HEALTH EFFECTS OF RAMADAN FASTING

HEALTH EFFECTS OF RAMADAN FASTING Dr.M.A.Aleem.MD.DM{Neuro} Professor of Neurology K.Apv Govt Medical collage&MGM Govt Hospital Trichy

This year the islamic month of Ramadan will start on July 20^th. Muslim all ove the world will start this month with fasting from dawn to dusk daily for 30 days as ordained in Quran.

Spiritual Aspect of Fasting:

“O you who believe fasting is prescribed to you as it was prescribed to those before you so that you can learn Taqwa”(Quran 2:183)

The Arabic word Taqwa is translated in many ways including God consciousness, God fearing, piety, and self restraing. Thus we are asked to fast daily for one Month from dawn to dusk and avoid food, water, sex and vulgar talk during that period.

But why do we need to fast? It is our experience that temptations and ways of the world tend to spoil our purity and austerity. Thus we indulge in food all of the time, snacking and nibbling the whole day, heading to obesity. We drink too much coffee, or tea, or carbonated drinks. Some sexaholics can not stay away from sex unless they do it at least once or more aday. When we argue, we leave our decency aside and resort to vulgar talk and even physical fighting.

Now when one is fasting, he or she cannot do all of that. When he looks at the mouth watering food, he cannot even taste it and he has to give up snacking and nibbling as well as smoking cigarettes if he dose. No constant coffee, tea, or coke drinking either. Sexual passions have to be curtailed and when he is provoked to fight, he says “I am fasting that Icannot respond to your provocation”. To achieve God consciousness or God nearness, a better, word, we are advised to do additional prayer and read the Quran.

Medical benefits of Fasting:

Medical benefits of Ramadan muslims do not fast because of medical benefits which are of a secondary nature. Fasting has been used by patients for weight management, to rest the digestive tract and for lowering lipids. There are many adverse effects of total fasting as well as of crash diets. Islamic fasting is different from such diet plans because in Ramadan fasting, there is no malnutrition or inadequate calorie intake. The calorie intake of Muslims during Ramadan is at or slightly below the nutritional 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, there effects will be long lasting. 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 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 for 8 to 10 hours is not necessarily bad for health 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.

Physiological effect of Fasting:

The physiological effect of fasting includes lowering of blood sugar, lowering of cholesterol and lowering of the systolic blood pressure. In fact, Ramadan fasting would be an ideal recoommendation for the 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 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 their baseline medical condition. On the other hand, patients who are suffering from sever diseases, whether type I diabetes or coronary artery disease, kidney stones, etc., are exempt from fasting and should not be allowed to fast.

Psychological effects of Fasting:

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. Muslims take advice from the prophet who said, “If one slanders you or aggresses against you, say I am fasting.” This psychological improvement could be related to better stabilization of blood glucose during fasting as hypoglycemia after eating, aggravates behavior changes. There is a beneficial effect of extra prayer at night. This not only helps with better utilization of food but also helps in energy output. There are 10 extra calories output for each unit of the prayer. Again, we do not do prayers for exercise, but a mild movement of the joints with extra calorie utilization is a better form of exercise. Similarly, recitation of the Quran not only produces a tranquility of heart and mind, but improves the memory.

One of the odd nights in the last 10 days of Ramadan is called the night of power when angels descend down, and take the prayer of worship to God for acceptance.

Fasting is a special act of worship which is only between humans and God since no one else knows for sure if this person is actually fasting. Thus God says in hadith qudsi that “Fasting is for Me and I only will reward it”. In another hadith, the Prophet Mohammed (peace be upon him) has said “If one does not give up falsehoods in words and actions, God has no need of him giving up food and drink”.

