Ramadan 12th April to 12th May 2021
All able-bodied Muslims are expected to fast during the month of Ramadan from dawn until dusk. This is complete abstinence from food, drink and sexual relations. There are a number of exemptions to this, and in such cases the individual will either make up a fast at a later date, or give a fixed sum to charity (fidyah). Fasting is both a physical and spiritual exercise, patients learn to manage eating habits, improve self-control and discipline and appreciate what they have compared to those less fortunate.
A light meal is eaten before sunrise (Sohour) before the start of the fasting period. After the fasting period a large meal, often with extra savoury and sweet foods (Iftar) is taken.
IS FASTING HEALTHY?
The changes that occur in the body as a response to fasting depend on the length of the fast. It takes 8 hours for the body to technically enter a fasting state once we have finished absorbing nutrients from the last meal. In the normal state glucose stored in the liver and the muscles is the main source of energy. During a fast this store of glucose is used first, and then fat becomes the next source of energy. It is only with a prolonged fast of many days/weeks that the body would start to break down protein from muscle for energy, and this is classified as starvation and clearly unhealthy.
During Ramadan there is plenty of opportunity to replenish energy stores at the pre-dawn and dusk meals and a balanced diet with plenty of fluids is essential. If this is adhered to, there is no evidence that fasting is unhealthy (in fit individuals), and many studies have shown there to be health benefits e.g. weight loss, reduction of cholesterol, better control of blood pressure and increased levels of endorphins resulting in a feeling of improved mood.
- Those suffering from illness
- The frail and elderly
- Those who are travelling
- Women during menstruation or who are bleeding post-partum
- If it is felt that fasting would have an adverse effect on their health
- Pregnant or breastfeeding women
- Children below the age of puberty
Medication and health issues during Ramadan
For some patents, including those with poorly controlled diabetes, pregnancy, kidney or heart disease fasting is not recommended or additional monitoring may be required. For patients who are concerned about their health at this time it is recommended that you speak to your Doctor before commencing the fast. In some instances it may not be advisable to fast or a change in medication may be recommended.
POTENTIAL HEALTH COMPLICATIONS:
- Indigestion – fasting usually reduces the amount of acid in the stomach, however if a patient suffers with this then those on regular antacids are advised to continue to take these at the pre-dawn meal. Dietary changes may also help e.g. eat in moderation, avoid spicy/oily food, reduce caffeine intake and stop smoking.
- Dehydration – This is a common problem and patients are advised to drink plenty of water during the non-fasting period. If a person feels disorientated, confused or faint they should stop fasting and rehydrate, and make up their fast at a later date.
- Headache – This is a common problem with many possible causes e.g. dehydration, hunger, inadequate rest, absence of caffeine or nicotine. Dietary advice should be given including consuming adequate quantities of fluid. If patients suffer with severe migraines these should be controlled before they start fasting, and if any point during a fast a patient feels unwell/dizzy/disorientated etc. they should break their fast.
- Constipation – This is often exacerbated by dehydration and advice should be given regarding this, including dietary advice on fruit and vegetables, increasing the fibre content of food, being active etc. If the problem persists a short course of bulk laxatives may be prescribed.
- Pregnancy– It is not compulsory to fast when pregnant and there is evidence that this is not advisable. If a patient is determined to fast in the early part of pregnancy she may do so, but it has been made very clear in Islamic law she does not have to do this, and can make up these fasts at a later date.
- Children – According to Islamic law children are required to fast from puberty, but the above exemptions should be reviewed according to each individual child. Fasting prior to the age of 7-8 years is not advisable.
- Hypertension – Those with severe hypertension or heart disease are advised not to fast. Those with well controlled hypertension may fast but their medication regime may need to be adjusted so that they can divide their medications before the pre-dawn meal and the after the sunset meal, and they should consult their Doctor regarding this. They should be advised to stop their fast if they become unwell during this period.
Guidance for Patients with Diabetes
Patients with diet controlled diabetes may fast, however those insulin are advised not to. Patients who fast should try to eat a healthy balanced diet at all times outside of the fasting period.
