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). 

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, 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.

EXEMPTIONS FROM FASTING

  1. All those who are unable to fast due to illness (physical or mental) or being very frail
  2. Pregnant and menstruating women
  3. Lactating women who have concerns about their own, or their child’s health
  4. Travellers
  5. Children under the age of puberty

POTENTIAL HEALTH COMPLICATIONS AND REMEDIES

Indigestion – fasting usually reduces the amount of acid, but thoughts of food or the smell of it make the brain order the stomach to produce more acid, so heartburn could be a problem during the fast. Those who are on regular medication for indigestion, such as antacids, antihistamines, or proton pump inhibitors are advised to continue taking them, at the pre-dawn meal. 

The control of heartburn or belching can be aided by eating in moderation and avoiding oily, deep-fried or very spicy food. Reducing your caffeine intake and/or stopping smoking can also be of benefit, if relevant. Preparations such as peppermint oil may help reduce belching or colic. Sleeping with your head raised on a few pillows and long-term weight loss may also help prevent heartburn.

Dehydration – Dehydration is a common occurrence during a fast. The body continues to lose water and salts through breathing, sweat and urine; the quantity of water loss will vary depending on the weather, how much you had to drink before your fast, the degree of physical exertion and the ability of the kidneys to retain water and salts. Prevention is always better than cure. However, if you do not adequately rehydrate before a fast, your risk of dehydration is increased. 

Depending on the severity of the dehydration, you may experience a general feeling of being unwell, lethargy, muscle cramps, dizziness, disorientation and even collapse or fainting. 

If you are unable to stand up due to dizziness, or you are disorientated, you should urgently rehydrate with regular, moderate quantities of water, ideally with sugar and salt 

If you faint due to dehydration, your legs should be raised above your head by others, and when you awake, you should urgently rehydrate as outlined above.

Headache – This is a common problem with many possible causes e.g. dehydration, hunger, inadequate rest, absence of caffeine or nicotine. Not missing the pre-dawn meal, consuming adequate quantities of fluid and if necessary taking a dose of painkillers such as paracetamol, may all go a long way towards either preventing or reducing the risk of developing a disabling headache. Headaches can also be prevented by sensible measures such as not exposing oneself to direct sunlight, wearing a hat when out, using sunglasses to reduce the effect of glare from the sun and relieving any tense muscles with a short, gentle massage.

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.

Stress- Lack of food and water, changes of routine and shorter periods of sleep can all collude to increase stress levels. Hence it is important to address any potential sources of stress in order to minimise harmful effects. This can be helped by not taking on more than you can reasonably handle, not playing sports in the hot sun, controlling your anger in advance and abstaining from smoking.

Obesity- For the unwary, or those lacking in caution, food consumed during the pre-dawn and dusk meals may lead to some unintended weight gain. Obesity is an epidemic in the making, and has numerous complications in its own right. 

It is ironic that you are able to become overweight or obese while you are fasting. But if you do not approach the fast with discipline and will, the opportunity to lose weight and become healthier is wasted.

FREQUENTLY ASKED QUESTIONS BY PATIENTS

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 you are requiring your inhalers often and are unwell, you would be exempt from fasting anyway. It may be possible to change the inhalers to longer acting varieties if you do not wish to use their inhaler whilst fasting. For further advice you should contact your local Imam.

Can I swim whilst fasting?

Yes, but avoid swallowing the water.

Can I have a blood test?

Yes, both fingerprick and intravenous tests do not invalidate the fast

Can I have a blood transfusion whilst fasting?

No, in this case you would be considered too unwell to fast

Can I fast if I am on antibiotics?

If you are unwell and require antibiotics regularly throughout the day then you would be exempt from fasting, and should make up your fasts at a later date when well. 

If the antibiotics are for e.g. acne you may fast and take your antibiotics either before the pre-dawn meal or after the sunset meal.

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 give up smoking and support can be offered at this time.

Can I take tablets, drops, injections or patches whilst fasting?

Tablets are not permitted during the fast. If you do take medications during the day, it is worth consulting with your Doctor to see if your medication regime may be amended

Eye and ear drops are permissible, provided your eardrum has not burst.

Vaginal pessaries and any form of skin patches e.g. Nicotine, are permissible

Rectal suppositories are not allowed

Nasal sprays are not allowed

Injections (IV, IM, SC, epidural) are all permissible, provided they are not for nutritional benefit

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

Can I use the pill so I do not have a period during Ramadan?

Yes. However, this should be discussed with your Doctor, as depending on which pill you may get some breakthrough pill.

It is also important to remember that Islamic law states that women should not fast when menstruating, and can make the fasts up at a later date.

Can I fast if I have Diabetes or other medical conditions?

The answer to this will vary on the severity of your condition. The safest plan is to discuss your condition and medicine regime with your Doctor who will be able to advise accordingly.

If patients have further queries they should contact their local Imam.

Dr Farah Ahmad

April 2019