Published on June 8, 2017
1. Islamic Fasting associated Adverse Effects Dr P. Naina Mohamed PhD Pharmacologist
2. Introduction The Prophet Muhammad (PBUH) said that fasting is a shield which protects a person from sin and lustful desires. Islamic fasting is observed during the holy month of Ramadan. Apart from Ramadan, Muslims are encouraged to observe fasting on the following days too… The 9th and 10th , or 10th and 11th days of Muharram (First month of Islamic Calendar). Any 6 days of Shawwal (Tenth month of Islamic Calendar). Mondays and Thursdays of every week, if possible. 13th, 14th, and 15th day of every Islamic month. 9th day of Dhu'I-Hijja (12th Month of Islamic Calendar). During the months of Rajab (7th month) and Sha'aban (8th month) before Ramadan, if possible. Devoted Muslims keep themselves refrain from food, drinks, smoking and sexual activities from the dawn to the dusk, during Ramadan Fasting. Fasting helps to control one's desires and to focus more on devoting Allah (swt).
3. Islamic Fasting Islamic fasting is similar to Alternate Day Fasting (ADF), since the feast and fast periods of Islamic fasting lasts 12 hours in average. Animal studies have been shown that Alternate Day Fasting (ADF) extend the lifespan and prevent the development of Cardiovascular disease (CVD) (Reduction of Cholesterol levels, Heart rate and Blood Pressure) Diabetes (Improved insulin sensitivity) Kidney disease Cancers (Decreased Inflammation, Pro-inflammatory cytokines IL-1b, IL-6, Tumour Necrosis Factor) https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-9-57 http://ajcn.nutrition.org/content/86/1/7.long Islamic fasting is a healthy non pharmacological means for minimizing the risk factors and improving health. Islamic Fasting can also provide other health benefits such as Detoxification Higher levels of endorphins Regeneration of immune cells (Damaged Immune cells are recycled to save energy) Overcome Addictions (Smoking, Caffeine, etc) Weight loss (Reduction of waist circumference, Body Mass Index, Body fat) https://www.ncbi.nlm.nih.gov/pubmed/26013791
4. Physiology of Fasting https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909082/ Islamic Fasting Abstinence from Food and Drinks Decreased glucose level Suppression of Insulin secretion Secretion of Glucagon and Catecholamines Glycogenolysis (App 12 hrs of fasting) Release of Fatty acids from Adipocytes (Lipid cells) for Gluconeogenesis and Ketogenesis Remaining glucose is reserved for the metabolism of Brain cells and RBCs & Ketone bodies serve as alternative body fuel for numerous cells
5. Islamic Fasting associated Adverse Effects Dehydration Headache Hypoglycemia Heartburn Constipation Muscle cramps Anemia
6. Dehydration Though Islamic fasting is associated with Dehydration, there was no detrimental effects on health attributed directly to intermittent negative water balance. http://www.nature.com/ejcn/journal/v57/n2s/full/1601899a.html Islamic Fasting No fluid intake during fasting hours Dehydration
7. TIPS to minimise Fasting associated Dehydration Drink enough water and fluids between Iftar and Suhour. Consume more fruits and vegetables with high water content like Watermelon, Tomatoes, Cucumber, Grapes, etc. Avoid Salty and spicy foods which increase the feeling of thirst. Avoid consuming high fat and fried foods especially at Suhour which may lead to thirst. Eat less or no sweets which increase thirst. Avoid Caffeinated beverages like energy drinks. Caffeine can increase the fluid loss and thirst due to its Diuretic activity. Minimise or avoid smoking which slows down salivation and induce Dry mouth and Thirst. Avoid direct sun exposure to reduce sweating. Indulge in physical activity only during non fasting hours to replenish lost fluids during exercise. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5066803/
8. Headache Lack of sleep, Stress and Dehydration may also contribute to the Fasting associasted Headache. It affects at least 40% of the fasting individuals mainly of headache prone individuals. Duration of fasting increases the frequency of Headache. https://link.springer.com/article/10.1007%2Fs11916-010-0119-5 Islamic Fasting Caffeine withdrawal & Hypoglycemia Headache
9. TIPS to minimise Fasting associated Headache Reduce the consumption of Tea, Coffee and Cigarette gradually one or two weeks before Ramadan. A cup of strong coffee at Suhour (Pre-dawn meal) may prevent Ramadan headache occurring due to caffeine withdrawal. Eating foods with low glycaemic index value would minimise the risk of headache induced by Hypoglycemia. Drink large amounts of water and fluids between Iftar and Suhour to avoid headache induced by Dehydration. Sleep at least 7 hours a day.
