Ramadan Fasting and Muslim Patients

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Shahid Athar, MD, FACP, FACE Author, Islamic
Perspective in Medicine (ATP)
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Ramadan Fasting and Muslim Patients
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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

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Quran 2183

• 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)

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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

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Physiological Effects of Fasting

• On Calorie intake
• On fluid /water intake
• Effects on Digestive System
• - Kidneys
• - Endocrine glands
• - Lipid Metabolism
• - Respiratory system
• - Neurological System

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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

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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

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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 lt40mg/dl)
• Increase Gluconeogenesis in liver

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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

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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

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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)

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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

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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)

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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

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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 .

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Fasting for NIDDM (ref3)

• 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

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NIDDM- Recommendations

• Control your Diabetes for two months prior to
  Ramadan bringing HbA1c to lt 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

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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

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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

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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

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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

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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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THANK YOU

• WWW.IMANA.ORG
• WWW.ISLAM-USA.COM
• WWW.IIIM.ORG
• SATHAR3624_at_AOL.COM

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Salaam from Sheikh Deedat