Advice for anyone fasting during Ramadan
This is a time to reap physical and mental benefits. It can be an opportunity to help lose weight, if done correctly, and to exercise your spiritual health.
The fast process can be broken down physiologically, though the changes that occur depend on the duration of fast. The body enters a fasting state eight hours after the last intake. Normally the body utilises glucose as its main source of energy and during a fast, this store is used first. Fat then becomes the next source, which is how weight loss can occur. This is especially beneficial for conditions such as blood pressure or diabetes. With a longer fast of days or weeks, the body starts using protein (starvation). During Ramadan this stage is not reached as fasts do not last for such lengths of time. It only extends from dawn till dusk, so there is opportunity for the body to replenish energy stores at pre-dawn and dusk meals.
After a few days of the fast, endorphins are released, making you more alert and improving your general mental wellbeing.
Healthy fasting not feasting fasting!
If the correct diet is not adhered the benefits of fasting can be lost and worse still be detrimental to health by weight gain! The deciding factor is not the fast itself, but rather what is consumed in the non-fasting hours. The diet should no different to a healthy balanced diet. Remember the principles of Ramadan are self-discipline and self-control.
Balanced diet- top tips!
ü Complex carbohydrates (eg grains, barley, wheat, pats semolina, beans, lentils, wholemeal flour and basmati rice) help release energy slowly during the long hours of fasting. So suitable for the pre-dawn meal.
ü Fibre-rich foods which are also digested slowly, such as bran, cereals, whole wheat, grains and seeds, potatoes with the skin, vegetables such as green beans and almost all fruit, including apricots, prunes and figs.
û Foods to avoid are the heavily-processed, fast-burning foods that contain refined carbohydrates (sugar and white flour), as well as fatty foods (for example, cakes, biscuits, chocolates and sweets such as Indian Mithai).
û Avoid caffeine-based drinks such as tea, coffee and cola. Caffeine is a diuretic so stimulates water loss through urination.
· Deep-fried foods, for example pakoras, samosas and fried dumplings.
Wholegrains, such as chickpeas (plain or with potato in yogurt with different Indian spices), samosas (baked instead of fried), and boiled dumplings.
· High-sugar and high-fat foods, including sweets such as Gulab Jamun, Rasgulla, Balushahi and Baklawa.
· Chapattis made without oil, baked or grilled meat and chicken. Make pastry at home and use a single layer.
· High-fat cooked foods, for example, parathas, oily curries and greasy pastries.
- Milk-based sweets and puddings such as Rasmalai and Barfee.
- Deep frying.
- Curries with excessive oil
- Shallow frying (usually there is little difference in taste).
- Grilling or baking is healthier and helps retain the taste and original flavour, especially with chicken and fish.
The two main meals of Ramadan
This is the pre-dawn meal. It may mean a break in your sleep but to ensure a healthy fast it is an important meal. The Prophet Muhammad said, ‘Take a meal a little before dawn, for there is a blessing in taking meal at that time.” This should be a meal that is filling and provides enough energy although as with all meals do not overeat. It is important to include slow digesting foods (See above).
Iftar is the meal which breaks the day’s fast. In keeping with the Prophetic traditions this includes dates, which provide much needed energy. It will be a lesson of self control to make sure this remains a moderate meal as opposed to a feast. The most commonly consumed foods by Prophet Mohammed (peace be upon him) were milk, dates, lamb/mutton and oats. Healthy foods mentioned in The Qur’an are fruit and vegetables, such as olives, onions, cucumber, figs, dates, grapes as well as pulses such as lentils.
Fasting and health complications
The following advice has been provided following consultation with medical experts and Islamic scholars.
Fasting usually reduces the amount of stomach acid, which digests food and kills bacteria. But thoughts of food or the smell of it make the brain tell the stomach to produce more acid, which can lead to heartburn.
People who regularly take medicine for indigestion, such as antacids, antihistamines or proton pump inhibitors are advised to continue taking them. A good time to do this could be the pre-dawn meal.
The control of heartburn or belching can be aided by eating in moderation and avoiding oily, deep-fried or very spicy food. Reducing your caffeine intake and/or stopping smoking can also be of benefit.
Preparations such as peppermint oil may help reduce belching or colic. Sleeping with your head raised on a few pillows and long-term weight loss may also help prevent heartburn.
Poor control of diabetes
People who regularly inject insulin are advised not to fast, as the potential risk to health, both in the short and long term, of not taking insulin is too great. Long-acting tablets, such as Glibenclamide, increase the risk of having a ‘hypo’ and should be changed to a shorter-acting variety before you embark on a fast but take advise from your GP first. As should people who have their diabetes under control using any other tablets.
