Staying healthy during the Ramadan fast

By Professor Dr Muhammad Aziz Rahman

Ramadan is the holy month of fasting for many Muslims worldwide and involves not eating or drinking from sunrise to sunset. While fasting is a personal choice, it is important to consider health and wellbeing.

Ramadan is the 9th month in the Islamic calendar. In 2023, the month commenced on 23rd March. At the end of one month, Muslims celebrate the day known as Eid-ul-Fitr, sharing special foods and joys with families and friends.

How do Muslims fast during Ramadan?

Intermittent fasting in different forms is popular for weight loss and other health benefits worldwide, and fasting during Ramadan can also be considered a type of fasting. People fast from sunrise to sunset and do not eat or drink during that period.

Fasting usually starts with a light meal like a breakfast called Suhoor, and fasting ends with a meal called Iftar. Fasting is obligatory for all Muslims when anyone reaches puberty.

Few people are exempt from fasting during this month in certain situations, such as while travelling, if someone is unwell, pregnant or breastfeeding women or women during menstrual cycles. They need to make up those missed days when they can do so.

If someone is chronically ill or elderly and unable to fast, compensation can be made through charity for each missed fasting.

Is it just fasting?

Ramadan is the month of self-regulation, self-control, self-purification and self-training for Muslims. It’s not only refraining from food or drink but also practising discipline and patience. Muslims develop empathy towards those deprived and can feel the hunger or thirst who struggle to manage basic needs worldwide.

It’s also an effort to develop spiritual strength and resist temptations and sins. Muslims are engaged more in worship and contribute to charity generously this month. Many Muslims pay their obligatory annual charity called Zakat to the poor this month, hoping to get more rewards from the Almighty.

Are there any health benefits from fasting?

Reducing body weight: Fasting during Ramadan limits calorie intake and suppresses appetite. It reduces body weight, fat mass, fat-free mass and body mass index (BMI). When body weight is controlled, it protects us from the risk of being obese and several non-communicable diseases like heart disease and diabetes.

Decreased blood lipids: Comparing the pre-Ramadan lipid profile with the post-Ramadan values shows that total cholesterol, triglycerides and low-density lipoprotein (LDL) levels are decreased. By reducing such lipid levels, we are reducing the risk of heart disease. Fasting controls blood sugar by decreasing insulin resistance, and we reduce the risk of diabetes.

Balance of oxidation and anti-oxidation: Fasting has been found to be effective in regulating oxidative and anti-oxidative balance leading to a healthy life.

Improvement of gut microbiome: Evidence from animal and human studies indicates that fasting has positive effects on the composition and structure of the gut microbiome.

Boosting brain power: Fasting causes stress in brains and produces brain-derived neurotrophic factor (BDNF), which helps to promote brain cell rejuvenation. Fasting is also thought to affect the onset of Alzheimer’s and Parkinson’s disease.

No impact on body immunity: Fasting during Ramadan did not have any severe effects on our immune system.

No impact on kidney function: Fasting during Ramadan does not impact kidney function. Although there is a risk of dehydration due to not drinking water during the fasting period, there is no evidence related to renal stone formation due to that dehydration. Studies also showed that kidney transplant patients can also fast safely.

Improved fatigue, mood and sleepiness: Fasting showed significant improvement in fatigue, mood and tiredness during the daytime.

Improved mental health: Due to a spiritual boost in the month of Ramadan, people who are fasting develop positive feelings, inner peace and tranquillity, which reduces anxiety and distress.

Are there any health benefits of breaking fast with dates?

Muslims worldwide break their fast with different food items according to their culture. However, the common food items are dates and water, the tradition of which is also related to Islamic history.

Scientists have examined the health benefits of eating dates according to different constituents they possess, which include lowering cholesterol, protecting bodies from harmful impacts of free radicals/oxidants and detoxification of bodies, strengthening bones (copper, selenium, magnesium, vitamin K), promoting brain health (chlorine and vitamin B), improving digestive system (high fibre), improving skin (vitamin C and D), controlling diabetes (by increasing production of insulin), aiding weight loss (high fibre), improving heart health (anti-oxidants) and other beneficial impacts on the reproductive systems of both males and females.

What health issues warrant caution for fasting during Ramadan?

Diabetes: This is the most researched topic to examine the impacts of fasting during Ramadan and a practical guideline has been published in 2021. There is a risk of both hypoglycaemia and hyperglycaemia for type 2 diabetes patients. Therefore, recommendations for fasting during Ramadan should be individualised, and consultation should be done on the aspects of medical, nutritional and physical activity.

Some diabetic patients are at risk of developing infectious complications and should also consider not fasting. The guideline recommends that healthcare professionals and diabetes patients understand the risks of fasting and make informed decisions.

Pregnancy: While it’s one of the exempt criteria for fasting during Ramadan, researchers investigated the impacts of fasting on offspring. They did not find any serious adverse impacts on offspring. However, due to the limited available data, researchers strongly recommend avoiding fasting.

Gastric ulcers: Patients with active gastric ulcers should not fast as there is a risk of complications.

Liver disease: While fasting is beneficial for patients with non-alcoholic fatty liver diseases, it is harmful to patients with acute hepatitis.

How to manage medications during fasting?

People who are taking medications regularly may be impacted by the fasting period. If the medications are scheduled for mornings, those can be taken during Suhoor.

If the medications are meant to be taken on an empty stomach, those can be taken during Iftar.

While a treating doctor can assess the clinical condition of each individual patient to advise accordingly, a pharmacist can also recommend alternative medicine, dosage and route of administration.

Give up bad habits

Fasting during Ramadan can be utilised as an opportunity to quit bad habits.

Smoking: Due to the prolonged period of not smoking during fasting, which is challenging for smokers, they can curb their nicotine addictions and quit smoking. It is also a good opportunity to promote smoking cessation in Muslim communities during this period.

Snacking: Snacking or unnecessary eating, especially sugar-rich diets, is controlled during fasting, and this practice can be continued post-Ramadan to maintain a healthy lifestyle.

Where is the knowledge gap?

Evidence suggests that many healthcare professionals lack the knowledge to manage or modify medication for diabetes patients who fast during Ramadan.

Patients with serious illnesses are exempt from fasting during Ramadan. But what should be the guideline if a cancer patient prefers to fast and asks about the guideline from the treating physicians? Unfortunately, there is no guideline or standardised protocols that can help them to address this issue.

What issues need to be considered further?

People may prefer to delay many scheduled screening and follow-up tests during the fasting period of Ramadan, specifically if those are invasive. For example, pap smear tests for cervical cancer screening for women and routine blood tests for heart health checks. Health professionals can consider having a conversation with patients to make a shared decision regarding this.

The health benefits of fasting during the month of Ramadan are already evident scientifically, but many Muslims are not aware of this. Health professionals should be consulted by patients with chronic diseases to determine whether fasting can impact their health and how regular medications can be managed.

In a multicultural country like Australia, health professionals should be sensitive about this religious ritual and be familiar with the practical guidelines for managing patients who desire to fast during Ramadan.

Public Health Professionals can utilise this opportunity to work with Muslim communities to promote a healthy lifestyle.

Professor Dr Muhammad Aziz Rahman is the Research Adviser and Discipline Leader of Public Health at the Institute of Health and Wellbeing. He is a medical doctor, a public health professional and is also a practising Muslim.