Health issues of Fasting:

Special issues that may arise in consultation during Ramadan include providing advice on appropriate diet and on medical compliance among the muslim population.In this article,I Provide a personal perspective of why muslim fast and, as a muslim doctor, what advice I consider may be appropriate for fasting customers both healthy and those on medication, such as diabetic patients

The observance of fasting during Ramadan constitutes one of the five pillars of Islam. The experience of fasting is intended to teach muslims self-discipline and self-restraint, and understand a little of the plight of the less privileged (e.g., the hungry, the thirsty and the poor). Furthermore, Ramadan fasting is not just about disciplining the body to refrain from eating and drinking from predawn until sunset but is also about exerting control over the mind. This involves restraining anger, doing good deeds, exercising personal discipline, and preparing oneself to serve as a good Muslim and a good person. Ramadan is a month of peace and love in which individuals are encouraged to bury dufferences, to forget and forgive and to renew both human and spiritual relationships. Therefore, it contributes to the overall principle of making the individual more humane, more considerate and generally a more responsible member of society not just the individual. It does this, in part, by setting a standard for behaviour not only in this month but during the rest of the year and, indeed, every year muslim’s life. These principal tenets of Ramadan are important wheb considering our intentions and subsequent actions during this spiritual month, including those pertaining to the health of the individual. Fasting during Ramadan is prescribed for every healthy, adult Muslim whereas the weak, the sick, children, travellers and menstruating women are among those exempt. Muslims observing the fast are required to abstain not only from eating food and drinking water but also from consuming oral medicines and injecting intravenous nutritional fluids. However, not all Muslims who are ill seek this exemption and insist on fasting in any case. Fasting by Muslims during illness can cause problems if not supervised by health professionals. However, health problems during Ramadan can develop in otherwise healthy individuals and such patients could benefit from receiving advice on their diet.

Advice on diet for Fasting:

During this year where Ramadan falls in the mansoon season, and we do not have the very long days of the summer heat to contend with, most health problems are likely to arise from inappropriate diet or as a consequence of over-eating and Insufficient sleep.

There is no need to consume excess food at iftar (the food eaten in the period immediately after sunset to break fast), dinner, or sahur (the light meal generally eaten about half an hour to one hour before dawn). The reasons for this are two-fold. First, and most importantly, such a lifestyle contradicts the principle aims and spirit of Ramadan. Over-eating can be seen as a reflection of weak discipline and irresponsibility. Secondly, the body has regulatory mechanisms that reduce the metabolic rate and ensure efficient utilisation of body fat. Furthermore, most people assume a more sedentary lifestyle while fasting. The net result is that a balanced diet, that consists of less than the normal amount of food intake, is sufficient to keep a person healthy and active during the month of Ramadan.

To remain healthy during Ramadan, one should consume food from the major food groups: bread and cereal, milk and dairy products, fish, meat and poultry, beans, vegetables and furits. (Vegetarians and vegans should amend this list as appropriate.) Intake of fruits after a meal is strongly suggested. Diet in Ramadan should not differ much from the normal diet and should be as simiple as possible. The diet should be such that normal weight is maintained, neither losing nor gaining. However, if one is overweight, Ramadan is an ideal time to try to normalise one’s weight.

In view of the long hours of fasting, the so-called “complex carbohydrates”or slow digesting foods should be consumed at sahur so that the food lasts longer (about eight hours) resulting in less hunger during the day. These complex carbohydrates are found in foods that contain grains and seeds like barley, wheat, oats, millet, semolina, beans, lentils, wholemeal flour and unpolished rice.

In contrast, refined carbohydrates or fast-digesting food last for only three to four hours and may be better taken at iftar to restore blood glucose levels rapidly. Fast-burning foods include those that contain sugar and white flour. Dates are an excellent source of sugar, fibre, carbohydrates, potassium and magnesium and have been recommended since the days of the prophet Mohammed asa good way of breaking the fast.

