.

Diabetics know that stress increases the blood glucose by increasing the catecholamine level and any
tool to lower the stress ; ie., biofeedback or relaxation improves diabetic control. Thus, Islamic
fasting during Ramadan should have a potentially beneficial effect with regard to dia- betic control.

EDUCATIONAL PROGRAM FOR DIABETICS DURING RAMADAN

It should be directed toward (a) diabetic home management; (b) preparing them for Ramadan; (c)
recognizing warning symptoms of dehydration, hypoglycemia and other possible complications.

Patients should be taught home glucose monitoring, checking urine for acetone, doing daily weights,
calorie-controlled diabetic diet, need for sleep and normal exercise. They should be able to take
pulse, temperature, look for skin infection and notice changes in the sensorium ( mental alertness ) .
They should be on special alert for any colicky pain, a sign for renal colic, or hyperventilation, a sign
of dehydration, and to be able to seek medical help quickly rather than wait for the next day.

CRITERIA ALLOWING DIABETICS TO FAST DURING RAMADAN

a. All male diabetics over age 20.
b. All female diabetics over age 20 if not pregnant or nursing.
c. Body weight normal or above ideal body weight.
d . Absence of infection, co-existing unstable medical conditions, ie,

coronary artery disease, severe hypertension (B/P 200/120), kidney stones, COPD or emphysema.

TABLE 1
1500 CALORIE AND DIET MENU FOR RAMADAN
FOOD EXCHANGES
PRE-DAWN BREAKFAST
American
Pakistani
Middle Eastern
Fruit 1
1/2 c Orange Juice
1/2 Grapefruit
1/2 Grapefruit
Starch 3
1/2 c Oatmeal1
English Muffin
1 Pit Bread
1/2 Potato Bhujia a
1 Pita Bread
1/3 c Fool Midammis
Meat 2
1 Boiled Egg
1/4 c Cottage Cheese
2 egg Omelet
1 oz Feta Cheese
1 Boiled Egg
Fat 1
1 tsp Margarine
1 tsp Olive Oil
1 tsp. Olive Oil
And 2 Black Olives
Skim Milk 1
1c Skim Milk
1 c Skim Milk
1 c Laban
Free Foods
2 tsp Sugar Free Jam
Coffee
Tea
Tea




POST-SUNSET ENDING THE FAST
Fruit 1
2 large Dates
2 large Dates
2 large Dates
Starch 1
6 sm Vanilla Wafers
1/3 c Chana Chaat
1/3 c Salatet Hummus
Skim Milk 1
1 c Skim Milk
1 c Lassi
1 c Rabat


DINNER
Meat 3
3 oz Roast Beef
3 oz Bhuna Gosht
3 oz Tikka Kebab
Starch 2
1 sm Baked Potato
1 Dinner Roll
1/3 c Daal
1 Chapati
1/3 c Lentil Soup
1 Pita Bread
Vegetable 2
1 c Tossed Salad
(carrot, cucumber,
tomato, radish) 1/2 c
Steamed
1 c Sliced Raw Vegetables

(tomato, cucumber, onion)

1/2 c Bhindi Bhujia
Cauliflower in Tomato
Broccoli Sauce
1/2 c Tomato and Onion
(cooked with Tikka
Kebab)
1/2 c Cooked
Fat 1
2 tsp Sour Cream
1 tsp Oil used in cooking
1 tsp Oil (used in
cooking)
Fruit 1
1 Fresh Apple
15 sm Grapes 1
Fresh Apple
Free Foods
Lettuce (for salad) -as
desired
2 Thl Reduced Calorie
Dressing
C coffee
Tea
Tea


BEDTIME SNACK
Fruit/Starch
3 Graham Cracker
1/2 Mango
2 Tangerines
Skim Milk 1
1 c Skim Milk
1 c Skim Milk
1 c Laban