10. Hypoglycemia https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3401746/ Islamic fasting Decreased food intake and Consuming too much refined carbohydrates at suhour Hypoglycemia
11. TIPS to prevent Hypoglycemia Predawn (Suhour) meal is a must to prevent the risk of Hypoglycemia. At Suhour, eat more complex carbohydrates (Slow-digesting foods) such as barley, wheat, oats, beans, lentils, brown rice and nuts. Avoid quickly digestible foods containing sugar, white flour or other refined carbohydrates. Avoid consuming Sweets at suhour. Eat vegetables such as broccoli, cucumber, and carrots which provide fiber and essential nutrients. Drink enough water and fluids between Iftar and Suhour. Avoid excessive physical activity while fasting. Get enough sleep.
12. Heartburn Consuming a high volume of food, especially during the Iftar meal, may increase the risk of Heartburn and GERD. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5066803/ Islamic Fasting Bulky, Fatty and fried foods Delayed gastric emptying Heartburn
13. TIPS to minimise Heartburn Avoid spicy, bulky and fatty foods to prevent heartburn induced by Ramadan fasting. Avoid carbonated drinks which may increase gastric acidity. Avoid eating a lot at once. Divide iftar meals in two portions. Drink a glass of Milk which may help to minimise Heartburn. Do not lie down right after meals. Avoid excessive use of Analgesics. Take Antacids, if required. Limit or Quit Smoking.
14. Constipation Constipation may result due to the consumption of Less fibrous diet, too much refined foods and too little water. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5066803/ Islamic fasting Changes in Diet and Sleep patterns Irregular and decreased bowel movement Constipation
15. TIPS to reduce Constipation Avoid excessive refined foods such as Paratha and other Maidha made foods. Consume Slow-digesting and more fibrous foods like whole grains such as Oats, Pulses, Wheat, Lentils, Flax seeds, etc. Eat fiber-rich fruits like Apples, Bananas, Papayas, Passion fruit, Figs, Avocados, etc. Have snack on fiber-rich dried fruits (Dates , Dried apricots, Figs, Prunes). Increase fiber-rich vegetables like Beans, Peas and Chickpeas. Drink large quantities of fluids like Water, Fresh fruit juices, Vegetable soups, etc. Probiotics like yoghurt helps in preventing constipation. Get moving and maintain the activity level.
16. Muscle cramps Low levels of minerals such as Potassium, Sodium, Calcium, and Magnesium can contribute to cramps. Fluids keep muscle cells hydrated and less irritable and help muscles contract and relax. Islamic fasting Inadequate Liquids and foods containing minerals Decreased Potassium, Sodium, Magnesium and Calcium levels Muscle cramps
17. TIPS to prevent Muscle cramps Drink plenty of fluids, preferably fruit and vegetable juices, Soups and dairy drinks. Drink more water to avoid dehydration and cramps. Eat foods rich in minerals such as Vegetables, Fruits, Dairy products, Meat and Dates. Dates are a very good source of dietary potassium and it has a wide range of essential nutrients such as protein, fiber, Iron, calcium, magnesium, selenium, boron, cobalt, copper, fluorine, manganese, and zinc. Magnesium rich foods include whole-grain breads and cereals, nuts, and beans. Potassium found more in fruits and vegetables, especially bananas, oranges, etc. Good source of Calcium is Dairy foods. Avoid sleeping toes pointed to prevent nighttime calf cramps. Do not tuck in bed sheets too tightly to avoid bending toes downward.