Fried foods, very spicy foods and foods containing too much sugar, such as sweets, can cause health problems and should be limited during Ramadan. They cause indigestion, heart-burn and weight problems. Fasting can often increase gastric acidity levels causing a burning feeling, a heaviness in the stomach, and a sour mouth. This can be overcome by eating foods rich in fibre such as whole wheat bread, vegetables, hummus, beans, and fruits. These foods trigger muscular action, churning and mixing food, breaking it into small particles, and thus help reduce the build up acid in the stomach. Drinking of sufficient water and juicies between iftar and sleep to avoid dehydration, and for detoxification of the digestive system, should be encouraged in fasting individuals. However, the intake of large amounts of caffeine-containing beverages should be avoided, especially at sahur. For example, drinking too much tea will increase urine output and inevitably cause the loss of valuable mineral salts.

Fruits such as bananas are a good source of potassium, magnesium and carbohydrates. However, bananas can cause constipation and their intake has to be balanced with adequate fibre intake.

It is recommended that everyone engage in some kind of light exercise, such as stretching or walking. Overweight people should increase the amount of exercise and reduce the amount of food intake to help reduce weight.

It is also important to follow good time management procedures for Ibada (prayer and other religious activities), sleep, studies, work, and physical activities of exercise. A good balance in the amount of time attributed for each activity will lead to a healthier body and mind in Ramadan.

Advice for the sick who fast during Ramadan Fasting :

Ramadan fasting is obligatory for the healthy adult but, when fasting might significantly affect the health of the fasting individual or when one is genuinely sick, Islam exempts him or her from fasting. “God intends every facility for you, he does not want to put you into difficulties” (koren 2:185). From an Islamic point of view, this exemption represents more than a simple permission not to fast. The prophet said: “God likes his permission to be fulfilled, as he likes his will to be executed.” Another saying suggests that “a gift that God gives you, you have to accept”. In the light of these sayings, many believe that any Muslim who is sick, or whose sickness would adversely affect his well-being during the fasting period, should either not fast or at least break his fast accordingley. An additional argument often used is that if the fasting by a sick Muslim would jeopardise his health further, then this ultimately will neither benefit himself nor his role in society (Ummah) and he should be discouraged from observing the fast.

However, a significant number of patients, for whatever reasons, do decide to observe the fast. It is these patients who need to seek the opinion of health professionals on an individual basis.

Those suffering from minor ailments do not really have any problems fasting.

Those suffering from acute conditions may need advice about altering their dosing regimen. Drug that are normally required to be taken frequently, such as antibiotics, can be problematic for fasting patients. However, the increasing formulation of short- acting drugs as sustained release preparations, have offered much needed assistance to fasting patients.

For example, patients suffering form acute upper respiratory infections, such as a severe sore throat, may still be able to fast. Such a patient might be prescribed antibiotics that have to be taken three or four times a day and would not be able to fast. However, in order to facilitate fasting, the patient could be given a long-acting antibiotic, such as co-trimoxazole, which only needs to be taken 12- hourly, or azithromycin, which only needs to be taken once daily. This can be done only when the infecting organisms are susceptible to the alternative antibiotics, and needs to be discussed with the patient’s doctor.

Alternative routes of drug administration can help fasting patiens. Some patiens suffering from mild forms of angina pectoris could benefit from taking glyceryl trinitrate as a patch rather than sublingual tablets. The drug would enter the blood stream through the skin, and not orally (which would break the fast).

Again, this may only be possible in specific patients and needs to be discussed with the patient’s doctor. Doctoris should be willing to advise patients and practitioners on the availability of alternative dosage forms for medication during Ramadan.

There is a school of thought among medical practitioners that those patients who have mild to moderate high blood pressure and are also overweight should be encouraged to fast as this physician to adjust their medication. For example, the dose of diuretics should be reduced to avoid dehydration, and sustained release formulations can be given once a day before the predawn meal.

An increasing area where practitioners are likely to advise patients on fasting is in those suffering from diabetes mellitus. Many muslim, especially of Asian descent, have an increased risk of suffering from some from of diabetes.

The International Journal of Ramadan Fasting Research has suggested the following guidelines for health professionals treating Muslim patients with diabetes: “Diadetic patients who are controlled by diet alone can fast and hopefully,with weight reduction, their diabetes may even be improved.

