An article looking at the month of Ramadan, what it means for Muslims and health advice for fasting.
Last updated 2011-07-05
An article looking at the month of Ramadan, what it means for Muslims and health advice for fasting.
Ramadan is the ninth month of the Islamic calendar, when Muslims fast during daylight hours.
There are several reasons why Ramadan is considered important:
The month of Ramadan in which was revealed the Qur'an, a guidance for mankind and clear proofs for the guidance and the criterion (between right and wrong)
The actual night that the Qur'an was revealed to the Prophet Muhammad is called Lailat ul Qadr, and to stand in prayer on this one night is said to be better than a thousand months of worship.
Ramadan is often called 'month of the Qur'an' because of this, and Muslims attempt to recite as much of the Qur'an as they can during the month. Most mosques will recite one thirtieth of the Qur'an each night during the Taraweeh prayers.
No one knows on which particular night the Qur'an was first revealed, but it is said to be one of the last ten nights of Ramadan.
It was narrated from Abu Hurayrah (may Allah be pleased with him) that the Messenger of Allah (peace and blessings of Allah be upon him) said: "When Ramadan comes, the gates of Paradise are opened and the gates of Hell are closed, and the devils are put in chains."
Muslims believe that their good actions bring a greater reward during this month than at any other time of year, because this month has been blessed by Allah.
They also believe that it is easier to do good in this month because the devils have been chained in Hell, and so can't tempt believers. This doesn't mean that Muslims will not behave badly, but that any evil that they do comes from within themselves, without additional encouragement from Satan.
Almost all Muslims try to give up bad habits during Ramadan, and some will try to become better Muslims by praying more or reading the Qur'an.
Muslims believe that this is one way that the chaining up of the devils is manifested, since there is no other reason for them to do so.
There are a number of special practices which are only done during Ramadan.
Although Muslims fast during other times of the year, Ramadan is the only time when fasting, or sawm, is obligatory during the entire month for every able Muslim.
Ramadan is intended to increase self-control in all areas, including food, sleeping, sex and the use of time.
These are long night prayers, which are not obligatory, but highly recommended.
Mosques are filled with worshippers who go to attend these prayers, which usually last for one and a half to two hours.
These prayers also give Muslims a chance to meet at the mosque every day, and so they also help to improve relationships in the Muslim community.
I'tikaf refers to going into seclusion during the last ten nights of Ramadan, in order to seek Lailat ul Qadr by praying and reading the Qur'an. Some people live in the mosque during this time for serious reflection and worship. Others spend a few hours at the mosque or home.
Ramadan is the ninth month of the Islamic calendar and as with all months in the Islamic calendar, its start is based on the sighting of the new moon.
There can be confusion and disagreement over the starting date of this month. Since the month is full of blessings and marks the beginning of fasting, or sawm, accuracy is very important.
Since Muslims live all over the world, but Islam started in what is now known as Saudi Arabia, they may not agree as to which country’s first moon sighting marks the start of the month.
But although Muslims do often start and end Ramadan on slightly different days, there is little real ill will, and it is forgotten once the fasting starts.
Some Muslims believe that a new moon sighting from their individual country marks the start of Ramadan.
One argument for accepting this is that Islam is regarded as a way of life for all people. Choosing a local sighting includes those who do not have access to technology or fast communication.
It's argued that unity within a known geographic location is more important than celebrating Ramadan with people who live in another country or continent.
Other Muslims believe that the sighting of the new moon from Saudi Arabia marks the beginning of Ramadan.
They believe this unifies all Muslims, as well as carrying on the tradition of the Prophet Muhammad.
Some Muslims believe that technology should be used to mark the true date.
In 2006, the Fiqh Council of North America decided they will no longer use naked eye sightings of the moon, but will use astronomical calculations instead to determine the start of Ramadan. Not all Muslims agree with this approach.
In this section, Professor Saghir Akhtar gives his health tips for fasting.