18. Anemia Consume more amount of iron-rich foods (Dates, Dried Apricots, Raisins, Nuts, red meat, Soya bean, Spinach, etc.) to avoid the risk of Anemia during the month of Ramadan. https://www.nature.com/ejcn/journal/v60/n7/full/1602393a.html Islamic Fasting Decreased Hemoglobin (Hb), Packed Cell Volume (PCV)and RBCs Elevated risk of Anemia
19. TIPS to prevent Anemia Eat Iron-rich foods such as Spinach, Broccoli, Apricot, Garlic, etc. Dates are rich in iron and regular consumption of Dates helps in the formation of haemoglobin. Include Lentils which are a good source of iron. Iron found in animal products such as meat, poultry, and fish might be absorbed better by the body. Plant source of iron include beans, pulses, and green leafy vegetables. The absorption of Iron could be increased by eating with foods containing Vitamin C, such as lemon and tomato. Avoid drinking coffee and tea with meals as this can reduce the amount of iron absorption. Calcium-rich dairy products may interfere with the absorption of Iron.
20. Decreased Sleep Quality Daytime sleepiness may result due to decreased sleep quality. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5066803/ Islamic Fasting Delayed meal time & High Protein (More than 50 gm) and High Calorie (More than 1200 Kcal) food at Iftar Thermogenic effect Increased bedtime body temperature Decreased Sleep quality
21. TIPS to improve Sleep Quality Avoid over eating before sleeping. Performing wudu before bed may reduce body temperature. Get exposed to sunlight especially in the first half of the day, to strengthen circadian rhythm. Avoid or decrease exposure to artificial light. Keep electronic devices such as Mobile phones, Tablets and Laptops out of the bedroom. Maintain the bedroom quiet, dark, and a little bit cool. Avoid sleeping on the back and sleeping on the side can improve the quality of sleep by reducing sleep apnea and snoring. Maintain a regular bed time, even during weekends. Avoid caffeinated drinks such as Energy drinks, Coffee, Tea, Cola drinks, etc. at least before 4-6 hours of bedtime.
22. Conclusion Though Islamic fasting is associated with some adverse effects, there was no detrimental effects on health attributed directly to them, in health individuals. And the adverse effects of fasting could be minimized very easily by following the preventive measures. The chronic patients with Diabetes, Coronary Artery Disease (CAD), Cancer, Ulcer, Urolithiasis, Chronic Kidney Disease (CKD), etc. should consult the healthcare professionals before observing Fasting. Moreover, Islam exempts the Sick, Travelers and Pregnant, Breast Feeding and Menstruating women from fasting. Islamic Fasting can be good for health if it's done correctly. And it causes many physiological, biochemical, metabolic and spiritual changes in the body. Eat a balanced diet containing fruit and vegetables, wholegrains, pulses, meat, fish, milk and dairy foods, etc. Avoid eating deep-fried foods (Pakoras, Samosas, etc), Sweets (Gulab jamun, Rasgulla, etc.), Fatty foods (Parathas, Oily curries, Greasy pastries, etc). Drink a lot of fluids like Water, Fresh fruit juices, Soups, etc.
23. References Pharmacotherapy: A Pathophysiologic Approach, 10e Joseph T. DiPiro, Robert L. Talbert, Gary C. Yee, Gary R. Matzke, Barbara G. Wells, L. Michael Posey Physical Therapy Ethics Donald L. Gabard, Mike W. Martin Improvised Medicine: Providing Care in Extreme Environments, 2e Kenneth V. Iserson Maingot's Abdominal Operations, 12e Michael J. Zinner, Stanley W. Ashley Fasting In Islam And The Month Of Ramadan Ramadanali
24. References https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2995774/ https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-9-57 http://www.nature.com/ejcn/journal/v57/n2s/full/1601899a.html http://onlinelibrary.wiley.com/doi/10.1046/j.1526-4610.1999.3907490.x/full https://thejournalofheadacheandpain.springeropen.com/articles/10.1007/s10194-010- 0242-z https://www.ncbi.nlm.nih.gov/pubmed/19472450 http://jpma.org.pk/supplement_details.php?article_id=179 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4208786/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235101/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4852067/