HEALTH GUIDELINES FOR FASTING IN RAMADAN
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.
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.
- 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
POTENTIAL HEALTH COMPLICATIONS:
- Indigestion – fasting usually reduces the amount of acid, however if a patient suffers with this the following can be advised: Those on regular antacids are advised to continue to take these at the pre-dawn meal; dietary changes may help e.g. eat in moderation, avoid spicy/oily food, reduce caffeine intake and stop smoking.
- Dehydration – This is a common problem and patients must be advised to drink plenty during the non-fasting period. If a patient feels disorientated, confused or faint they should be advised to stop fasting and rehydrate, and they can 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 should be 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. They should be advised to stop their fast if they become unwell during this period.
- Diabetes –
- Patients with diet controlled diabetes may fast, but should avoid eating large amounts of food at the break of the fast and have 2-3 smaller meals during the non-fasting period. The pre-dawn meal should be eaten as close to the start of the fast as possible, foods rich in complex carbohydrates are preferable.
- In patients taking metformin the likelihood of hypoglycaemia is low, however the regime could be adjusted to have 2/3 of the daily dose immediately before the main meal at sunset and 1/3 before the pre-dawn meal.
- In patients taking sulphonylureas: If on a once daily dose this should be taken at the pre-dawn meal, specialists also advise that the dose could be halved, but this can be decided based upon BM’s and the patients symptoms. If on a twice daily preparation recommendations are to half the normal dose for the pre-dawn meal and take the full dose at the main meal at sunset.
- Patients should be advised to not miss the pre-dawn meal, not to over eat at sunset, not to attempt self reduction or omission of treatment, to regularly monitor blood glucose during the fast and to break the fast immediately if unwell.
- Patients on insulin are advised not to fast, in addition to those with concurrent kidney disease, heart failure, infections, stroke, retinopathy, neuropathy, pregnancy and poorly controlled diabetes.
- It should be noted that insulin is now considered permissible during the fast and does not invalidate it.
- If unsure contact the diabetes team for further advice.
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 is requiring 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 to 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.
- 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. Most scholars agree that nicotine patches are not permissible during fasting.
- Can I take tablets, drops, injections or patches whilst fasting?
Tablets will invalidate the fast. Injections, patches and eye drops are allowed. Nose and ear drops/sprays are not allowed and neither is pr/pv medication. Sublingual tablets for angina are permissible. Insulin is also permissible. There are differing opinions between scholars on the above, so if patients are unsure they should contact their 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
- Can I use the pill so I do not have a period during Ramadan?
If patients wish to do this the following can be advised after risks/contraindications are excluded:
-If already on the COC, can run two packs together and thus miss the pill free break.
-Usual method for starting the pill if suitable
-If on POP advise this may cause breakthrough spotting/erratic bleeding thus the patient would not be able to fast on these days
-Finally patients should be reminded that Islamic law states that women should not fast when menstruating, and can make the fasts up at a later date.
If patients have further queries they should contact their local mosque: http://www.iccuk.org/page.php?section=religious&page=masjiddirectory
Department of Health Ramadan Guidelines
With thanks to London Central Mosque and Islamic Cultural Centre and East London Mosque