Shahid Athar, MD, FACP, Face Author, "Islamic Perspective in Medicine" (ATP)

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

THANK YOU
WWW.IMANA.ORG
WWW.ISLAM-USA.COM
WWW.IIIM.ORG

SATHAR3624@AOL.COM

Salaam from Sheikh Deedat

Shahid Athar, MD, FACP, Face Author, "Islamic Perspective in Medicine" (ATP)

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