Ramadan is a month where believers learn to exercise self-control. A major facet of this is the abstinence from food and drink that is prescribed to all healthy Muslims during the hours of sunrise to sunset. Although the sick are exempt, many continue to fast and therefore abstain not only from eating and drinking water but also from consuming oral medications and intravenous nutritional fluids. This article provides a personal reflection on what advice might be pertinent for fasting Muslims in good health and those on medication.
During years where Ramadan falls in the winter, and the long hot days of the summer a mere distant memory, most of the health problems are likely to arise from inappropriate diet, over-eating and insufficient sleep. Firstly, there is no need to consume excess food at Iftar (the food eaten immediately after sunset to break the fast), dinner or Sahur (the light meal generally eaten about half an hour to one hour before dawn).
The reasons for this are two-fold. Firstly and most importantly such a lifestyle contradicts the principal aims and spirit of Ramadan. A learned scholar once said that "There is no receptacle more odious to God, than a belly stuffed full of food after a fast" and therefore "of what use is the Fast as a means of conquering God's enemy and abating appetite, if at the time of breaking it one not only makes up for all one has missed during the daytime, but perhaps also indulges in a variety of extra foods?" Indeed, there is a concern that it is becoming customary for some to "stock up" for Ramadan, so that more is consumed during this time than in the course of several other months combined. It is therefore worth reflecting on the true objective of fasting which is to experience hunger and to check desire in an attempt to reinforce the soul in piety.
Secondly, the body has regulatory mechanisms that reduce the metabolic rate and ensure efficient utilization of the body's fat reserves in times of hunger. Add to this the fact that most people assume a more sedentary lifestyle whilst fasting and the implication is that a balanced diet that is even less in quantity that normal will be sufficient to keep a person healthy and active during the month of Ramadan.
To remain healthy during Ramadan, normal quantities of food from the major food groups: bread and cereal, milk and dairy product, fish, meat and poultry, bean, vegetable and fruit should be consumed. (Vegetarians and Vegans should amend this list as appropriate). Intake of fruits after a meal is strongly suggested. In actual fact, our diet in Ramadan should not differ very much from our normal diet and should be as simple as possible. The diet should be such that we maintain our normal weight, neither losing nor gaining. However, if one is over-weight, Ramadan is an ideal time to shed those extra pounds!
In view of the long hours of fasting, we should consume the so-called 'complex carbohydrates' or slow digesting foods at Sahur so that the food lasts longer (about 8 hours) making you less hungry during the day. These complex carbohydrates are found in foods that contain grains and seeds like barley, wheat, oats, millet, semolina, beans, lentils, wholemeal flour, and unpolished rice.
In contrast, refined carbohydrates or fast-digesting foods last for only 3 to 4 hours and may be better taken at Iftar to rapidly restore blood glucose levels. Fast-burning foods include foods that contain sugar and white flour. Dates are an excellent source of sugar, fibre, carbohydrates, potassium and magnesium and have been recommended since the days of the Prophet Mohammed (pbuh) as a good way of breaking the fast.
Fried foods, very spicy foods and foods containing too much sugar such as sweets, the delight of many Muslims, can cause health problems and should be limited during Ramadan. They cause indigestion, heartburn, and weight problems. Fasting can often increase gastric acidity levels in the stomach causing a burning feeling, a heaviness in the stomach and a sour mouth. This can be overcome by eating foods rich in fibre such as whole wheat bread, vegetables, humus, beans and fruits. These foods trigger muscular action, churning and mixing of food, breaking it into small particles, and thus help reduce the build up of acid in the stomach.
Drinking of sufficient water and juices between Iftar and sleep to avoid dehydration and for detoxification of the digestive system should be encouraged in fasting individuals. However, the intake of large amounts of caffeine-containing beverages should be avoided especially at Sahur. For example, drinking too much tea will make one pass more urine and inevitably cause the loss of valuable mineral salts that your body would otherwise need during the day. Fruits such as bananas are a good source of potassium, magnesium and carbohydrates. However, bananas can cause constipation and their intake has to be balanced with adequate fibre intake.
It is recommended that everyone engage in some kind of light exercise, such as stretching or walking. Exercise, together with a balanced diet, should help everyone watch their weight during Ramadan. Anyone overweight should increase the amount of exercise and reduce the amount of food intake to help reduce weight.
