Medical benefits, fasting & Diabetes Mellitus

From an Articles by Shahid Athar, M.D.



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
a. All male diabetics over age 20. Please see editor's note (1).
b. All female diabetics over age 20 if not pregnant or nursing. Please see editor's note (2).
c. Body weight normal or above ideal body weight. Please see editor's note (3).
d . 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 (4).
TABLE 1
1500 CALORIE AND DIET MENU FOR RAMADAN
FOOD EXCHANGES
PRE-DAWN BREAKFAST
American Pakistani Middle Eastern
Fruit 1 1/2 c Orange Juice 1/2 Grapefruit 1/2 Grapefruit
Starch 3 1/2 c Oatmeal1
English Muffin 1 Pit Bread
1/2 Potato Bhujia a 1 Pita Bread
1/3 c Fool Midammis
Meat 2 1 Boiled Egg
1/4 c Cottage Cheese 2 egg Omelet
1 oz Feta Cheese 1 Boiled Egg
Fat 1 1 tsp Margarine 1 tsp Olive Oil 1 tsp. Olive Oil
And 2 Black Olives
Skim Milk 1 1c Skim Milk 1 c Skim Milk 1 c Laban
Free Foods 2 tsp Sugar Free Jam
Coffee Tea Tea

POST-SUNSET ENDING THE FAST
Fruit 1 2 large Dates 2 large Dates 2 large Dates
Starch 1 6 sm Vanilla Wafers 1/3 c Chana Chaat 1/3 c Salatet Hummus
Skim Milk 1 1 c Skim Milk 1 c Lassi 1 c Rabat


DINNER
Meat 3 3 oz Roast Beef 3 oz Bhuna Gosht 3 oz Tikka Kebab
Starch 2 1 sm Baked Potato
1 Dinner Roll 1/3 c Daal
1 Chapati 1/3 c Lentil Soup
1 Pita Bread
Vegetable 2 1 c Tossed Salad
(carrot, cucumber,
tomato, radish) 1/2 c Steamed 1 c Sliced Raw Vegetables
(tomato, cucumber, onion)
1/2 c Bhindi Bhujia
Cauliflower in Tomato
Broccoli Sauce 1/2 c Tomato and Onion
(cooked with Tikka Kebab)
1/2 c Cooked
Fat 1 2 tsp Sour Cream 1 tsp Oil used in cooking 1 tsp Oil (used in cooking)
Fruit 1 1 Fresh Apple 15 sm Grapes 1 Fresh Apple
Free Foods

Lettuce (for salad) -as desired
2 Thl Reduced Calorie Dressing
C coffee Tea Tea


BEDTIME SNACK
Fruit/Starch 3 Graham Cracker 1/2 Mango 2 Tangerines
Skim Milk 1 1 c Skim Milk 1 c Skim Milk 1 c Laban


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.

Medical Benefits of Ramadan

by Shahid Athar, M.D.
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. Muslims take advice from the Prophet who said, "If one slanders you or aggresses against you, say I am fasting.'" This psychological improvement could be related to better stabilization of blood glucose during fasting as hypoglycemia after eating, aggravates behavior changes.

There is a beneficial effect of extra prayer at night. This not only helps with better utilization of food but also helps in output. There are 10 extra calories output for each rikat of the prayer. Again, we do not do prayers for exercise, but a mild movement of the joints with extra calorie utilization is a better form of exercise. Similarly, recitation of the Quran not only produces a tranquility of heart and mind, but improves the memory.
by Shahid Athar, M.D.
Courtesy: www.everymuslim.com

The Holy Ramadan

Muslims worship Allah as a clear expression of their sincere obedience, thankfulness and devotion to Him. Man, who is in a steady effort to be a good servant to Him, demonstrate His faith by being mindful to His orders and bounds. One of these worships is fasting as decreed in the verse below;

O ye who believe! Fasting is prescribed to you as it was prescribed to those before you, that ye may (learn) self-restraint. (Sura Al-Baqara, 183)

The importance attached to this worship is stated in many hadiths as well.