The Pre-dawn meal (Sohour) should be taken as close to the start of the fast as possible. In general eat a normal balanced, healthy diet however also include foods rich in complex carbohydrates as they are digested over a number of hours (wheat, semolina, beans and rice).
It is important to ensure you eat at Sohour and not to miss any meals.
At the Break of Fast (Iftar) patients with diabetes who fast should avoid eating large amounts of food at the break of the fast. Instead, patients with diabetes should take two or three smaller meals in the non-fasting period.
Also try to include foods which are high in fibre such as wholegrain cereals, granary bread, brown rice, beans and pulses, fruits, vegetables and salads.
It is best to minimise foods which are high in saturated fat (such as ghee, samosa and pakoras) and to only use a small amount of mono unsaturated oils (such as rapeseed or olive oil).
It is important not to attempt any self-reduction or omission of treatment, and if you are on any medication of any kind that you consultant with your Doctor. If you are diabetic regularly monitor your blood glucose during the fast.
If you already undertake light and moderate exercise then it is safe to continue with this during the fasting period, however rigorous exercise is not recommended for patients with medical issues.
FREQUENTLY ASKED QUESTIONS BY PATIENT’S:
Can I use an inhaler during fasting?
There is mixed opinion on this, some scholars say that the use of inhalers will invalidate the fast and this must be made up later, other scholars state that this is permissible as it is not eating or drinking, or providing nutrition. If a patient requires their inhalers often and are unwell, they would be exempt from fasting anyway. It may be possible to change the inhalers to longer acting varieties if a patient does not wish to use their inhaler whilst fasting. If the patient wishes to get further advice they should contact their local mosque.
Can I swim whilst fasting?
Yes, but avoid swallowing the water.
Can I have a blood test?
Yes, this does not invalidate the fast.
Can I have a blood transfusion whilst fasting?
No, in this case the patient would be considered too unwell to fast.
Can I fast if I am on antibiotics?
If the patient is unwell and requires antibiotics regularly throughout the day then they would be exempt from fasting, and should make up their fasts at a later date when well. If the antibiotics are for e.g. acne they may fast and take their antibiotics either before the pre-dawn meal or after the sunset meal. Again the individual should consult with their Doctor before any medication change.
Do breastfeeding women have to fast?
No, Islamic law exempts women from fasting whilst breastfeeding and they can make these up at a later date.
Can I smoke during fasting?
No, smoking is not permitted. Ramadan is an excellent time to help patients give up smoking and support should be offered at this time. Note that most scholars agree that nicotine patches are not permissible during fasting.
Can I take tablets, drops, injections or patches whilst fasting?
There are varying opinions around the taking of medication, tablets, patches etc so it is advised that individuals should consult with their local mosque. Tablets generally will invalidate the fast; whereas injections, patches and eye drops are allowed. Nose and ear drops or sprays are not allowed but sublingual tablets for angina are permissible. Insulin is also permissible. As stated it is best to consult with your local mosque.
Can I fast whilst having dialysis?
Such patients are not advised to fast, and in these cases as they will not be able to fast at a later date, Islamic law states they must give to charity instead, and should consult an Islamic scholar for further advice.
Do nose bleeds invalidate a fast?
No, and if this happens patients do not have to make any fasts up. The fast can only become invalid if such a large amount of bleeding occurs and the patient swallows it.
Can I use mouthwash/gargles
Yes provided nothing is swallowed, it is advisable to rinse the mouth with water following use of these, and to avoid if possible.
Can I have immunisations?
Yes, childhood immunisations and vaccines for travel do not invalidate a fast.
Can I use creams and ointments?
Yes, anything where the medication is absorbed through the skin is permissible.
The London General practice provides General Medical Services to individuals and families.
Our Harley Street Practice is open Monday to Friday, 8:30am to 6:00pm and outside of these hours we operate a 24/7 on-call service which include home visits.
To contact the Practice day or night call 020 7935 1000.