Medical Aspects Of Islamic Fasting

There are close to 1.5 billion Muslims in the world observe total fasting (no food orwater) between dawn to sunset in the month of Ramadan. They do so not forlosing weight or any medical benefit, but for them it is ordained in their HolyBook Quran which says.

“O you who believe! Fasting is prescribed to you, as it wasprescribed for those before you (i.e. Jews, & Christians) so that you may(learn) self-restraint.” (Quran 2:183)

According to Islamic Laws, children below 12, sick patients, travelers, and women who aremenstruating or nursing a baby are exempt from fasting. In addition to stayingaway from food or water for the whole day, they are asked to stay away fromsex, smoking or misconduct during the period of fast. In addition, they areencouraged to do more acts of piety i.e.prayer, charity, or reading Quranduring this month.

Food is needed by the body to provide energy for immediate use by burning upcarbohydrates, that is, sugar. Excess of carbohydrates which cannot be used isstored up as fat tissue in muscles, and as glycogen in liver for future use.Insulin, a hormone from the pancreas, lowers blood sugar and diverts it toother forms of energy storage, that is, glycogen. To be effective, insulin hasto be bound to binding sites could receptor. obese people lack receptor;therefore, they cannot utilize their insulin. This may lead to glucoseintolerance.

When one fasts (or decreases carbohydrate intake drastically), it lowers his bloodglucose and Insulin level. This causes breakdown of glycogen from liver toprovide glucose for energy need and breakdown of fat from adipose tissue toprovide for energy needs.

On the basis of human physiology described above, semi-starvation (ketogenic diets(I -5) have been devised for effective weight control. These diets providecalculated amount of protein in divided doses with plenty of water,multi-vitamins, etc. These effectively lower weight, blood sugar, but becauseof their side effects, should be used only under supervision of physicians.

Total fasting reduces or eliminates hunger and causes rapid weight loss. In 1975,Allan Cott in his “Fasting as a Way of life” noted that “fastingbrings a wholesome physiological rest for the digestive tract and centralnervous system and normalizes metabolism.” It must be pointed out,however, that there are also many averse effects of total fasting. Thatincludes hypokalemia and cardiac arrythmia associated with low caloriestarvation diets used in unsupervised manner.

Studies On Islamic Fasting

Dr.Soliman, from the University Hospital, Amman, Jordan has reported that duringthe month of Ramadan 1404 AH (June-July, 1984 AD) healthy Muslim volunteers; 42males and 26 females, ranging in age from 15-64 and 16-28 years respectivelywere studied. They were weighed and their blood levels of cortisol,testosterone, Na, K, urea, glucose, total cholesterol, high density lipoprotein(HDL), low density lipoprotein (LDL), triglycerides (TG) and serum osmolalitywere measured at the beginning and at the end of Ramadan.There was significantloss of weight in males form a mean of 73.8 +- 6.2 kg 72.0+- 7.1 kg (P lessthan 0.01) and in females from 55.2 +- 4.8 to 54.6 +- 4.2 kg (P less than0.05). Blood glucose levels rose in males from 77.7 +- 23.6 mg/dl to 90.2 mg/dl(P less than 0.05) and in females from 76.0 +- 7 mg/dl to 84.5 +- I 1.1 mg/dl(P less than 0.002). All other parameters did not show significant changes.

Dr.F. Azizi and his associates from the University of Medical sciences, Tehran,Iran has reported the following. serum levels of glucose, bilirubin, calcium,phosphorous, protein, albumin, FSH, LH, testosterone, prolactin, TSH, TI, TI,and T uptake, as well as prolactin and TSH responses to TRH were evaluated ingroup of nine healthy men before and on the 1Oth, 20th and 29th days ofRamadan. Mean body weight decreased from 65.4 +- 9.1 to 61.6 +- 9.0 kg at 29thday. Serum glucose decreased from 82 +- 4 mg/dl on the 10th day, and increased thereafter(76 +- 3 and 84 +- 5 on the 20th and 29th days of fasting respectively). Serumbilirubin increased from 0.56 +- 0.17 to 1.43 +- 52 mg/dl on the 10th day, anddecreased thereafter (I. I.+- 0.4 on the 20th and 29th days.) All Changesreturned to basal values four weeks after fasting. There were no significantchanges in serum levels of Ca, P, protein, albumin, and any of measuredhormones. Prolactin and TSH responses to TRH were also unaltered. He concludedthat:: (1) intermittent abstinence from food and drink for 17 hours a day for29 days does not alter male reproductive hormones,hypothalainic-pituitary-thyroid axis or peripheral metabolism of thyroidhormones and (2) physicians caring for Muslims should be aware of changes ofglucose and bilirubin during Ramadan.

Therefore it is concluded from the above two studies that Islamic fasting does not causeany adverse medical effect and may have some beneficial effect on weight andlipid metabolism.

