ISLAMIC MEDICINE
(Edited by Shahid Athar , M. D.)
Medical Aspects Of Islamic Fasting
Shahid Athar, M.D.
There are close to 900 million Muslims in the world, including about 8
million in the North America. The majority of them observe total fasting (no
food or water) between dawn to sunset in the month of Ramadan. They do
so not for losing weight or any medical benefit, but for them it is ordained
in their Holy Book Quran which says.
"O you who believe! Fasting is prescribed to you, as it was
prescribed for those before you (i.e. Jews, & Christians) so
that you may (learn) self-restraint." 2:183
According to Islamic Laws, children below 12, sick patients, travelers,
and women who are menstruating or nursing a baby are exempt from
fasting. In addition to staying away from food or water for the whole day,
they are asked to stay away from sex, smoking or misconduct during the
period of fast. In addition, they are encouraged to do more acts of piety
i.e.prayer, charity, or reading Quran during this month.
Food is needed by the body to provide energy for immediate use by
burning up carbohydrates, that is, sugar. Excess of carbohydrates which
cannot be used is stored 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 to other forms of energy storage, that is, glycogen. To be effective,
insulin has to be bound to binding sites could receptor. obese people lack
receptor; therefore, they cannot utilize their insulin. This may lead to
glucose intolerance.
When one fasts (or decreases carbohydrate intake drastically), it lowers
his blood glucose and Insulin level. This causes breakdown of glycogen
from liver to provide glucose for energy need and breakdown of fat from
adipose tissue to provide 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 provide calculated amount of protein in divided doses with plenty of
water, multi-vitamins, etc. These effectively lower weight, blood sugar, but
because of 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 "fasting
brings a wholesome physiological rest for the digestive tract and central
nervous system and normalizes metabolism." It must be pointed out,
however, that there are also many averse effects of total fasting. That
includes hypokalemia and cardiac arrythmia associated with low calorie
starvation diets used in unsupervised manner.
Studies On Islamic Fasting
Dr. Soliman, from the University Hospital, Amman, Jordan (ref. 8) has
reported that during the month of Ramadan 1404 AH (June-July, 1984
AD) healthy Muslim volunteers; 42 males and 26 females, ranging in age
from 15-64 and 16-28 years respectively were 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 osmolality were measured at the beginning
and at the end of Ramadan.There was significant loss of weight in males
form a mean of 73.8 +- 6.2 kg 72.0+- 7.1 kg (P less than 0.01) and in females
from 55.2 +- 4.8 to 54.6 +- 4.2 kg (P less than 0.05). 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 (ref.9) 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 in group of nine healthy men before and
on the 1Oth, 20th and 29th days of Ramadan. Mean body weight decreased
from 65.4 +- 9.1 to 61.6 +- 9.0 kg at 29th day. 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). Serum bilirubin increased
from 0.56 +- 0.17 to 1.43 +- 52 mg/dl on the 10th day, and decreased
thereafter (I. I.+- 0.4 on the 20th and 29th days.) All Changes returned to
basal values four weeks after fasting. There were no significant changes in
serum levels of Ca, P, protein, albumin, and any of measured hormones.
Prolactin and TSH responses to TRH were also unaltered. He concluded
that:: (1) intermittent abstinence from food and drink for 17 hours a day for
29 days does not alter male reproductive hormones, hypothalainic-pituitary-thyroid axis or peripheral metabolism of thyroid hormones and
(2) physicians caring for Muslims should be aware of changes of glucose
and bilirubin during Ramadan.
Therefore it is concluded from the above two studies that Islamic
fasting does not cause any adverse medical effect and may have some
beneficial effect on weight and lipid metabolism.
Why Islamic Fasting Is Different Than Other Types of
Fasting (ref. 7)
The Islamic fast, is different from the above "Diet Plans". It has
beneficial features of both plans. Its unique medical benefits are due to the
following factors :
I . As compared to other diet plans, in fasting during Ramadan, there is no
malnutrition or inadequate calorie intake since there is no restriction on
the type or amount of food intake during Iftaar or Sahar. This was
confirmed by M.M.Hussaini (ref. 6) during Ramadan 1974 when he
conducted dietary analysis of Muslim students at the University of
North Dakota State University at Fargo. He concluded that calorie
intake of Muslim students during fasting was at two thirds of NCR-
RDA.
2. Fasting, in Ramadan is voluntarily undertaken. It is not a prescribed
imposition from a physician. In the hypothalamus part of the brain there
is a center called "lipostat" which controls the body mass. When severe
and rapid weight loss is achieved by starvation diet, the center does not
recognize this as normal and, therefore re-programs itself to cause
weight gain rapidly once the person goes off the starvation diet. So the
only effective way of losing weight is slow, self-controlled, and gradual
weight loss by modifying our behavior, and the attitude about eating
while eliminating excess food. Ramadan is a month of self-regulation
and self-training if terms of food intake thereby causing hopefully, a
permanent change in lipostat reading.
3. In Islamic fasting, we are not subjected to a diet of selective food only
(i.e. protein only, fruits only etc). An carry breakfast, before dawn is
taken and then at sunset fast is broken with something sweet i.e. dates,
fruits, juices to warrant any hypoglycemia followed by a regular dinner later on.
