Shahid Athar, MD, FACP,

FACE
Author, “Islamic Perspective
in Medicine” (ATP)
Ramadan Fasting and
Muslim Patients
 Abstract
“ Fasting from dawn to dusk in the holy month
of Ramadan for healthy adult Muslims has
been ordained and physically sick Muslims
are exempt from it. However many Muslims
with mild to moderate Diabetes,
Hypertension and other medical conditions
do want to fast. The purpose of this
presentation is make some
recommendations as to how they can fast
safely in light of research on fasting”
 Quran 2:183

“ O you who believe! Fasting has been

prescribed to you as it was prescribed
to those before you so that you attain
Taqwa (self restraint , God Awareness)”
 Who Cannot Fast

1. Physically sick ( Quran 2: 184-185)

2. Traveler on a journey (above)
3. Women during menstruation
4. ? Pregnant and lactating women
5. pre pubertal children
Physiological Effects of Fasting
• On Calorie intake
• On fluid /water intake
• Effects on – Digestive System
- Kidneys
- Endocrine glands
- Lipid Metabolism
- Respiratory system
- Neurological System
Uniqueness of Islamic Fasting
• It is a voluntary undertaking rather than
being ordered by a physician
• There is no selective food intake i.e. protein
only, juice only, fruit only , water only etc
• There is no total calorie malnutrition i.e. it
not a semi starvation diet.
• An exercise in self discipline i.e. from
constant nibbling , drinking, smoking etc
• Psychological effect and additional prayer
 Effects of Fasting on
Carbohydrate Metabolism

1. Slight fall in serum Glucose (to 60 mg)

2. Serum Insulin decreases due to 1
3. Serum Glucagon and Growth Hormone
increases due to 1
4. Increase in sympathetic activity
5. Increase in liver Cyclic AMP due to 4
CHO Metabolism in Ramadan

• Slight decrease in first week then

normalization by day 20 and some rise
in the last week
• 22% children develop hypoglycemia
(BG <40mg/dl)
• Increase Gluconeogenesis in liver
Fasting and Lipid Metabolism

• Decrease in both Total Cholesterol

and Triglycerides in first few days
then rise to pre fasting levels
• Increase in HDL-C
• Effects are variable according to
quality and quantity of food consumed
at Iftaar and Sahur
Endocrine functions in Fasting
• Fall in free T3 but rise in rT3
• Slight fall in total T4 (due to fall in TBG)
but normal freeT4 and TSH
• TSH response to TRH unchanged
• Serum Testosterone, LH, FSH may be
normal or slightly low but GNRH
response is normal
• Plasma Prolactin and PTH are normal
 Renal Function in Fasting

• Urinary volume, osmolality, solute and

electrolyte excretion remain normal
• Slight increase in BUN (insignificant)
• Increase in Uric acid (less in Ramadan
fasting than in prolonged fasting)
 Other Effects of Fasting

• Slight rise in Bilirubin but no change

in SGOT or SGPT
• Fall in Gastric secretions
• No change in Heart rate and BP
• No change in Ca+ or Electrolytes
• No change in Hb, blood counts or Fe
store
 Other Effects of Fasting
• Weight loss of 1.7-3.8 Kg (obese lost
more weight than non obese)
• Decrease in appetite due to ketosis and
increase in Beta-endorphins
• Fewer suicide in Ramadan than in other
months (reported in Jordan)
• No change in outcome of pregnancy or
in birth weight in those who fasted and
those who did not (reported in Gambia)
Patients who should not fast
• Diabetes Mellitus Type 1
• Chronic Renal Failure including Renal
Transplant and Nephrolithiasis
• Severe cardiac and pulmonary
conditions
• G.I. Bleed and acute ulcers
• Severe Epilepsy
• Severe Migraine
General advice for those who fast
• Consult your (Muslim) doctor first
• Practice fasting in Shaban first
• With the approval of physician switch to
either long acting or twice daily medication
• Elderly patients on NSAID should have
frequent monitoring of renal functions
• Anticoagulant and Antiepileptic
medications should be given at night .
 Fasting for NIDDM (ref:3)
Benefits of Fasting in Ramadan
• A. Better control of Diabetes
• B. Better control of Hypertension
• C. Better control of Lipid
• D. 5-10 lb weight loss

Thus Fasting is advised for stable NIDDM

 NIDDM- Recommendations

• Control your Diabetes for two months prior

to Ramadan bringing HbA1c to < 8
• Discontinue Metformin a week before fast
• Drugs like Actos, Avandia , Glucotol XL are
safer than Diabeta, Amyril , and Starlix
• Continue Diabetic diet in Iftaar and Sahur
 Fasting for those on Insulin
• Consult your Diabetologist (Muslim) first
• Discontinue Insulin mixtures such as 70/30
, 75/25, or Regular Insulin
• If on NPH then reduce the total dose by
20% and take 2/3 at Iftaar and 1/3 at Sahur
• If on Lantus then reduce by 20% and take
at night -Titrate by 2 units ( BG 120-140)
• Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
 Monitoring for IDDM
• Finger stick BG after Iftaar and before
sahur
• BG if feeling bad (low)
• Terminate fast if BS below 60 or over
400
• No exercise before Iftaar
• Drink plenty of water at iftaar and Sahur
 Questions from Muslims
• Fasting and Pregnancy
• Fasting and Nursing
• Blood draw during Fasting
• Medications during Fasting
-Tablets, inhalers, patches , injections
• Exercise / Sports during Fasting
• Mouth washes and gums during Fasting
 References
• Azizi , F et all” Evaluation of blood hormones
and constituents in Ramadan” JIMA, Nov. 1987
• Soliman , N “ Effects of Fasting during
Ramadan” JIMA Nov 1987
• Athar, Shahid “Management of NIDDM during
Islamic Fasting in Ramadan :JIMA vol 27 1995
• Athar , Shahid “Fasting for Medical Patients-
suggested guidelines” Islamic Horizon, May ’85
• Athar , Shahid “Therapeutic Benefits of
Ramadan Fasting” Islamic Horizon: May’ 84
 Some Parting Thoughts
• “Fasting is for Me and I (Allah) only will
reward it” (Hadith Qudsi)
• “While fasting , if one does not give up
falsehood in words and actions , then
Allah has no need of him giving up food
and drink (saying of Prophet Muhammad-
pbuh)

HAVE A BLESSED RAMADAN

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