Why Islamic Fasting Is Different Than Other Types of Fasting

The Islamic fast, is different from the above “Diet Plans”. It hasbeneficial features of both plans. Its unique medical benefits are due to thefollowing factors:

1. As compared to other diet plans, infasting during Ramadan, there is no malnutrition or inadequate calorie intakesince there is no restriction on the type or amount of food intake duringIftaar or Sahar. This was confirmed by M.M.Hussaini during Ramadan 1974 when heconducted dietary analysis of Muslim students at the University of North DakotaState University at Fargo. He concluded that calorie intake of Muslim studentsduring fasting was at two thirds of NCR- RDA.

2. Fasting, in Ramadan is voluntarilyundertaken. It is not a prescribed imposition from a physician. In thehypothalamus part of the brain there is a center called “lipostat”which controls the body mass. When severe and rapid weight loss is achieved bystarvation diet, the center does not recognize this as normal and, thereforere-programs itself to cause weight gain rapidly once the person goes off thestarvation diet. So the only effective way of losing weight is slow,self-controlled, and gradual weight loss by modifying our behavior, and theattitude about eating while eliminating excess food. Ramadan is a month ofself-regulation and self-training if terms of food intake thereby causinghopefully, a permanent change in lipostat reading.

3. In Islamic fasting, we are notsubjected to a diet of selective food only (i.e. protein only, fruits onlyetc). An carry breakfast, before dawn is taken and then at sunset fast isbroken with something sweet i.e. dates, fruits, juices to warrant anyhypoglycemia followed by a regular dinner later on.

4. Additional prayers are prescribedafter the dinner, which helps metabolize the food. Using a calorie counter, Icounted the amount of calories burnt during extra prayer called Traveeh. Itamounted to 200 calories. Islamic prayer called Salat uses all the muscles andjoints and can be placed in the category of a mild exercise in terms of caloricout put.

5. Ramadan fasting is actually anexercise in self discipline. For those who are a chain smoker, or nibble foodconstantly, or drink coffee every hour, it is a good way to break the habit,hoping that the effect will continue after the month is over.

6.Psychological effect of Ramadan fasting are also well observed by thedescription of people who fast. They describe a feeling of inner peace andtranquility. The prophet has advised them “If one slanders you oraggresses against you, tell them I am fasting”. Thus personal hostilityduring the month is minimal. Crime rate in muslim countries fall during thismonth.

Fasting For Medical Patients: Suggested Guide-line

As mentioned earlier, patients are exempt from fasting. But some, for whatever reasons,do decide to observe fasting. For physicians treating Muslim patients, thefollowing guidelines are suggested.

a. Diabetic Patients: Diabetics who arecontrolled by diet alone can fast and hopefully with weight reduction, theirdiabetes may even be cured or at least improved. Diabetics who are taking oralhypoglycemia agents like Orinase along with the diet should exercise extremecaution if they decide to fast. They should reduce their dose to one-third, andtake the drug not in the morning, but with Iftar in the evening. If theydevelop low blood sugar symptoms in the day time, they should break the fastimmediately. Diabetics taking insulin should not fast. If they do, at their ownrisk, they should do so under close supervision and make drastic changes in theinsulin dose. For example, eliminate regular insulin altogether and take onlyNPH in divided doses after Iftar or before Sahar. Diabetics, if they fast,should still take a diabetic diet during Iftar, Sahar and dinner. The sweetsnacks common in Ramadan are not good for their disease. they should checktheir blood sugar before breakfast and after ending their fast.

b.Hypertensive or Cardiac Patients: Those who have mild to moderate high bloodpressure along with being overweight should be encouraged to fast, sincefasting may help to lower their blood pressure. They should see their physicianto adjust medicines. for example, the dose of water pill (diuretic) should bereduced for fear of dehydration and long acting agents like Inderal LA or Tenormincan be given once a day before Sahar. Those with severe hypertension or heartdiseases should not fast at all.

c.Those with Migrain Headache: Even in tension headache, dehydration, or lowblood sugar will aggravate the symptoms, but in migraine during fasting, thereis an increase in blood free fatty acids, which will directly affect theseverity or precipitation of migraine through release of catecholamines.Patients with migraines are advised not to fast.

d. Pregnant Women (Normal Pregnancy): Thisis not an easy situation. Pregnancy is not a medical illness, therefore, thesame exemption does not apply. There is no mention of such exemption inQuran.However, the Prophet said the pregnant and nursing women do not fast.This is in line with God not wanting anyone, even a small fetus, to suffer.There is no way of knowing, the damage to the unborn child until the delivery,and that might be too late. In my humble opinion, during the first and thirdtrimester (three months) women should not fast. If however, Ramadan happens tocome during the second trimester (4th-6th months) of pregnancy, a woman mayelect to fast provided that (1) her own health is good, and (2) it is done withthe permission of her obstetrician and under close supervision. The possibledamage to the fetus may not be from malnutrition provided the Iftar and Saharare adequate, but from dehydration, from prolonged (10-14 hours) abstinencefrom water.

Therefore it is recommended that Muslim patients if they do fast. Do so under medical supervision.