4. Additional prayers are prescribed after the dinner, which helps metabolize the food. Using a calorie counter, I counted the amount of calories
burnt during extra prayer called Traveeh. It amounted to 200 calories.
Islamic prayer called Salat uses all the muscles and joints and can be
placed in the category of a mild exercise in terms of caloric out put.
5. Ramadan fasting is actually an exercise in self discipline. For those who
are a chain smoker, or nibble food constantly, 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 the
description of people who fast. They describe a feeling of inner peace
and tranquility. The prophet has advised them "If one slanders you or
aggresses against you, tell them I am fasting". Thus personal hostility
during the month is minimal. Crime rate in muslim countries fall during
this month.
It is my experience that within the first few days of Ramadan, I begin
to feel better even before losing, a singIe pound. I work more and pray more;
physical stamina and mental alertness improve. As I have my own lab in the
office, I usually check my chemistry, that is, blood glucose, cholesterol,
triglyceride before the commencement of Ramadan and at its end. I note
marked improvement at the end. As I am not overweight, thank God, weight
loss is minimal. The few pounds I lose, I regain soon after. Fasting in
Raniadan will be a great blessing for the overweight whether with or
without mild diabetes (type II). It benefits those also who are given to
smoking or nibbling. They can rid themselves of these addictions in this
month.
Fasting For Medical Patients: Suggested Guide-line (ref. 10)
As mentioned earlier, patients are exempt from fasting. But some, for
whatever reasons, do decide to observe fasting. For physicians treating
Muslim patients, the following guidelines are suggested.
a. Diabetic Patients: Diabetics who are controlled by diet alone can fast
and hopefully with weight reduction, their diabetes may even be cured
or at least improved. Diabetics who are taking oral hypoglycemia
agents like Orinase along with the diet should exercise extreme caution
if they decide to fast. They should reduce their dose to one-third, and
take the drug not in the morning, but with Iftar in the evening. If they
develop low blood sugar symptoms in the day time, they should break
the fast immediately. Diabetics taking insulin should not fast. If they do,
at their own risk, they should do so under close supervision and make
drastic changes in the insulin dose. For example, eliminate regular
insulin altogether and take only NPH in divided doses after Iftar or
before Sahar. Diabetics, if they fast, should still take a diabetic diet
during Iftar, Sahar and dinner. The sweet snacks common in Ramadan
are not good for their disease. they should check their blood sugar
before breakfast and after ending their fast.
b. Hypertensive or Cardiac Patients: Those who have mild to moderate
high blood pressure along with being overweight should be encouraged
to fast, since fasting may help to lower their blood pressure. They
should see their physician to adjust medicines. for example, the dose of
water pill (diuretic) should be reduced for fear of dehydration and long
acting agents like Inderal LA or Tenormin can be given once a day
before Sahar. Those with severe hypertension or heart diseases should
not fast at all.
c. Those with Migrain Headache: Even in tension headache, dehydration,
or low blood sugar will aggravate the symptoms, but in migraine during
fasting, there is an increase in blood free fatty acids, which will directly
affect the severity or precipitation of migraine through release of catecholamines. Patients with migraines are advised not to fast.
d. Pregnant Women (Normal Pregnancy): This is not an easy situation.
Pregnancy is not a medical illness, therefore, the same exemption does
not apply. There is no mention of such exemption in Quran.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
third trimester (three months) women should not fast. If however,
Ramadan happens to come during the second trimester (4th-6th months)
of pregnancy, a women may elect to fast provided that (1) her own
health is good, and (2) it is done with the permission of her obstetrician
and under close supervision. The possible damage to the fetus may not
be from malnutrition provided the Iftar and Sahar are adequate, but
from dehydration, from prolonged (10-14 hours) abstinence from
water.
Therefore it is recommended that Muslim patients if they do fast. do so
under medical supervision.
References:
1. Bistrian,B.R.,"Semi-starvation Diet Recent Development", Diabetic
Care, November 1978.
2. Blackbum, G.L., et el, "Metabolic Changes On PSMF diet" diabetes,
June 1976.
3. Cott, A., "Fasting Is A Way Of Life", New York: Bantam Books, 1977.
4. Hirsch, Jules, "Hypothalmic Control Of Appetite" Hospital Practices,
February 1984.
5. Khurane, R.C., "Modified Ketogenic Diet For Obesity" , Cancer
Monthly Digest, July 1973.
6. Hussaini, N.M., Joumal of Islamic Medical Association, October 1982.
7. Athar, S., "Therapeutic Benefits Of Ramadan Fasting ", Islamic Horizon May 1984.
8. Soliman, N., "Effects Of Fasting During Ramadan", Journal of Islamic
Medical Association, November 1987.
9. F. Azizi et el, "Evaluation of Certain Hormones And Blood Constituents During Islamic Fasting Month", Journal of Islamic Medical
Association, Nov. 1987.
10. Athar, S., "Fasting For Medical Patients - Suggested Guide-line"
Islainic Horizon, May 1985.