Ramadan is a very important month for believers; it is an opportunity bestowed to man to engage in good deeds and become one of those prospers with “heavy scales” in the Judgement Day. A Muslim whose intention is to attain eternal salvation in the Hereafter looks forward to this Holy month. The fact that all Muslims both in Muslim and non-Muslim countries seek repentance and the consent of Allah in this month means a mere solidarity for the world of Islam.

Muslims fast primarily because it is a means of seeking the consent of Allah. Yet, there are also various benefits this worship offers to believers.

First of all fasting is the means by which a believer displays his gratefulness to his Creator, who is the one and only owner of everything around us.

In many hadiths, our Prophet Muhammmad (Pbuh) stated that one of the important aspects of Ramadan is the fact that it is a month bringing blessings to man. Ramadan is the month when believers especially care for the poor, when they provide their free will offerings and when believers try to engage in good deeds...Every believer tries to attain a perfect moral attitude by sharing what is endowed to him by Allah with his brothers and by displaying a great spirit of contentedness. It is a time full of spiritual joy and satisfaction, a time when a good deed is awarded with more blessings and spiritual relief.

No doubt, the greatest award will be given by Allah to those believers on the Judgment Day, who seek no other benefit other than attaining the Will of Allah and be one of those believers who are awarded with the ultimate salvation. Apart from that in many hadiths, our Prophet explained many aspects of fasting bringing happiness and other worldly benefits to believers.

Another favour fasting brings to believers is the nature of spirit full of patience, determination and benevolence. Besides, enhancement of unity and solidarity among believers is another favour Ramadan delivers to man. Fasting, which is a sign of man’s submission to Allah, becomes a means by which believers secure more understanding and social integrity in their individual communities and in the world of Islam as a whole.

Ramadan has a distinctive place amongst other months of the year. In this time, believers have to be ready to be tested physically as well as being tested spiritually. Getting along well with other people, settling disputes, removing anger, hatred and enmity from hearts will give believers relief and welfare.

Indeed, Muslims avoid making gossip of other people, engaging in misdeeds and they primarily become concerned of always thinking the good and beneficial side of things. This is surely the path by which ears, eyes and all other favours given to man display their individual gratitude to Allah.

Another aspect Ramadan reminds man most is the death and the Hereafter. Muslims welcome this month with an intense sensitivity of heart towards matters regarding the Afterworld. They ponder more over the Judgment day, the Hereafter and the ways to attain Heaven. That is why, their primary concern becomes to engage in more good deeds and hence the Will of Allah. For instance, those who are rich think more of the poor and avoid wasting what is given to them by Allah. They refrain from being fond of worldly goods and share as much as they can, being aware of the fact that everything they do will be awarded justly.

However, there is one important point every believer has to keep in mind. This high moral attitude is not something peculiar only to Ramadan. A believer should feel the same way everyday and every hour of his life. This is surely the only way to become the type of believer depicted in the Holy Qur’an. A believer whose ultimate intention in this life is to attain the Will of Allah, would by no means limit himself to a month; he would seek Allah’s guidance and enlightenment at every moment of his life and hence feel close to Him. That is because Allah sees and hears man every moment; He is with man all the time.

Those who have fear of Allah should spend every hour of their life with good and beneficial deeds. Ramadan, therefore, is a time when believers practise their daily regular prayers as well as fasting.

Another distinctive feature of Ramadan is also expressly stated in the Qur’an; Ramadan is the (month) in which was sent down the Qur’an, as a guide to mankind, also clear (Signs) for guidance and judgment (Between right and wrong). So every one of you who is present (at his home) during that month should spend it in fasting, but if any one is ill, or on a journey, the prescribed period (Should be made up) by days later. Allah intends every facility for you; He does not want to put to difficulties. (He wants you) to complete the prescribed period, and to glorify Him in that He has guided you; and perchance ye shall be grateful. (Sura Al-Baqara, 185)

This month is an opportunity for those who hope to become closer to Allah and be an even better servant of Him. We are fortunate that Allah once again favours us with this holy month.

We hope that Allah endows all believers with His mercy and lets His servants experience this month with the ultimate joy of worshipping to Him.

May the Mercy and Compassion of Allah be on all Muslims.