Diabetics who are taking oral hypoglycaemic agents along with the dietary control should exercise extreme caution if they decide to fast. These patients should consult their medical doctor for dose adjustment. If they develop low blood sugar symptoms in the daytime, they should end the fast immediately.” In addition, diabetic patients taking insulin, should consult their doctor to see if their dose can be adjusted to allow fasting during Ramadan. In all cases of fasting with diabetes, blood sugar levels should be closely monitored, especially before and after meals.

General Recommendations for Ramadan fasting:

Do’s

• Maintain calorie intake to roughly what you take when not fasting. Ramadan is not for losing weight, unless you are overweight and. want to lose weight. Maintain the same level of activities (calorie expenditure) as when you were not fasting

• Eat slow burning foods, esp. At Suhur time. Complex carbohydrates are slow burning foods;e.g. wheat, bran, oat, beans, lentils, whole wheat flour, etc. Haleem is a good healthy slow burning meal!

• Eat high fiber foods, like whole wheat, oats, beans, lentils, vegetables (green beans, peas, spinach, and beetroot), fruits like figs, purnes, etc.

• Eat balanced meal, e.g. vegetables, fruit, meat (chicken, beef, and fish), bread, cereal, dairy products.

• Drink plenty of water and fluids. (water is preferable)

Do not

• Do not eat fast burning foods. Refined carbohydrates are fast burning foods, e.g. White flour bread, refined sugar, etc
• Do not eat fried and fatty foods. These cause heartburn and weight gain.

Do not (continued)

• Do not over-eat, especially at suhur time
• Tea: Do not drink excessive amount of tea, especially at suhur time. It contains theophylline, which is a mild diuretic (causes urination) and may exacerbate fasting related dehydration, and may contribute to salt and electrolyte deprivation. (coffee does not contain theophylline.) It is not healthy to drink tea for breaking the Fast.

Special Considerations:

Diabetes.

Non-insulin requiring diabetes mellitus (NIDDM) is aiso called adult onset diabetes. If it diet controlled or requires oral medication, then fasting may be done with precaution, after consulting your doctor. It may require reducing the dose of diabetic medication, and strict adherence to anti-diabetic diet, including eating complex carbohydrates (slow burning foods.) If you require insulin shots, then it may be too risky to observe Fasting.

Constipation.

Causes: Dehydration may exacerbate constipation, leading to piles or anal fissure which is very painful cracking lesion in anal area. Remedies: Drink plenty of water and fluids, high fiber containing fooda & vegetable. Using a stool softener pill (over the counter), psyllium (metamucil, etc.) powder, prune juice, etc. As a preventive measure might be helpful

Indigestion, Bloating.

Causes: Overeating, fried and fatty foods, eggs, cabbage, carbonated, drinks, like colas. Remedies. Avoid the above foods.

Lethargy, Feeling weak & Lightheaded.

Causes: Insufficient fluid and salt intake, or excessive fluid and

Electrolyte loss. Remedies: Increase water and fluid intake. Avoid

Excessive sweating and keep cool.

Hypoglycemia.

Low blood sugar. May cause feeling of weakness, especially in the

afternoon. Remedies: Eat Suhur. Eat slow digesting foods (complex

carbohydrates.) Avoid fast burning refined foods (white flour freads,

refined sugar containing foods)

Headache, nevousness, irritability.

Causes: This may be due to caffeine or nicotine withdrawal in those people who are dependent on these substances. Remedies: One to two errkd prior to starting the Fasts, gradually reduce the intake of tea, coffee, and

Cigarettes. Several carbonated drinks have added

Caffeine. Read the lable and what you are drinking!

Muscle Cramps.

Causes: Inadequate intake of calcium, magnesium and potassium

Remedies Eat foods rich in minerals, like vegetables,

Fruits, dairy products, dates,meat products.

Peptic Ulcer, Hiatal hernia, Gastritis, High Blood pressure, Kidney stones.

Consult tour doctor if you intend to Fast in Ramadan, if you suffer

From any of these.