Most Muslims do not fast because of medical benefits but because it has been ordained to them in the Quran. The medical benefits of fasting are as a result of fasting. Fasting in general has been used in medicine for medical reasons including weight management, for rest of the digestive tract and for lowering lipids. There are many adverse effects of total fasting as well as so-called crash diets. Islamic fasting is different from such diet plans because in Ramadan fasting, there is no malnutrition or inadequate calorie intake. The caloric intake of Muslims during Ramadan is at or slightly below the national 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, it is beneficial for one's entire life. 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 only 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 during this period is not bad at all 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.

The physiological effect of fasting includes lower of blood sugar, lowering of cholesterol and lowering of the systolic blood pressure. In fact, Ramadan fasting would be an ideal recommendation for 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 research papers from all over the world, from Muslim and non-Muslim researchers who have done 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 baseline medical condition. On the other hand, patients who are suffering from severe diseases, whether diabetes or coronary artery disease, kidney stones, etc., are exempt from fasting and should not try to fast.

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. This psychological improvement could be related to better stabilization of blood glucose during fasting as hypoglycemia after eating, aggravates behavior changes.

Recitation of the Quran not only produces a tranquility of heart and mind, but improves the memory. Therefore, I encourage my Muslim patients to fast in the month of Ramadan, but they must do it under medical supervision. Healthy adult Muslims should not fear becoming weak by fasting, but instead it should improve their health and stamina.

DIABETES MELLITUS AND RAMADAN FASTING

Diabetes mellitus affects people of all faiths. Muslims are no exception. Many diabetic Muslims have a desire to fast during the month of Ramadan, although if they cannot for health reasons, they have a valid exemption. The dilemma for physicians and Muslim scholars is whether or not Muslim diabetic patients (1) should be allowed to fast if they decide to; (2) can fast safely; (3) can be helped to fast if they decide to; (4 ) can have their disease monitored at home; and (5) are going to derive any benefit or harm to their health. Fasting during Ramadan by a Muslim diabetic patient is neither his right nor Islamic obligation, but only a privilege to be allowed by his physician, at the patient's request, knowing all the dangers and assuming full responsibility in dietary compliance and glucose monitoring, with good communication between the physician and the patient .

PSYCHOLOGICAL STATE OF DIABETES DURING RAMADAN

Diabetes mellitus itself adversely affects patients' psychological states by changes in glucose metabolism, blood and CSF osmolality, needs for discipline and compliance, fear of long term complications and threat of hypoglycemic attacks and the possibility of dehydration and coma.

On the other hand, fasting during Ramadan has a tranquilizing effect on the mind, producing inner peace and decrease in anger and hostility. Fasting Muslims realize that manifestations of anger may take away the blessings of fasting or even nullify them.

Diabetics know that stress increases the blood glucose by increasing the catecholamine level and any tool to lower the stress ; ie., biofeedback or relaxation improves diabetic control. Thus, Islamic fasting during Ramadan should have a potentially beneficial effect with regard to diabetic control.

EDUCATIONAL PROGRAM FOR DIABETICS DURING RAMADAN

It should be directed toward (a) diabetic home management; (b) preparing them for Ramadan; (c) recognizing warning symptoms of dehydration, hypoglycemia and other possible complications.

Patients should be taught home glucose monitoring, checking urine for acetone, doing daily weights, calorie-controlled diabetic diet, need for sleep and normal exercise. They should be able to take pulse, temperature, look for skin infection and notice changes in the sensorium ( mental alertness ) . They should be on special alert for any colicky pain, a sign for renal colic, or hyperventilation, a sign of dehydration, and to be able to seek medical help quickly rather than wait for the next day.

CRITERIA ALLOWING DIABETICS TO FAST DURING RAMADAN

1. All male diabetics over age 20. Please see editor's note.
2. All female diabetics over age 20 if not pregnant or nursing. Please see editor's note.
3. Body weight normal or above ideal body weight. Please see editor's note.
4. Absence of infection, co-existing unstable medical conditions, ie, coronary artery disease, severe hypertension (B/P 200/120), kidney stones, COPD or emphysema. Please see editor's note.

1500 CALORIE AND DIET MENU FOR RAMADAN FOOD EXCHANGES

PRE-DAWN BREAKFAST

POST-SUNSET ENDING THE FAST

DINNER

BEDTIME SNACK

Editor's Notes

1. The age limit of 20 has no Quranic basis. The actual physical development and tolerance which can precede the physiological age is the criteria here, not the age. If a male diabetic has the physical built and ability of fasting, he should be instructed to fast if he can do it without difficulty or compromising his heatlh as explained in the rest of the article. Back
2. Again the age limit of 20 has no Quranic basis. See note (1). Also the ban on fasting of pregnant females or nursing mothers is not Quranic or called for. Pregnant and or nursing mothers have to assess their own tolearance and ability of fasting. Those who are healthy enough, having mild Dibetes should be able to fast. Back
3. Again. These are general suggestions, not Quranic rules. We should not use the scale to decide when to fast or not. A healthy slightly under weight person has no excuse not to fast, if he/she can. He/she can check with his/her physician if he/she is questioning his/her ability to fast. Back
4. Again. these are generalization that is not necessarily correct. Some COPD or emphysema patients, mild infections, mild coronary artery disease....etc. may be able to fast withut diffclulty or compromising their well being. If in any doubt ask your good submitter (Muslim) doctor. Back

Notes are sent to us by Mohammed Shafik, M.D., New York, N.Y.