Low blood sugar levels (a ‘hypo’) are dangerous, and if untreated may lead to fainting or fits. Feeling dizzy, sweaty and disorientated may all suggest a hypo. If a person with diabetes has these symptoms, they should immediately have a sugary drink, or place sugar or a sugar-rich sweet below their tongue.
Complications of any common chronic diseases
Other common diseases such as high blood pressure and asthma which are controlled using medication that needs to be taken regularly every day of the year. This is necessary in order to avoid possible complications from the inadequate control of disease, such as a stroke or an asthma attack. A consultation with your doctor should enable you to formulate a mutually agreed management plan to fast safely while continuing to take medication. If your disease is unstable or poorly controlled, you are advised not to fast however.
This common problem has many causes. Headaches during a fast could be due to dehydration or hunger, poor rest, or the absence of addictive substances such as caffeine or nicotine.
A moderate and balanced diet, especially not missing the pre-dawn meal, taking in enough fluids and, if necessary, some painkillers such as paracetamol, can help prevent or reduce the risk of headache.
Headaches can also be prevented by not exposing yourself to direct sunlight, wearing a hat when out, using sunglasses to reduce the effect of glare from the sun and relieving any tense muscles with a short, gentle massage.
Dehydration is common during a fast. The body continues to lose water and salts through breathing, sweat and urine. If you don’t drink sufficiently before a fast, your risk of dehydration is increased. This risk is higher in older people and in those taking tablets such as diuretics.
If you are unable to stand up due to dizziness, or you are disorientated, you should urgently drink regular, moderate quantities of water, or Dioralyte or Lucozade.
If you faint due to dehydration, your legs should be raised above your head by others, and when you awake, you should urgently rehydrate as outlined above.
When you are fasting, being active, drinking regularly and eating healthily will help to keep your bowel motions regular. Include lots of fruit and vegetables in your diet and and increase the fibre content of your food using bran. If the problem persists, a short course of laxatives may help. Your GP or pharmacist can advise you.
Lack of food and water, changes of routine and shorter periods of sleep can cause stress. It’s important to deal with any potential sources of stress to stop any harmful effects. This can be helped by not taking on more than you can handle, not playing sports in the hot sun, controlling your anger and not smoking.
Food consumed during the pre-dawn and dusk meals may lead to some unintended weight gain. It’s ironic that you are able to become overweight or obese while you are fasting. But if you do not approach the fast with discipline, the opportunity to lose weight and become healthier is wasted.
Fasting is a requirement after puberty for all able-bodied Muslims of sound mind and good health, but there are concessions. Islam recognizes that not every person will fall under this category. Those who are exempt from fasting:
– menstruating women,
– breastfeeding mothers,
They are required to make up the number of days missed at a later date or give a fixed sum to charity.
Every year hundreds of thousands of people around the world die from diseases caused by smoking. Tobacco smoke also contributes to a number of cancers. The mixture of nicotine and carbon monoxide in each cigarette you smoke temporarily increases your heart rate and blood pressure, straining your heart and blood vessels. This can cause heart attacks and stroke. What better time to quit this habit.
NHS Asian Tobacco Helpline
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In the last decade, argila (hubbly bubbly) smoking has become a popular pastime. In contrast to smoking there is little awareness of the harmful effects of argila smoking. However it has been found that sheesha has more nicotine in it and that smoking one sheesha is equivalent to smoking 18 cigarettes. Numerous studies have shown that extended use of hookah over many sessions can be as detrimental to a person's health as smoking cigarettes. Each hookah session typically lasts no more than 10 minutes which is enough to cause cancer in a lab rat.
The answers have been put together by medical experts and Islamic scholars and researchers.
Should a person with diabetes fast?
People who have their diabetes under control, either by their diet or using tablets, may fast. However, their GP may require them to change their medication to help them take tablets outside fasting times. Those who need insulin to control their diabetes should not fast.
I get severe migraines when I don't eat and they get worse when I fast. Should I fast?
People with uncontrolled migraines should not fast. However, managing your migraines is possible with the right medicine and with changes to the person's lifestyle. Ask your GP for further advice on controlling your migraines.
Should a person with high or low blood pressure fast?
People with well-controlled high blood pressure may fast. Their GP may require a change to their medicine to help them take tablets outside fasting times. Someone with low blood pressure who is otherwise well and healthy may fast. They must drink enough fluid and have enough salt.