It is also important to follow good time management procedures for Ibada (prayer and other religious activities), sleep, studies, work, and physical activities or exercise. A good balance in the amount of time attributed for each activity will lead to a healthier body and mind in Ramadan.
Ramadan fasting is obligatory for the healthy adult but when fasting may significantly affect the health of the fasting individual or when one is genuinely sick, Islam exempts him from fasting. "God intends every facility for you, he does not want to put you into difficulties" (Quran 2:185). However, a significant number of ill patients, for whatever reasons, do decide to observe the fast. And it is these patients who need to seek the opinion of health professionals on an individual basis.
Those suffering from minor ailments really do not have any problems fasting. Those suffering from acute conditions may need advice about altering their dosing regimen i.e. the amount and frequency of their medication. Drugs that are normally required to be taken frequently, such as many antibiotics, can be problematic for the fasting patient. However, the increasing availability of alternative drugs with long half-lives (circulation times in the body) and the increasing formulation of short-acting drugs as sustained release preparations have offered much needed assistance to fasting patients.
For example patients suffering from acute upper respiratory infections such as a severe sore throat may still be able to fast. Normally such a patient may be prescribed antibiotics that have to be taken 3 or 4 times a day and would not be able to fast. However in order to facilitate fasting, the patient could be given a long-acting antibiotic such as Septrin (co-trimaxozole), which only needs to be taken once every 12 hours, or Zithromax (azithromycin), which only needs to be taken once daily. This can only be done when the infecting organisms are treatable with the alternative antibiotics and this needs to be discussed with the patient's own medical practitioner on a case-by-case basis.
An example where alternative routes of drug administration may help fasting patients is the use of transdermal (skin) patches. For example some patients suffering from mild forms of angina pectoris, a heart condition, could benefit from taking their medication, glyceryl trinitrate, as a skin patch rather than sub-lingual tablets. Here, the drug would be effective by entering the blood stream through the skin, and not orally (which would break the fast). Again, this may only be possible in specific patients and needs to be discussed with the patient's doctor. Pharmacists are generally willing to advise patients on the availability of alternative dosage forms for medication during Ramadan.
An example of where sustained release formulations may help is that of the fasting patients suffering from mild forms of hypertension (high blood pressure). These patients can be given their drug in formulations that only require once-daily dosing. Here the drug can be administered orally at Sahur and the special formulation then allows the drug to slowly release into the body over a day. In fact, there is a school of thought among medical practitioners that those patients who have mild to moderate high blood pressure and are also overweight should be encouraged to fast as fasting may help to lower their blood pressure. Such patients should see their physician to adjust medication. For example, the dose of diuretics should be reduced to avoid dehydration, and sustained release formulations such as Inderal LA can be given once a day before the pre-dawn meal.
An increasing case where practitioners are likely to advise patients on fasting is in those suffering from Diabetes mellitus. Many Muslims, especially of Asian descent, have an increased risk of suffering from some form of diabetes. The International Journal of Ramadan Fasting Research has suggested the following guidelines for health professionals treating Muslim patients with diabetes: "Diabetic patients who are controlled by diet alone can fast and hopefully, with weight reduction, their diabetes may even be improved. Diabetics who are taking oral hypoglycaemic agents along with the dietary control should exercise extreme caution if they decide to fast. These patients should consult their medical doctor for dose adjustment. If they develop low blood sugar symptoms in the daytime, they should end the fast immediately."
In addition, diabetics taking insulin should consult their doctor to see if their dose can be adjusted for them to fast during Ramadan. In all cases of Muslim diabetics fasting, they should closely monitor their blood sugar levels especially before and after meals.
In summary, Islam offers an exemption to the sick from observing their fast during the holy month of Ramadan. However, some patients may be able to fast if their health is not adversely affected during the period of fasting. In such cases, advice from pharmacists and doctors about changing prescriptions to equally effective drugs that have reduced dosing, such as sustained release formulations, may be beneficial to the fasting Muslim. In all cases of illness, it is recommended that Muslim patients, if they do fast, do so under medical supervision.