Is fasting harmful when a woman is expecting a baby? Must pregnant women fast?
There's medical evidence to show that fasting in pregnancy is not a good idea. If a pregnant woman feels strong and healthy enough to fast, especially during the early part of the pregnancy, she may do so. If she doesn't feel well enough to fast, Islamic law gives her clear permission not to fast, and to make up the missed fasts later. If she is unable to do this, she must perform fidyah (a method of compensation for a missed act of worship).
Is Ramadan a good time to quit smoking?
Yes. Smoking is wasteful and seriously bad for your health. Ramadan is a great opportunity to change many unhealthy habits, and smoking is definitely one of them.
From what age can children fast safely?
Children are required to fast from the age of puberty. It isn't harmful. Fasting before this age is tolerated differently depending on the child’s general health, nutrition and attitude. Fasting under the age of seven or eight isn't advisable. Children can practise fasting for a few hours at a time.
Can I use an asthma inhaler during Ramadan?
Muslim experts differ on this issue. Some say that using an asthma inhaler isn't the same as eating or drinking, and is therefore permitted during fasting. In their view, people with asthma can fast and use their inhalers whenever they need to.
But other scholars say that the inhaler provides small amounts of liquid medicine to the lungs, so it breaks the fast. They say that people with poor control of their asthma must not fast until good control is achieved. Some people with asthma may opt for longer-acting inhalers so that they can fast. See your GP for further advice.
Can I swim during fasting?
Yes, but do not drink the water. A bath or shower or swimming has no effect on the fast. But no water should be swallowed during any of these activities as that would break the fast.
Can a person fast if they are getting a blood transfusion in hospital?
No. A person receiving a blood transfusion is advised not to fast on medical grounds. They may fast on the days when no transfusions are required but consult your doctor.
I am on regular medication. Can I still fast?
If the medicine needs to be taken during fasting, do not fast. If this medication is required as treatment for a short illness, you can compensate for missed fasts by fasting on other days when you are well.
If you are on long-term medication then you could talk to your GP whether to change your medication, so that you can take it outside the time of the fast.
If your disease is unstable or poorly controlled, do not fast. Those who are unable to do the missed fasts later, due to the long-term use of medication, should do fidyah.
• Eye and ear drops
• All substances absorbed into the body through the skin, such as creams, ointments, and medicated plasters
• Insertion into the vagina of pessaries, medical ovules, and vaginal washes
• Injections through the skin, muscle, joints, or veins, with the exception of intravenous feeding
• Oxygen and anaesthetic gases
• Nitroglycerin tablets placed under the tongue for the treatment of angina
• Mouthwash, gargle, or oral spray, provided nothing is swallowed into the stomach.
Are investigations by a doctor allowed, especially internal ones?
Physical examinations do not invalidate the fast. Clinical investigations such as blood tests, or those requiring intravenous access or oral contrast, would preclude the fast during those particular days. Where these are elective outpatient investigations, you may patients may prefer to reschedule them outside Ramadan. However urgent investigations should clearly not be delayed.
Does a breastfeeding woman have to fast?
No. Islamic law says a breastfeeding mother does not have to fast. Missed fasts must be compensated for by fasting or fidyah once breastfeeding has stopped.
Can a Muslim patient take tablets, injections, inhalers or patches while fasting?
Taking tablets breaks the fast. However, injections, inhalers, patches, ear drops and eye drops do not break the fast, as they are not food and drink. But it is best to avoid them if possible, due to the difference of opinion among Muslim scholars on these issues. Islamic law says sick people should not fast.
Could dehydration become so bad that you have to break the fast?
Yes. You could have harmful levels of water loss if you were poorly hydrated (not drinking enough water) before the fast. Poor hydration can be made worse by weather conditions, and even everyday activities like walking to walk or housework.
If you produce very little or no urine, feel disorientated and confused, or faint due to dehydration, you must stop fasting and have a drink of water or other fluid. Islam doesn't require you harm yourself in fulfilling the fast. If a fast is broken, it will need to be compensated for by fasting at a later date.
Can I fast while I have dialysis?
People on peritoneal dialysis must not fast and should perform fidyah. Haemodialysis is performed about three times a week, and causes significant shifts of fluids and salts within the body. Such patients must not fast and should perform fidyah.
*Fidyah: a method of compensation in Islam for a missed act of worship that must be otherwise fulfilled. If you are unable to fulfil a missed fast, for example due to an ongoing illness, you should feed a hungry person (two meals per day) if you are able to. Please consult an Islamic scholar for further details.